Hospital Management of Opioid Dependence. Dependence. Disclosure. Pharmacologic Management. Methadone Utilization. Hospital Management of Opioid

Size: px
Start display at page:

Download "Hospital Management of Opioid Dependence. Dependence. Disclosure. Pharmacologic Management. Methadone Utilization. Hospital Management of Opioid"

Transcription

1 Disclosure Hospital Management of Opioid Dependence Attended Buprenorphine advisory board meeting (Schering Canada) May 2007, but personal honorarium/compensation was declined Dr. Alex Chan Canadian Society of Hospital Pharmacists September 26, 2007 Hospital Management of Opioid Dependence Physical dependence/withdrawal Relapse prevention Polysubstance abuse/dependence Behavioural problems Pain-acute acute & chronic Sleep disorder Psychiatric co-morbidity Discharge planning Pharmacologic Management of Opioid Dependence Detoxification Non-opioids Opioids Opioid Dependent Patient Opioid Substitution Opiate Receptor Blockade Naltrexone Start Methadone Continue Methadone Alternative Opioid Morphine Buprenorphine Methadone Utilization s in BC As prescription use of methadone for the treatment of opioid dependence and/or chronic pain has increased, hospitalization of methadone patients has become more common Number of Patients Year 1991 Year 1992 Year 1993 Year 1994 Year 1995 Year 1996 Year 1997 Year 1998 Year 1999 Year 2000 Year 2001 Year

2 QuickTime and a Photo - JPEG decompressor are needed to see this picture. Methadone Utilization Location of Methadone Prescribers in BC Methadone Prescribers Methadone Patients British Columbia 353 8,207 Lower Mainland 44% Vancouver Island and Gulf Islands 22% Alberta Ontario ,923 Other 15% Okanagan East to AB 8% Northern BC 4% Fraser Valley 7% Methadone: Key Points Methadone Pharmacology Synthetic opioid agonist Uses Analgesic Detoxification Maintenance therapy Good GI absorption with detection in plasma within 30 minutes of ingestion Peak concentration h after oral ingestion Half-life life 24 (15-40) h Hepatic biotransformation with excretion of methadone metabolites in bile & urine Methadone Pharmacology Potential interaction with drugs that affect cytochrome P450 3A4 Methadone levels are increased by: Fluvoxamine Diazepam Acute alcohol ingestion Nifedipine Cimetidine Methadone Pharmacology Methadone levels are decreased by: Rifampin Phenytoin, carbamazepine, phenobarbital Chronic alcohol use Ritonavir, nelfinavir, nevirapine 2

3 Methadone Pharmacology Methadone effect can be blocked by Pure antagonist-naloxone naloxone, naltrexone Mixed agonist/antagonist-buprenorphine buprenorphine, pentazocine Methadone Overdose Minimum lethal dose (non-tolerant individuals) Adults: mg single dose or 40 mg x 3 days Children: 10 mg single dose Continuation of methadone at the same dose in hospital as in the community may lead to overdose: Patient not taking full prescribed dose on regular basis prior to admission Altered pattern of use of illicit drugs or prescribed medications during hospitalization Acute medical illness: LOC,, respiratory compromise, hepatic dysfunction or renal failure Methadone Prescription in Hospital Methadone can only be prescribed by physicians who receive authorization by the College of Physicians & Surgeons via an exemption under Section 56 of the Controlled Drug and Substances Act Methadone Prescription in Hospital In BC, physicians with a restricted exemption may prescribe methadone under the following terms: In-hospital prescription of methadone for patients who are currently prescribed methadone in the community Methadone dose prescribed in hospital shall not be higher than the dose prescribed in the community Starting Methadone Usual starting dose mg Starting dose is safe dose, but usually does not eliminate all withdrawal symptoms In the community,, methadone doses are increased by no more than 10 mg or 10% Q 5-75 days In hospital,, dose escalation can be accelerated by using prn breakthrough doses Q 4 h 3

4 Continuing Methadone Determine if continued use of methadone in hospital is appropriate Determine the methadone dose to be used Reassess and adjust methadone dose accordingly Transition back to community upon hospital discharge Assessment of the Confirm the dose of methadone prescribed and actually ingested by the patient Obtain a history of recent use of illicit drugs and prescribed medications Assess for CNS and respiratory depression, and hepatic or renal dysfunction Assessment of Community Methadone Dose Patient History Current dose, date last taken, doses missed in last 7 days, duration of time on current dose Name of methadone prescriber and dispenser Recent use of street methadone Confirm methadone dose prescribed and ingested Methadone bottle label Medication administration records from institution of origin (e.g. hospital to hospital transfer) Pharmanet record Discussion with community pharmacist (Cancel existing community prescription to avoid double dipping ) Assessment of Community Methadone Dose Limitations of Pharmanet Doses received in hospital are not included Doses may be entered by pharmacist ahead of time Reduced or missed doses at institutions (e.g. jail) not documented Only doses that have been witnessed ingestion under the supervision of a qualified health professional can be confirmed Cannot confirm ingestion of doses dispensed as take home doses Assessment: Drugs and Medications CNS or respiratory stimulants/depressants Stimulants: e.g. cocaine, crystal methamphetamine Opioids Alcohol, benzodiazepines, barbiturates Withdrawal syndromes Alcohol, benzodiazepines, barbiturates Interactions with methadone metabolism Assessment: Acute Medical Illnesses CNS-GCS Respiratory-RR, RR, oxygen saturation, ABG Hepatic-asterixis asterixis,, stigmata of chronic liver disease, liver function (albumin, INR, bili) Even mild changes in liver or respiratory function can have significant effect Renal-urine output, BUN/CR Substance intoxication and withdrawal syndromes 4

5 Management of the Methadone dose prescribed in hospital should be reduced or dispensed in split doses if: Patient not ingesting full prescribed dose on a regular basis (e.g. vomiting, sharing or selling a portion of their doses) Patient has missed 2 consecutive doses or 3 of the last 7 days Ingestion of methadone cannot be confirmed (e.g. community pharmacist not available or take home doses dispensed) Patient reports sedation on current dose Medical condition affecting breathing, LOC, or methadone metabolism Management of the 1. Methadone dose reduction Reduce the methadone dose by 25-33% and add the balance as prn doses e.g. community dose: 100 mg po q am hospital order: 70 mg po q am + 10 mg po q h prn (maximum 3 doses per 24 h) hold if drowsy 2. Methadone splitting Split the dose into 3 or 4 equal doses e.g. community dose: 200 mg po q am hospital dose: 50mg po qid hold if drowsy Management of the 3. Hold methadone, and substitute with short-acting morphine e.g. obtundation, hypercapneic respiratory compromise, drug overdose 4. Continue methadone in hospital at same dose as in the community Management of the Patients who require methadone dose reduction or splitting in hospital may be gradually titrated back towards single daily dosing as tolerated e.g. 70 mg q am + 10 mg prn (3 doses used in last 24 h) 80 mg + 10 mg q 4 h prn (max 2 doses/24 h) 90 mg q am + 10 mg q 4 h prn (max 1 dose/24 h) 100 mg q am e.g. 50 mg qid 100 mg q am + 50 mg q pm + 50 mg q hs 150 mg q am + 50 mg q pm 200 mg q am Management of the Community methadone prescription should be cancelled to prevent double dipping Ingestion of all methadone doses dispensed in hospital should be witnessed by nursing staff Vomited Doses Only replace if emesis witnessed by staff (if vomiting occurs <15 minutes post-ingestion, replace full dose; minutes, replace half of dose; > 30 minutes, do not replace dose) If emesis is recurrent, consider split dosing or reduced volume NPO Most surgeons & anesthetists will permit ingestion of methadone the morning of surgery If sustained NPO, substitute with sc or iv morphine 5

6 Discharge Planning Confirm that the patient has received hospital methadone on the day of discharge Notify community methadone prescriber/pharmacist of current methadone dose, date of last dose received in hospital, and confirm plans for community methadone prescription and follow-up Case #1 45 y.o. woman admitted with cellulitis Community pharmacist confirms methadone dose stable at 60 mg daily for last year, daily witnessed ingestion, no recently missed doses, & last dose received yesterday Case #2 41 y.o. male admitted with COPD exacerbation due to pneumonia Patient reports methadone dose 50 mg daily, and no recently missed doses Pharmacy confirms witnessed ingestion 2 days/week, last dose yesterday Case #3 35 y.o. male admitted with leg fracture Patient reports methadone dose 150 mg, dispensed daily by staff at his DTES residence. He denies any recently missed doses, but cannot recall name of pharmacy he goes to Pharmanet consistent with patient s history, and there is no answer when you call staff at his residence Case #4 45 y.o. male admitted to psychiatry with depression and suicidal ideation but denies actual attempt He reports daily ingestion of methadone 200 mg bid for chronic pain. He denies any recently missed doses His pharmacist confirms monthly dispensing, last dispensed 5 days ago 6

7 Case #5 55 y.o. male with HIV/AIDS admitted with pneumonia Patient is diaphoretic, hypotensive (80/40), and tachypneic on high flow oxygen Pharmacist confirms daily witnessed ingestion of methadone 100 mg, last dose received 3 days ago Case #6 32 y.o. woman admitted to hospital with probable endocarditis. On presentation yesterday afternoon, she reported a history of 5 day cocaine binge (1 gm/day), and was found to be very agitated. It is now 24 h later and she appears to be hypersomnolent.. She gets very annoyed when her sternum is rubbed Community pharmacist confirms daily witnessed ingestion of methadone 50 mg, last dose received yesterday morning, and no recently missed doses Use of Alternative Opioids Patient is currently prescribed methadone in the community, but a hospital methadone prescriber is not available Patient is not prescribed methadone in the community, and refuses to use methadone in hospital Methadone to Morphine Standard opioid equivalency tables usually state that the methadone to morphine ratio is between 1:1 and 1:3 Standard opioid equivalency tables are based on studies of equianalgesia,, not equivalence in terms of respiratory depression Equivalency tables become more inaccurate with increasing doses Equivalency may vary considerably between individuals Between Methadone & Morphine Equivalence between morphine & methadone is not a constant relationship Daily Oral Morphine Dose < 100 mg mg mg mg mg > 1000 mg Morphine:Methadone 3:1 5:1 10:1 12:1 15:1 20:1 Methadone to Morphine Confirm the dose of methadone prescribed and actually ingested by the patient Obtain a history of recent use of illicit drugs and prescribed medications Assess for CNS and respiratory depression, and hepatic or renal dysfunction Apply methadone to morphine conversion ratio conservatively (more morphine can always be given, but once it is given you can t take it back) In a stable patient it is preferable to continue methadone rather than convert to morphine or other opioid 7

8 Methadone to Morphine Example Patient is receiving methadone 100 mg daily in the community Based on an equivalence ratio of 1:3, the estimated morphine equivalence is about 300 mg per day Order half of this in split dosing: morphine oral solution 25 mg po q 4 h prn Reassess and adjust dose based on patient s response to initial doses With higher methadone doses, more conservative equivalence ratios are used (Please note that this is based on my experience) Heroin to Morphine 1 Paper 1/2 point ( ( $10) 1Point 1/10 gram ( ( $15-20) 1 Eight Ball 3.5 grams Heroin to Morphine Considerations Response to opioids already received ( if any) in hospital Clinical presentation Patient self-reported drug use Some patients will over-report report the amount of heroin used Other patients will under-report report the amount of heroin used The quality/purity of street heroin can vary widely (3-90%) Heroin to Morphine Starting dose (based on my experience) 1/4 gm/day MOS mg q h prn 1/2 gm/day MOS mg q h prn 1 gm/day MOS mg q h prn Adjust dose based on response to initial doses Consider shift from prn dosing to regular dosing e.g. MOS 30 mg po q 4 h regularly while awake + 10 mg q 2 h prn (max 4 doses/24 h) Consider use of long acting morphine (needs to be weighed against risk of diversion of tablet/capsule vs liquid preparation) Pain Management In addition to pain, requests for opioid analgesics may be in response to pain, fear, anxiety, stress, or boredom ( chemical coping behavior ) Avoid parenteral route if possible (restrict use to patients who have significant witnessed vomiting or are NPO) Avoid use of Meperidine Routine use of oral liquid forms reduces diversion or injection Concurrent use of non-opioid opioid analgesics Treat withdrawal syndromes and sleep disturbance Taper opioids as acute problem improves Psychiatric Issues Avoid benzodizapines if possible due to disinhibition,, sedation and addictive potential Treat anxiety/agitation with quetiapine or loxapine Use sedatives with low abuse potential including quetiapine, trazadone, amitriptyline 8

9 9

Considerations in Medication Assisted Treatment of Opiate Dependence. Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT

Considerations in Medication Assisted Treatment of Opiate Dependence. Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT Considerations in Medication Assisted Treatment of Opiate Dependence Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT Disclosures Speaker Panels- None Grant recipient - SAMHSA

More information

Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling

Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling Patients with a substance misuse history are at increased risk of receiving inadequate

More information

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN MANAGEMENT OF CHRONIC NON MALIGNANT PAIN Introduction The Manitoba Prescribing Practices Program (MPPP) recognizes the important role served by physicians in relieving pain and suffering and acknowledges

More information

Substitution Therapy for Opioid Dependence The Role of Suboxone. Mandy Manak, MD, ABAM, CCSAM Methadone 101-Hospitalist Workshop, October 3, 2015

Substitution Therapy for Opioid Dependence The Role of Suboxone. Mandy Manak, MD, ABAM, CCSAM Methadone 101-Hospitalist Workshop, October 3, 2015 Substitution Therapy for Opioid Dependence The Role of Suboxone Mandy Manak, MD, ABAM, CCSAM Methadone 101-Hospitalist Workshop, October 3, 2015 Objectives Recognize the options available in treating opioid

More information

Non medical use of prescription medicines existing WHO advice

Non medical use of prescription medicines existing WHO advice Non medical use of prescription medicines existing WHO advice Nicolas Clark Management of Substance Abuse Team WHO, Geneva Vienna, June 2010 clarkn@who.int Medical and Pharmaceutical role Recommendations

More information

Triage, Assessment & Treatment Methadone 101/Hospitalist Workshop

Triage, Assessment & Treatment Methadone 101/Hospitalist Workshop Triage, Assessment & Treatment Methadone 101/Hospitalist Workshop Launette Rieb, MSc, MD, CCFP, FCFP Clinical Associate Professor, Dept. Family Practice UBC American Board of Addiction Medicine Certified

More information

Pain, Addiction & Methadone

Pain, Addiction & Methadone Pain, Addiction & Methadone A CHALLENGING INTERFACE METHADONE AND SUBOXONE OPIOID SUBSTITUTION CONFERENCE Objectives 2 Explore the interface between concurrent pain and addiction. Appreciate the challenges

More information

Discontinuation: Involuntary Discharge

Discontinuation: Involuntary Discharge Discontinuation: Involuntary Discharge TYPICALLY A PROCESS NOT AN EVENT Objectives 2 Review indications for discharge. Develop a therapeutic approach, in the context of the nature of Substance Use Disorders.

More information

One example: Chapman and Huygens, 1988, British Journal of Addiction

One example: Chapman and Huygens, 1988, British Journal of Addiction This is a fact in the treatment of alcohol and drug abuse: Patients who do well in treatment do well in any treatment and patients who do badly in treatment do badly in any treatment. One example: Chapman

More information

DSM V criteria. Defining Opioid Use Disorder (Addiction)

DSM V criteria. Defining Opioid Use Disorder (Addiction) Opioid Addiction DSM V criteria Defining Opioid Use Disorder (Addiction) Defining Opioid Use Disorder (Addiction) DSM V criteria 3 C s compulsions control (lack there of) consequences Identifying Opioid

More information

Opioid Addiction and Methadone: Myths and Misconceptions. Nicole Nakatsu WRHA Practice Development Pharmacist

Opioid Addiction and Methadone: Myths and Misconceptions. Nicole Nakatsu WRHA Practice Development Pharmacist Opioid Addiction and Methadone: Myths and Misconceptions Nicole Nakatsu WRHA Practice Development Pharmacist Learning Objectives By the end of this presentation you should be able to: Understand how opioids

More information

Treatment of opioid use disorders

Treatment of opioid use disorders Treatment of opioid use disorders Gerardo Gonzalez, MD Associate Professor of Psychiatry Director, Division of Addiction Psychiatry Disclosures I have no financial conflicts to disclose I will review evidence

More information

Methadone Maintenance Treatment for Opioid Dependence

Methadone Maintenance Treatment for Opioid Dependence COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO P O L I C Y S TAT E M E N T # 2 1 0 Methadone Maintenance Treatment for Opioid Dependence APPROVED BY COUNCIL: PUBLICATION DATE: KEY WORDS: REFERENCE MATERIALS:

More information

Review of Pharmacological Pain Management

Review of Pharmacological Pain Management Review of Pharmacological Pain Management CHAMP Activities are possible with generous support from The Atlantic Philanthropies and The John A. Hartford Foundation The WHO Pain Ladder The World Health Organization

More information

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification

More information

Opioid overdose can occur when a patient misunderstands the directions

Opioid overdose can occur when a patient misunderstands the directions Facts About Opioid Overdose How Does an Overdose Occur? Opioid overdose can occur when a patient misunderstands the directions for use, accidentally takes an extra dose, or deliberately misuses a prescription

More information

Using Buprenorphine to Treat Acute Opioid Withdrawal in the ED

Using Buprenorphine to Treat Acute Opioid Withdrawal in the ED Using Buprenorphine to Treat Acute Opioid Withdrawal in the ED Dr. Karine Meador MD CCFP DABAM Assistant Director Inner City Health and Wellness Team Physician Addiction Recovery and Community Health (ARCH)

More information

Opioid Agonist Therapy: The Duration Dilemma Edwin A. Salsitz, MD, FASAM Mount Sinai Beth Israel, New York, NY March 10, 2015

Opioid Agonist Therapy: The Duration Dilemma Edwin A. Salsitz, MD, FASAM Mount Sinai Beth Israel, New York, NY March 10, 2015 Q: I have read 40 mg of methadone stops withdrawal, so why don t we start at 30mg and maybe later in the day add 10mg? A: Federal Regulations stipulate that 30mg is the maximum first dose in an Opioid

More information

Heroin. How is Heroin Abused? What Other Adverse Effects Does Heroin Have on Health? How Does Heroin Affect the Brain?

Heroin. How is Heroin Abused? What Other Adverse Effects Does Heroin Have on Health? How Does Heroin Affect the Brain? Heroin Heroin is a synthetic opiate drug that is highly addictive. It is made from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears

More information

Acute Pain Management in the Opioid Dependent Patient. Maripat Welz-Bosna MSN, CRNP-BC

Acute Pain Management in the Opioid Dependent Patient. Maripat Welz-Bosna MSN, CRNP-BC Acute Pain Management in the Opioid Dependent Patient Maripat Welz-Bosna MSN, CRNP-BC Relieving Pain in America (IOM) More then 116 Million Americans have pain the persists for weeks to years $560-635

More information

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE INTRODUCTION High dose sublingual buprenorphine (Subutex) tablets are available in the following strengths 0.4 mg, 2 mg, and 8 mg. Suboxone tablets,

More information

A G U I D E F O R U S E R S N a l t r e x o n e U

A G U I D E F O R U S E R S N a l t r e x o n e U A GUIDE FOR USERS UNaltrexone abstinence not using a particular drug; being drug-free. opioid antagonist a drug which blocks the effects of opioid drugs. dependence the drug has become central to a person

More information

Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care

Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care Hull & East Riding Prescribing Committee Guidelines for the Prescribing, Supply and Administration of Methadone and Buprenorphine on Transfer of Care 1. BACKGROUND Patients who are physically dependent

More information

Neurobiology and Treatment of Opioid Dependence. Nebraska MAT Training September 29, 2011

Neurobiology and Treatment of Opioid Dependence. Nebraska MAT Training September 29, 2011 Neurobiology and Treatment of Opioid Dependence Nebraska MAT Training September 29, 2011 Top 5 primary illegal drugs for persons age 18 29 entering treatment, % 30 25 20 15 10 Heroin or Prescription Opioids

More information

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Although prescription pain medications are intended to improve the lives of people with pain, their increased use and misuse

More information

Death in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery

Death in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery Death in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery Marvin D. Seppala, MD Chief Medical Officer Hazelden Betty Ford Foundation This product is supported by

More information

Care Management Council submission date: August 2013. Contact Information

Care Management Council submission date: August 2013. Contact Information Clinical Practice Approval Form Clinical Practice Title: Acute use of Buprenorphine for the Treatment of Opioid Dependence and Detoxification Type of Review: New Clinical Practice Revisions of Existing

More information

Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP

Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP Medical assessment of patient with Alcohol Use Disorder Identification patients suitable for home detox Process for referral to inpatient

More information

Information for Pharmacists

Information for Pharmacists Page 43 by 42 CFR part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. Information for Pharmacists SUBOXONE (buprenorphine HCl/naloxone HCl

More information

College of Physicians and Surgeons of Saskatchewan. Saskatchewan METHADONE GUIDELINES AND STANDARDS. for the Treatment of Opioid Addiction/Dependence

College of Physicians and Surgeons of Saskatchewan. Saskatchewan METHADONE GUIDELINES AND STANDARDS. for the Treatment of Opioid Addiction/Dependence College of Physicians and Surgeons of Saskatchewan Saskatchewan METHADONE GUIDELINES AND STANDARDS for the Treatment of Opioid Addiction/Dependence March, 2015 cps.sk.ca ACKNOWLEDGEMENTS The information

More information

SUBOXONE for Opioid Addiction Medication Assisted Therapy. Dr. Jennifer Melamed MBChB, ABAM, CISAM, CCSAM

SUBOXONE for Opioid Addiction Medication Assisted Therapy. Dr. Jennifer Melamed MBChB, ABAM, CISAM, CCSAM N SUBOXONE for Opioid Addiction Medication Assisted Therapy Dr. Jennifer Melamed MBChB, ABAM, CISAM, CCSAM CONTENTS Part 1 Introduction to N SUBOXONE Part 2 Pharmacology of N SUBOXONE Part 3 Pharmacokinetics

More information

Arkansas Emergency Department Opioid Prescribing Guidelines

Arkansas Emergency Department Opioid Prescribing Guidelines Arkansas Emergency Department Opioid Prescribing Guidelines 1. One medical provider should provide all opioids to treat a patient s chronic pain. 2. The administration of intravenous and intramuscular

More information

Urine Drug Testing Methadone 101 Methadone for hospitalists

Urine Drug Testing Methadone 101 Methadone for hospitalists Urine Drug Testing Methadone 101 Methadone for hospitalists Dr. Patricia Mark MB, BCh LEARNING OBJECTIVES Clarify the purpose of urine drug testing Distinguish between UDT for detection of illicit drug

More information

How To Treat Anorexic Addiction With Medication Assisted Treatment

How To Treat Anorexic Addiction With Medication Assisted Treatment Medication Assisted Treatment for Opioid Addiction Tanya Hiser, MS, LPC Premier Care of Wisconsin, LLC October 21, 2015 How Did We Get Here? Civil War veterans and women 19th Century physicians cautious

More information

INTOXICATED PATIENTS AND DETOXIFICATION

INTOXICATED PATIENTS AND DETOXIFICATION VAMC Detoxification Decision Tree Updated May 2006 INTOXICATED PATIENTS AND DETOXIFICATION Patients often present for evaluation of substance use and possible detoxification. There are certain decisions

More information

Financial Disclosures

Financial Disclosures Opioid Agonist Therapy: To Maintain or Not To Maintain - A Case Discussion PCSS-MAT American Psychiatric Association Drs. Ed Salsitz, John Renner, Timothy Fong April 14, 2015 Financial Disclosures Edwin

More information

Prescription Drugs: Abuse and Addiction

Prescription Drugs: Abuse and Addiction EAP Drug Free Workplace Newsletter March 2014 Prescription Drugs: Abuse and Addiction What are some of the commonly abused prescription drugs? Although many prescription drugs can be abused or misused,

More information

Co-morbid physical disorders e.g. HIV, hepatitis C, diabetes, hypertension. Medical students will gain knowledge in

Co-morbid physical disorders e.g. HIV, hepatitis C, diabetes, hypertension. Medical students will gain knowledge in 1.0 Introduction Medications are used in the treatment of drug, alcohol and nicotine dependence to manage withdrawal during detoxification, stabilisation and substitution as well as for relapse prevention,

More information

EPIDEMIOLOGY OF OPIATE USE

EPIDEMIOLOGY OF OPIATE USE Opiate Dependence EPIDEMIOLOGY OF OPIATE USE Difficult to estimate true extent of opiate dependence Based on National Survey of Health and Mental Well Being: 1.2% sample used opiates in last 12 months

More information

Hulpverleningsmodellen bij opiaatverslaving. Frieda Matthys 6 juni 2013

Hulpverleningsmodellen bij opiaatverslaving. Frieda Matthys 6 juni 2013 Hulpverleningsmodellen bij opiaatverslaving Frieda Matthys 6 juni 2013 Prevalence The average prevalence of problem opioid use among adults (15 64) is estimated at 0.41%, the equivalent of 1.4 million

More information

Nurses Self Paced Learning Module on Pain Management

Nurses Self Paced Learning Module on Pain Management Nurses Self Paced Learning Module on Pain Management Dominican Santa Cruz Hospital Santa Cruz, California Developed by: Strategic Planning Committee Dominican Santa Cruz Hospital 1555 Soquel Drive Santa

More information

Dependence and Addiction. Marek C. Chawarski, Ph.D. Yale University David Metzger, Ph.D. University of Pennsylvania

Dependence and Addiction. Marek C. Chawarski, Ph.D. Yale University David Metzger, Ph.D. University of Pennsylvania Dependence and Addiction Marek C. Chawarski, Ph.D. Yale University David Metzger, Ph.D. University of Pennsylvania Overview Heroin and other opiates The disease of heroin addiction or dependence Effective

More information

How To Use Methadone

How To Use Methadone Alberta Methadone Maintenance Treatment STANDARDS AND GUIDELINES FOR DEPENDENCE 2014 Table of Contents Introduction... 1 Standards and Guidelines - Overview... 3 Methadone Maintenance Treatment in Alberta...

More information

The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office

The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office Adopted April 2013 for Consideration by State Medical Boards 2002 FSMB Model Guidelines

More information

1. According to recent US national estimates, which of the following substances is associated

1. According to recent US national estimates, which of the following substances is associated 1 Chapter 36. Substance-Related, Self-Assessment Questions 1. According to recent US national estimates, which of the following substances is associated with the highest incidence of new drug initiates

More information

Question one. 1. You increase her to 90mg 2. You increase her to 95mg 3. You hold her dose where it is (80mg)

Question one. 1. You increase her to 90mg 2. You increase her to 95mg 3. You hold her dose where it is (80mg) What it all means Question one. Ms. Presley was on methadone under your care years ago. She had been off the program for a few years and restarted back on methadone after a lengthy IV heroin and Oxycontin

More information

Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients

Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients Developed by the Mid Atlantic Renal Coalition and the Kidney End of Life Coalition September 2009 This project was supported,

More information

Abstral Prescriber and Pharmacist Guide

Abstral Prescriber and Pharmacist Guide Abstral Prescriber and Pharmacist Guide fentanyl citrate sublingual tablets Introduction The Abstral Prescriber and Pharmacist Guide is designed to support healthcare professionals in the diagnosis of

More information

13. Substance Misuse

13. Substance Misuse 13. Substance Misuse Definitions Misuse or abuse this is the taking of something with the intention of producing pleasurable mind-altering effects, intoxication or altered body image. The mind-altering

More information

MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION

MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION Mark Fisher Program Administrator State Opioid Treatment Adminstrator Kentucky Division of Behavioral Health OBJECTIVES Learn about types of opioids and

More information

Heroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health?

Heroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health? Heroin Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown

More information

Methadone and the Risk of Opamine Poisoning

Methadone and the Risk of Opamine Poisoning Newfoundland and Labrador Pharmacy Board Standards of Practice Standards for the Safe and Effective Provision of Medication for the Treatment of Opioid Dependence January 2015 Revised September 2015 Table

More information

Medical marijuana for pain and anxiety: A primer for methadone physicians. Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015

Medical marijuana for pain and anxiety: A primer for methadone physicians. Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015 Medical marijuana for pain and anxiety: A primer for methadone physicians Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015 Conflict of interest statement No conflict of interest to

More information

Heroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health?

Heroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health? Heroin Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown

More information

DRUG AND ALCOHOL DETOXIFICATION: A GUIDE TO OUR SERVICES

DRUG AND ALCOHOL DETOXIFICATION: A GUIDE TO OUR SERVICES 01736 850006 www.bosencefarm.co.uk DRUG AND ALCOHOL DETOXIFICATION: A GUIDE TO OUR SERVICES An environment for change Boswyns provides medically-led drug and alcohol assessment, detoxification and stabilisation.

More information

Treatments for drug misuse

Treatments for drug misuse Understanding NICE guidance Information for people who use NHS services Treatments for drug misuse NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases and

More information

Integrating Medication- Assisted Treatment (MAT) for Opioid Use Disorders into Behavioral and Physical Healthcare Settings

Integrating Medication- Assisted Treatment (MAT) for Opioid Use Disorders into Behavioral and Physical Healthcare Settings Integrating Medication- Assisted Treatment (MAT) for Opioid Use Disorders into Behavioral and Physical Healthcare Settings All-Ohio Conference 3/27/2015 Christina M. Delos Reyes, MD Medical Consultant,

More information

Medications to address the opioid crisis - methadone, buprenorphine, naltrexone, and naloxone

Medications to address the opioid crisis - methadone, buprenorphine, naltrexone, and naloxone Medications to address the opioid crisis - methadone, buprenorphine, naltrexone, and naloxone Alexander Y. Walley, MD, MSc Director, Addiction Medicine Fellowship and Addiction Medicine Consult Service

More information

EXPLORING NALOXONE UPTAKE AND USE PUBLIC MEETING July 01 02, 2015 Fred Wells Brason II fbrason@projectlazarus.org

EXPLORING NALOXONE UPTAKE AND USE PUBLIC MEETING July 01 02, 2015 Fred Wells Brason II fbrason@projectlazarus.org EXPLORING NALOXONE UPTAKE AND USE PUBLIC MEETING July 01 02, 2015 Fred Wells Brason II fbrason@projectlazarus.org Disclosures Project Lazarus Zogenix Charitable Contribution 2015 Kaléo Charitable Contribution

More information

MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION

MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION Sidarth Wakhlu,M.D. Addiction Team Leader North Texas VA Health Care System Addiction Psychiatry Fellowship Director Associate Professor Of Psychiatry

More information

EPIDEMIC 4.6 % OF INDIVIDUALS 18 25 USED PAIN RELIEVERS FOR NON-MEDICAL REASONS. 1.5 MILLION YOUNG ADULTS USED PAIN RELIEVERS IN THE PAST MONTH.

EPIDEMIC 4.6 % OF INDIVIDUALS 18 25 USED PAIN RELIEVERS FOR NON-MEDICAL REASONS. 1.5 MILLION YOUNG ADULTS USED PAIN RELIEVERS IN THE PAST MONTH. Drug Court EPIDEMIC In the 10 years (1997 2007) the per capita retail purchases of Methadone, Hydrocodone and Oxycodone in the United States increased 13-fold, 4-fold and 9-fold, respectively. 4.6 % OF

More information

SUPPORTING WOMEN USING OPIATES IN PREGNANCY: A Guideline for Primary Care Providers May, 2011

SUPPORTING WOMEN USING OPIATES IN PREGNANCY: A Guideline for Primary Care Providers May, 2011 INTRODUCTION SUPPORTING WOMEN USING OPIATES IN PREGNANCY: A Guideline for Primary Care Providers May, 2011 Prevalence of Opiate Use and Impact on Maternal, Fetal, and Neonatal Health: The prevalence of

More information

Like cocaine, heroin is a drug that is illegal in some areas of the world. Heroin is highly addictive.

Like cocaine, heroin is a drug that is illegal in some areas of the world. Heroin is highly addictive. Heroin Introduction Heroin is a powerful drug that affects the brain. People who use it can form a strong addiction. Addiction is when a drug user can t stop taking a drug, even when he or she wants to.

More information

Medication is not a part of treatment.

Medication is not a part of treatment. Medication is not a part of treatment. Medication can be an effective part of treatment. Medication is used in the treatment of many diseases, including addiction. Medical decisions must be made by trained

More information

Opioids Research to Practice

Opioids Research to Practice Opioids Research to Practice CRIT Program May 2011 Daniel P. Alford, MD, MPH Associate Professor of Medicine Boston University School of Medicine Boston Medical Center 32 yo female brought in after heroin

More information

Alberta Standards & Guidelines for Methadone Maintenance Treatment for Dependence 1 College of Physicians & Surgeons of Alberta

Alberta Standards & Guidelines for Methadone Maintenance Treatment for Dependence 1 College of Physicians & Surgeons of Alberta Alberta & Guidelines for Methadone Maintenance Treatment for Dependence 1 College of Physicians & Surgeons of Alberta January 7, 2014 2013 1 Replaces & Guidelines for Methadone Maintenance Treatment in

More information

Southlake Psychiatry. Suboxone Contract

Southlake Psychiatry. Suboxone Contract Suboxone Contract Thank you for considering Southlake Psychiatry for your Suboxone treatment. Opiate Addiction is a serious condition for which you may find relief with Suboxone treatment. In order to

More information

Conceptualizing and Integrating Medication Assistant Treatment into your Court s Armamentarium

Conceptualizing and Integrating Medication Assistant Treatment into your Court s Armamentarium Conceptualizing and Integrating Medication Assistant Treatment into your Court s Armamentarium Ted Parran JR. M.D. FACP Carter and Isabel Wang Professor of Medical Education CWRU School of Medicine tvp@case.edu

More information

Beyond SBIRT: Integrating Addiction Medicine into Primary Care

Beyond SBIRT: Integrating Addiction Medicine into Primary Care Beyond SBIRT: Integrating Addiction Medicine into Primary Care Community Clinic Association of Los Angeles County 14 th Annual Health Care Symposium March 6, 2015 Keith Heinzerling MD, Karen Lamp MD; Allison

More information

Naloxone treatment of opioid overdose

Naloxone treatment of opioid overdose Naloxone treatment of opioid overdose Opioids Chemicals that act in the brain to relieve pain, often use to suppress cough, treat addiction, and provide comfort After prolonged use of opioids, increasing

More information

Provider enews TREATING PRESCRIPTION DRUG ADDICTION

Provider enews TREATING PRESCRIPTION DRUG ADDICTION Provider enews TREATING PRESCRIPTION DRUG ADDICTION Treating addiction to prescription opioids July 2012 Several options are available for effectively treating prescription opioid addiction. These options

More information

Treatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone )

Treatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone ) Treatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone ) Elinore F. McCance-Katz, M.D., Ph.D. Professor and Chair, Addiction Psychiatry Virginia Commonwealth University Neurobiology of Opiate

More information

Triage, Assessment & Treatment

Triage, Assessment & Treatment Triage, Assessment & Treatment Launette Rieb, MSc, MD, CCFP, FCFP, dip ABAM Clinical Associate Professor, Dept. Family Practice, UBC Physician Director, St. Paul's Hospital Goldcorp Addiction Medicine

More information

Section Editor Andrew J Saxon, MD

Section Editor Andrew J Saxon, MD Official reprint from UpToDate www.uptodate.com 2015 UpToDate Pharmacotherapy for opioid use disorder Author Eric Strain, MD Section Editor Andrew J Saxon, MD Deputy Editor Richard Hermann, MD All topics

More information

Medication for the Treatment of Alcohol Use Disorder. Pocket Guide

Medication for the Treatment of Alcohol Use Disorder. Pocket Guide Medication for the Treatment of Alcohol Use Disorder Pocket Guide Medications are underused in the treatment of alcohol use disorder. According to the National Survey on Drug Use and Health, of the estimated

More information

Program Assistance Letter

Program Assistance Letter Program Assistance Letter DOCUMENT NUMBER: 2004-01 DATE: December 5, 2003 DOCUMENT TITLE: Use of Buprenorphine in Health Center Substance Abuse Treatment Programs TO: All Bureau of Primary Health Care

More information

SUBOXONE /VIVITROL WEBINAR. Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12

SUBOXONE /VIVITROL WEBINAR. Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12 SUBOXONE /VIVITROL WEBINAR Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12 WEBINAR INTRODUCTIONS Cynthia Parsons- Program Manager

More information

GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS

GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS Bristol Palliative Care Collaborative Contact Numbers: Hospital Specialist Palliative Care Teams: Frenchay 0117 340 6692 Southmead 0117 323

More information

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline: CSD - Suboxone Therapeutic Class: Central Nervous System Agents Therapeutic Sub-Class: Analgesics and Antipyretics (Opiate Partial Agonists) Client: County of San

More information

The TIRF REMS Access program is a Food and Drug Administration (FDA) required risk management program

The TIRF REMS Access program is a Food and Drug Administration (FDA) required risk management program Subject: Important Drug Warning Announcement of a single shared REMS (Risk Evaluation and Mitigation Strategy) program for all Transmucosal Immediate Release Fentanyl (TIRF) products due to the potential

More information

Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence

Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Information for Family Members Family members of patients who have been prescribed buprenorphine/naloxone for treatment of opioid addiction

More information

Buprenorphine: what is it & why use it?

Buprenorphine: what is it & why use it? Buprenorphine: what is it & why use it? Dr Nicholas Lintzeris, MBBS, PhD, FAChAM Locum Consultant, Oaks Resource Centre, SLAM National Addiction Centre, Institute of Psychiatry Overview of presentation

More information

OVERVIEW WHAT IS POLyDRUG USE? Different examples of polydrug use

OVERVIEW WHAT IS POLyDRUG USE?  Different examples of polydrug use Petrol, paint and other Polydrug inhalants use 237 11 Polydrug use Overview What is polydrug use? Reasons for polydrug use What are the harms of polydrug use? How to assess a person who uses several drugs

More information

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN ISSUE DATE September 4, 2015 SUBJECT EFFECTIVE DATE September 9, 2015 MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Opiate Dependence Treatments, Oral Buprenorphine Agents - Pharmacy

More information

CNCP and Addiction. Disclosures 17/02/2015. CPSNS CPSNL Atlantic Mentorship Network P&A. John Fraser February 18, 2015

CNCP and Addiction. Disclosures 17/02/2015. CPSNS CPSNL Atlantic Mentorship Network P&A. John Fraser February 18, 2015 CNCP and Addiction John Fraser February 18, 2015 Disclosures CPSNS CPSNL Atlantic Mentorship Network P&A "Your eyes are fine. It s just that on some eye charts the type is too small." 1 CNCP with history

More information

OPIOIDS. Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School

OPIOIDS. Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School OPIOIDS Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School Rutgers New Jersey Medical School Fundamentals of Addiction Medicine Summer Series Newark, NJ July 24, 2013

More information

Dosing Guide. For Optimal Management of Opioid Dependence

Dosing Guide. For Optimal Management of Opioid Dependence Dosing Guide For Optimal Management of Opioid Dependence KEY POINTS The goal of induction is to safely suppress opioid withdrawal as rapidly as possible with adequate doses of Suboxone (buprenorphine HCl/naloxone

More information

NALTREXONE INDUCED DETOXIFICATION FROM OPIOIDS A METHOD OF ANTAGONIST INITIATED TREATMENT

NALTREXONE INDUCED DETOXIFICATION FROM OPIOIDS A METHOD OF ANTAGONIST INITIATED TREATMENT NALTREXONE INDUCED DETOXIFICATION FROM OPIOIDS A METHOD OF ANTAGONIST INITIATED TREATMENT Opioid dependence is a devastating and frequently fatal medical condition. It is a manifestation of addictive disorder

More information

Opiate Abuse and Mental Illness

Opiate Abuse and Mental Illness visited on Page 1 of 5 LEARN MORE (HTTP://WWW.NAMI.ORG/LEARN-MORE) FIND SUPPORT (HTTP://WWW.NAMI.ORG/FIND-SUPPORT) GET INVOLVED (HTTP://WWW.NAMI.ORG/GET-INVOLVED) DONATE (HTTPS://NAMI360.NAMI.ORG/EWEB/DYNAMICPAGE.ASPX?

More information

Acute & Chronic Pain Management (requiring opioid analgesics) in Patients Receiving Pharmacotherapy for Opioid Addiction

Acute & Chronic Pain Management (requiring opioid analgesics) in Patients Receiving Pharmacotherapy for Opioid Addiction Acute & Chronic Pain Management (requiring opioid analgesics) in Patients Receiving Pharmacotherapy for Opioid Addiction June 9, 2011 Tufts Health Care Institute Program on Opioid Risk Management Daniel

More information

Frequently asked questions

Frequently asked questions Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction Frequently asked questions What is Naltrexone? Naltrexone is a prescription drug that completely blocks the effects of all opioid drugs

More information

Update and Review of Medication Assisted Treatments

Update and Review of Medication Assisted Treatments Update and Review of Medication Assisted Treatments for Opiate and Alcohol Use Disorders Richard N. Whitney, MD Medical Director Addiction Services Shepherd Hill Newark, Ohio Medication Assisted Treatment

More information

SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE

SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE 1 P a g e The following Operational Guidance Manual has been prepared with input from both community and prison addictions specialists

More information

STATISTICS. Opiate Substitution Therapy for Opiate Dependence. Alan Shein, M.D.

STATISTICS. Opiate Substitution Therapy for Opiate Dependence. Alan Shein, M.D. Opiate Substitution Therapy for Opiate Dependence Alan Shein, M.D. OH #1-1 STATISTICS Prevalence of Specific Drug Abuse and Vulnerability to Develop Addictions National Household Survey and Related Surveys

More information

Opioid Treatment Services, Office-Based Opioid Treatment

Opioid Treatment Services, Office-Based Opioid Treatment Optum 1 By United Behavioral Health U.S. Behavioral Health Plan, California Doing Business as OptumHealth Behavioral Solutions of California ( OHBS-CA ) 2015 Level of Care Guidelines Opioid Treatment Services,

More information

MAT Counselor Education Course Exam Questions Packet Part 1

MAT Counselor Education Course Exam Questions Packet Part 1 MAT Counselor Education Course Exam Questions Packet Part 1 Course No: Course Title: Course Objective: MA-1901P1 Medication-Assisted Treatment (MAT) Counselor Education Course Part 1 Includes primer on

More information

Opioid Analgesics. Week 19

Opioid Analgesics. Week 19 Opioid Analgesics Week 19 Analgesic Vocabulary Analgesia Narcotic Opiate Opioid Agonist Antagonist Narcotic Analgesics Controlled substances Opioid analgesics derived from poppy Opiates include morphine,

More information

Understanding Addiction: The Intersection of Biology and Psychology

Understanding Addiction: The Intersection of Biology and Psychology Understanding Addiction: The Intersection of Biology and Psychology Robert Heimer, Ph.D. Yale University School of Public Health Center for Interdisciplinary Research on AIDS New Haven, CT, USA November

More information

Opioid Dependence Treatment with Buprenorphine/Naloxone: An Overview for Pharmacists and Physicians

Opioid Dependence Treatment with Buprenorphine/Naloxone: An Overview for Pharmacists and Physicians Opioid Dependence Treatment with Buprenorphine/Naloxone: An Overview for Pharmacists and Physicians Phyllis A. Grauer, PharmD, CGP, CPE Clinical Pharmacist Legislation Passed Enabling Office Based Treatment

More information

Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction. Frequently Asked Questions

Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction. Frequently Asked Questions Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction Frequently Asked Questions What is Naltrexone? Naltrexone is a prescription drug that effectively blocks the effects of heroin, alcohol,

More information