Treating Addiction in Chronic Pain Patients A Clinical Journey. Brad Anderson, MD Chief, Department of Addiction Medicine Kaiser Permanente Northwest

Size: px
Start display at page:

Download "Treating Addiction in Chronic Pain Patients A Clinical Journey. Brad Anderson, MD Chief, Department of Addiction Medicine Kaiser Permanente Northwest"

Transcription

1 Treating Addiction in Chronic Pain Patients A Clinical Journey Brad Anderson, MD Chief, Department of Addiction Medicine Kaiser Permanente Northwest

2 Pain Addiction

3 Kaiser Permanente Northwest 480,000 members clinicians Portland Metro and Salem in Oregon Vancouver and Longview in Washington

4 Department of Addiction Medicine 40 counselors 5 medical staff 11 medical offices 6,000 patients per year Level I, II, III, adult & adolescent Inpatient and outpatient detox Codependency treatment Chronic Pain Addiction Group (CPAG)

5 Diagnoses at Intake Alcohol Amphetamine Cannabis No diagnosis Cocaine Opioid

6 Half of referrals to Addiction Medicine from primary and specialty care are due to concerns about opioid addiction. Is this addiction? If so, what do I do about it?

7

8

9

10

11

12

13

14 Contract for long-term opioid therapy for chronic nonmalignant pain Single prescriber Medicine, dose, refills Risk / benefit Reasons to discontinue

15 Contract for long-term opioid therapy for chronic nonmalignant pain Introduced the concept that addiction is not an absolute contraindication to prescribing opioids Challenged the idea that opioid therapy is only for end-of-life care Developed with cooperation of state BMEs

16 Evaluation for appropriateness of long-term opioid therapy from an addiction medicine standpoint What we found Concerning behaviors were often due to inadequately treated pain, not addiction Rarely resulted in recommendation to discontinue opioids Physical dependence and addiction often confused

17 Evaluation for appropriateness of long-term opioid therapy from an addiction medicine standpoint What we found Mainly short acting opioids being prescribed Poor utilization of non-opioid therapies Difficult to make addiction diagnosis Patients with addiction who were on opioids for pain didn t fit well into standard treatment

18

19

20

21

22 Cougalgia Chronic pain syndrome seen in Washington State Cougar fans Also known as Pullman-ary hypertension Associated with Depression Anxiety PTSD Delusional thinking

23 Cougalgia Predominantly genetic with some environmental influence Differential diagnosis Cubosis Mal-de-Mariner Beavertigo Overlap with addiction Continued viewing despite adverse consequences Loss of remote control Compulsive ESPN use

24 Cougalgia - Treatments Three 10 win seasons with top 10 rating Unanticipated side effects 3 Apple Cup losses Dobamine Seahawk substitution therapy Rose Bowl victory probably only hope

25 Chronic Pain / Addiction Group I Initially lead by staff from both the Dept of Addiction Medicine and Pain Clinic Pain management strategies predominated during group time Eventually discontinued as census decreased

26 Chronic Pain / Addiction Group II Lead by counselor and physician assistant from the Dept of Addiction Medicine For inclusion, patients must have, and agree with, the diagnoses of Addiction Chronic pain Most patients were on an opioid and had addiction treatment experience All patients had an assessment and treatment plan

27 Chronic Pain / Addiction Group II Goal of the group To learn how to live with pain and addiction on a daily basis.

28 Chronic Pain / Addiction Group II In other words Learn how to have to opioids be a medication for pain without being a drug of choice Keeping things black and white

29 Pain Addiction

30 Chronic Pain / Addiction Group II In other words Learn how to have to opioids be a medication for pain without being a drug of choice Keeping things black and white Stay on the analgesic curve

31 DOSE Analgesia Euphoria Pseudoaddiction Euphoria to Analgesia TIME

32 Name Your Treatment Column A Column B Column C New Step Program Change Direction House Life Point Group Turning Works Community Recovery Pathways System Health Day People Care Dawn Place Safe Roads Home Fresh Start Center

33 CPAG II Check In Name Substance of choice Sobriety date Number of meetings attended in past week Pain level Taking meds as prescribed? One word feeling today Do you need time in group today?

34 Chronic Pain / Addiction Group II To accomplish goals, coordination with the Primary Care Provider is key. Develop Opiate Therapy Plan Long acting opioids, scheduled, not PRN Eliminate short acting opioids Avoid benzodiazepines Random urine toxicology Referral to Pain Clinic and participation in pain management 8 week class

35 CPAG II Female 76% Male 24% 0

36 CPAG II Addiction Diagnoses Opioid 69% Alcohol 41% Marijuana 16% Amphetamine 10% Other 10%

37 CPAG II Pain Diagnoses Back/neck 60% Fibromyalgia 28% Headaches 17% Arthritis 8% Other 12%

38 CPAG II Psych Diagnoses Depression 72% Anxiety 28% PTSD 20% Axis II 10% Other 16%

39 CPAG II Long Acting Opioids Methadone 54% Sustained release morpine 37% 10 0 Oxycontin 6%

40

41 Chronic Pain / Addiction Group II What we found Most patients love the group Need to remind patients that this is an addiction group, not a pain group Need to remind patients to attend a pain group Strong interplay between psychological factors (stress, anxiety), pain and addiction Patients who left the group and relapsed, often returned

42 Chronic Pain / Addiction Group II What we found The group DID NOT significantly change the behavior of the patients Primary Care Provider! 1. Opiate therapy plans not consistently developed 2. Short acting opiates were prescribed again 3. Urine toxicology not done

43 Research Opportunities Identify barriers to PCP cooperation with Addiction Medicine recommendations Development of meaningful and measurable outcome measures to assess efficacy of chronic pain / addiction groups Identify patient characteristics which would predict good or poor outcomes with opioid therapy Evaluate use of case managers to improve functioning and decrease health care utilization

44 For more information, please contact us Lucile Gauger, PA-C Christine Finucane, LCSW Brad Anderson, MD

45

46

47

48

49

50

51

52

53

54 A Confusing Nomenclature Substance abuse Addiction Dependence Psychological dependence Chemical dependency Drug abuse

55 Opioid Dependence Physical dependence - a physiological state of adaptation to opioids Withdrawal syndrome with abstinence Relief of withdrawal with reintroduction As little as two weeks at therapeutic doses

56 Opioid Dependence Psychological dependence - subjective sense of need for opioids Positive effects Avoidance of negative effects associated with abstinence

57 Opioid Dependence Physical dependence does not equal psychological dependence. Physical dependence usually accompanies psychological dependence.

58 Addiction A primary, chronic disease with - genetic, - psychosocial and - environmental factors influencing its development and manifestations. It is often progressive, fatal and characterized by - impaired control, - preoccupation with use and - continued use despite adverse consequences. These symptoms may be continuous or periodic.

59 Addiction Latin for given over or awarded to, from ad - to + dicere - say, pronounce U2 - lifeless lifeline, running to stand still C.S. Lewis - an ever increasing craving for an ever diminishing pleasure.

60 Pain & Addiction Pain is often poorly treated in patients with addiction Fear of addicting patient Poor pain management skills Unfamiliarity with addiction Fear of regulatory sanctions

61 Pain & Addiction Patient concerns Fear of inadequately treated pain Fear of withdrawal Fear of relapse

62 Chronic Pain & Addiction Addiction - functioning decreases with increasing dose Pseudoaddiction - functioning increases with increasing dose

63 Common Recommendations Develop opiate therapy plan ( contract ) Use long acting / sustained release opiates Random urine toxicology Maximize non-opiate pharmacology Maximize non-pharmacologic modalities Pain clinic referral

64 Summary Pain & Addiction Demonstrate interest is in pain control, not medication (chronic pain treatment equation) Do everything through the front door Goal is pain control and increased functioning

65 Chronic Pain Treatment Equation chronic pain Tx = + other meds + physical therapy + relaxation opiates + ice/heat + education + etc

66 Chronic Pain & Addiction Treatment Goals Decrease pain Decrease associated symptoms anxiety depression insomnia Increase functioning Opioid remains a medication, not a drug of choice

67 Chronic Pain & Addiction To achieve these goals Addiction must be treated Use non-pharmacological modalities Use non-opioid medications If opioids are needed, use long acting or time released and take on scheduled basis Random urine toxicology

68 Chronic Pain & Addiction Opiate Therapy Plan Basic or Complex based upon addiction risk prescriber medication & dose amount & refill schedule patient s goals for therapy description of risks & responsibilities for patient signed by patient and prescriber

69 The 3 C s of Addiction Loss of CONTROL using month s meds in a few days or weeks early refills requests, obtaining meds from family, friends, Internet, street Adverse CONSEQUENCES sedation, OD, decrease functioning Preoccupation or COMPULSION reliance on opioids, poor compliance with other treatment modalities

70 Diagnosing Addiction Ask yourself Has this patient developed a relationship with this medication beyond what I prescribed it for? Does this patient go to lengths to get this medication that most of my patients don t?

71 Diagnosing Addiction Using supply before refills due Calling after hours, weekends, Friday at 5:00 Calling when PCP not available Multiple ER and UCC visits Calling provider at home Lost and/or stolen prescriptions Meds eaten by dog, fell in toilet, left in Seaside, picked up by ex-wife, etc...

72 Diagnosing Addiction Patient says med gives me energy Euphoria or sense of well-being Forging or changing scripts Borrowing or lending medications Obtaining meds from Internet or illegally Stockpiling medications Family/friends concerned about use Reported allergies to other analgesics

73 Diagnosing Addiction History of addictive disease Prior attempts to decrease or stop meds Annoyance at other s comments about use Guilt or embarrassment about use Use to treat non-targeted symptoms Use when no symptoms present Unsanctioned dosage increases

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Section I: Preamble The Michigan Boards of Medicine and Osteopathic Medicine & Surgery recognize that principles of quality

More information

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION Effective June 13, 2010 02-313, 02-373, 02-380, 02-383, 02-396 Chapter 21 page 1 02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 313 BOARD OF DENTAL EXAMINERS 373 BOARD OF LICENSURE IN MEDICINE

More information

Kaiser Permanente Department of Addiction Medicine Panel May 21, 2010

Kaiser Permanente Department of Addiction Medicine Panel May 21, 2010 Youth and Opiates Kaiser Permanente Department of Addiction Medicine Panel May 21, 2010 Panel Members Dr. Brad Anderson Kathy Tomlin Jeff Beatty Phil Anderson Panel Program Introduce to KP-AM Suboxone

More information

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Section I: Preamble The New Hampshire Medical Society believes that principles

More information

Prescription Medication Abuse: Skills for Prevention and Intervention

Prescription Medication Abuse: Skills for Prevention and Intervention Prescription Medication Abuse: Skills for Prevention and Intervention icare Partnership www.icarenc.org James Finch, MD North Carolina Society of Addiction Medicine NC Governor s Institute on Alcohol and

More information

Michigan Board of Nursing Guidelines for the Use of Controlled Substances for the Treatment of Pain

Michigan Board of Nursing Guidelines for the Use of Controlled Substances for the Treatment of Pain JENNIFER M. GRANHOLM GOVERNOR STATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH LANSING JANET OLSZEWSKI DIRECTOR Michigan Board of Nursing Guidelines for the Use of Controlled Substances for the Treatment

More information

HAWAII BOARD OF MEDICAL EXAMINERS PAIN MANAGEMENT GUIDELINES

HAWAII BOARD OF MEDICAL EXAMINERS PAIN MANAGEMENT GUIDELINES Pursuant to section 453-1.5, Hawaii Revised Statutes, the Board of Medical Examiners ("Board") has established guidelines for physicians with respect to the care and treatment of patients with severe acute

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

ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;03/13;06/14;07/15

ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;03/13;06/14;07/15 ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;/13;06/14;07/15 WRITTEN BY Jim Johnson Page 1 REVISED BY AUTHORIZED BY Jessica Moeller Debra Johnson I. APPLICATION: THUMB

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

Naltrexone and Alcoholism Treatment Test

Naltrexone and Alcoholism Treatment Test Naltrexone and Alcoholism Treatment Test Following your reading of the course material found in TIP No. 28. Please read the following statements and indicate the correct answer on the answer sheet. A score

More information

These changes are prominent in individuals with severe disorders, but also occur at the mild or moderate level.

These changes are prominent in individuals with severe disorders, but also occur at the mild or moderate level. Substance-Related Disorders DSM-V Many people use words like alcoholism, drug dependence and addiction as general descriptive terms without a clear understanding of their meaning. What does it really mean

More information

Opioid Contracts: A Tool for Providing Relief and Preventing Abuse?

Opioid Contracts: A Tool for Providing Relief and Preventing Abuse? Opioid Contracts: A Tool for Providing Relief and Preventing Abuse? Jane Jurcic McMaster Family Practice and Hamilton Family Health Team Hamilton, Ontario Opioid Prescribing in Chronic Pain Legitimate

More information

Substance Abuse Issues in Pain Management

Substance Abuse Issues in Pain Management Substance Abuse Issues in Pain Management Steven D. Passik, PhD Associate Attending Psychologist Memorial Sloan Kettering Cancer Center New York, NY Opioid Rhetoric: From Complete Avoidance to Complete

More information

Guidelines for Use of Controlled Substances for the Treatment of Pain

Guidelines for Use of Controlled Substances for the Treatment of Pain 1.0 Purpose: Use of Controlled Substances for the Treatment of Pain The Physicians Advisory Committee for Controlled Substances of the Medical Society of Delaware supports the Federation of State Medical

More information

MQAC Rules for the Management of Chronic Non-Cancer Pain

MQAC Rules for the Management of Chronic Non-Cancer Pain MQAC Rules for the Management of Chronic Non-Cancer Pain Effective January 2, 2012 246-919-850 Pain management Intent. These rules govern the use of opioids in the treatment of patients for chronic noncancer

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

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

Opioid Treatment Agreement

Opioid Treatment Agreement Opioid Treatment Agreement 1. I understand that my provider and I will work together to find the most appropriate treatment for my chronic pain. I understand the goals of treatment are not to eliminate

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

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

Patients are still addicted Buprenorphine is simply a substitute for heroin or

Patients are still addicted Buprenorphine is simply a substitute for heroin or BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module VI: Myths About the Use of Medication in Recovery Patients are still addicted Buprenorphine is simply a substitute

More information

Managing Chronic Pain in Adults with Substance Use Disorders

Managing Chronic Pain in Adults with Substance Use Disorders Question from chapter 1 Managing Chronic Pain in Adults with Substance Use Disorders 1) What is the percent of chronic pain patients who may have addictive disorders? a) 12% b) 22% c) 32% d) 42% 2) Which

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

The Chemical Coper Steven D. Passik, PhD

The Chemical Coper Steven D. Passik, PhD The Chemical Coper Steven D. Passik, PhD Associate Attending Psychologist Memorial Sloan Kettering Cancer Center New York, NY The Opioid Pendulum Avoidance Even dying people at risk of addiction Balance

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

MSD Guidelines for the Use of Controlled Substances for the Treatment of Pain

MSD Guidelines for the Use of Controlled Substances for the Treatment of Pain GUIDELINES MSD Guidelines for the Use of Controlled Substances for the Treatment of Pain To address the current epidemic of prescription drug abuse, your Medical Society has been working closely with the

More information

CONTROLLED SUBSTANCE CONTRACT

CONTROLLED SUBSTANCE CONTRACT CONTROLLED SUBSTANCE CONTRACT The purpose of this contract is to protect my access to controlled substances and to protect our ability to prescribe for you. The long-term use of substances such as opiates

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

Addiction Medicine for FP / GP. Dr. Francisco Ward, DABPMR/PM SetonPainRehab.com setonpr@gmail.com

Addiction Medicine for FP / GP. Dr. Francisco Ward, DABPMR/PM SetonPainRehab.com setonpr@gmail.com Addiction Medicine for FP / GP Dr. Francisco Ward, DABPMR/PM SetonPainRehab.com setonpr@gmail.com S Disease of Chemical Addiction Short Definition of Addiction (ASAM): Addiction is a primary, chronic disease

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

opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 Ranked #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380

opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 Ranked #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380 opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 ed #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380 effects of alcohol in the brain 100 Top 30 698 heroin addiction 100

More information

KENTUCKY ADMINISTRATIVE REGULATIONS TITLE 201. GENERAL GOVERNMENT CABINET CHAPTER 9. BOARD OF MEDICAL LICENSURE

KENTUCKY ADMINISTRATIVE REGULATIONS TITLE 201. GENERAL GOVERNMENT CABINET CHAPTER 9. BOARD OF MEDICAL LICENSURE KENTUCKY ADMINISTRATIVE REGULATIONS TITLE 201. GENERAL GOVERNMENT CABINET CHAPTER 9. BOARD OF MEDICAL LICENSURE 201 KAR 9:260. Professional standards for prescribing and dispensing controlled substances.

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

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

Drug overdose death rates by state per 100,000 people (2008) SOURCE: National Vital Statistics System, 2008

Drug overdose death rates by state per 100,000 people (2008) SOURCE: National Vital Statistics System, 2008 PRESCRITPION DRUG ABUSE: AN EPIDEMIC What is Addiction? By: Lon R. Hays, M.D., M.B.A. Professor and Chairman Department of Psychiatry University of Kentucky Healthcare Addiction is a primary, chronic disease

More information

Disclosure. C.R. Sullivan, MD 1. Carl R. Sullivan, M.D. Professor and Director Addictions Program csullivan@hsc.wvu.edu. The West Virginia Model

Disclosure. C.R. Sullivan, MD 1. Carl R. Sullivan, M.D. Professor and Director Addictions Program csullivan@hsc.wvu.edu. The West Virginia Model West Virginia University School of Medicine BEHAVIORAL MEDICINE & PSYCHIATRY Morgantown, WV Carl R. Sullivan, M.D. Professor and Director Addictions Program csullivan@hsc.wvu.edu Disclosure Reckitt Benckiser

More information

Appendices to Interim Report on the Baltimore Buprenorphine Initiative. Managed Care Organization Information Pages

Appendices to Interim Report on the Baltimore Buprenorphine Initiative. Managed Care Organization Information Pages Appendices to Interim Report on the Baltimore Buprenorphine Initiative Appendix A Managed Care Organization Information Pages Appendix B Buprenorphine Online Physician Training Information Packet Appendix

More information

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015 The Clinical Level of Care Guidelines contained on the following pages have been developed as a guide to assist care managers, physicians and providers in making medical necessity decisions about the least

More information

Opioids for Pain Treatment. Opioids for Chronic Pain and Addiction Treatment. Outline for Today. Opioids for pain treatment

Opioids for Pain Treatment. Opioids for Chronic Pain and Addiction Treatment. Outline for Today. Opioids for pain treatment Opioids for Chronic Pain and Addiction Treatment Joseph Merrill M.D., M.P.H. University of Washington February 24, 2012 Outline for Today Opioids for pain treatment Trends Problems High dose prescribing

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

Today s Topics. Session 2: Introduction to Drug Treatment. Treatment matching. Guidelines: where should a client go for treatment?

Today s Topics. Session 2: Introduction to Drug Treatment. Treatment matching. Guidelines: where should a client go for treatment? Session 2: Introduction to Drug Treatment Today s Topics Level of care determination How to know when treatment works What does treatment include Description of treatment modalities Naomi Weinstein, MPH

More information

Karla Ramirez, LCSW Director, Outpatient Services Laurel Ridge Treatment Center

Karla Ramirez, LCSW Director, Outpatient Services Laurel Ridge Treatment Center Karla Ramirez, LCSW Director, Outpatient Services Laurel Ridge Treatment Center 1 in 4 Americans will have an alcohol or drug problems at some point in their lives. The number of alcohol abusers and addicts

More information

American Society of Addiction Medicine

American Society of Addiction Medicine American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,

More information

If the only tool you have is a hammer, you tend to see every problem as a nail.

If the only tool you have is a hammer, you tend to see every problem as a nail. How do we approach addiction? ADDICTION 101 A basic primer on addiction If the only tool you have is a hammer, you tend to see every problem as a nail. (Abraham Maslow) Definition of addiction Alcoholism

More information

TENNESSEE BOARD OF MEDICAL EXAMINERS POLICY STATEMENT OFFICE-BASED TREATMENT OF OPIOID ADDICTION

TENNESSEE BOARD OF MEDICAL EXAMINERS POLICY STATEMENT OFFICE-BASED TREATMENT OF OPIOID ADDICTION TENNESSEE BOARD OF MEDICAL EXAMINERS POLICY STATEMENT OFFICE-BASED TREATMENT OF OPIOID ADDICTION The Tennessee Board of Medical Examiners has reviewed the Model Policy Guidelines for Opioid Addiction Treatment

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

ANCILLARY STABILIZATION AND WITHDRAWAL. The Why And How Of Stabilizing The Patient In A Comprehensive Treatment Setting

ANCILLARY STABILIZATION AND WITHDRAWAL. The Why And How Of Stabilizing The Patient In A Comprehensive Treatment Setting ANCILLARY STABILIZATION AND WITHDRAWAL The Why And How Of Stabilizing The Patient In A Comprehensive Treatment Setting About CASAColumbia A science-based, multidisciplinary organization Focused on transforming

More information

Behavioral Health Medical Necessity Criteria

Behavioral Health Medical Necessity Criteria Behavioral Health Medical Necessity Criteria Revised: 7/14/05 2 nd Revision: 9/14/06 3 rd Revision: 8/23/07 4 th Revision: 8/28/08; 11/20/08 5 th Revision: 8/27/09 Anthem Blue Cross and Blue Shield 2 Gannett

More information

Judith Martin, MD Medical Director, Substance Abuse Services, San Francisco DPH

Judith Martin, MD Medical Director, Substance Abuse Services, San Francisco DPH Western Occupational & Environmental Medical Association CME Webinar April 17, 2013 Judith Martin, MD Medical Director, Substance Abuse Services, San Francisco DPH PLEASE STAND BY - WEBINAR WILL BEGIN

More information

Sample Patient Agreement Forms

Sample Patient Agreement Forms Sample Patient Agreement Forms Introduction This resource includes two sample patient agreement forms that can be used with patients who are beginning long-term treatment with opioid analgesics or other

More information

Treatment of Chronic Pain: Our Approach

Treatment of Chronic Pain: Our Approach Treatment of Chronic Pain: Our Approach Today s webinar was coordinated by the National Association of Community Health Centers, a partner with the SAMHSA-HRSA Center for Integrated Health Solutions SAMHSA

More information

Background & Significance

Background & Significance The Impact Of A Structured Opioid Renewal Clinic On Aberrant Drug Behavior Outcomes At A Northeastern VA Medical Center Salimah H. Meghani, PhD, MBE, CRNP Assistant Professor, University of Pennsylvania

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

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call 1-800-662-HELP(4357)

More information

Drug Abuse and Addiction

Drug Abuse and Addiction Drug Abuse and Addiction Introduction A drug is a chemical substance that can change how your body and mind work. People may abuse drugs to get high or change how they feel. Addiction is when a drug user

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

Alcohol and Drug. A Cochrane Handbook. losief Abraha MD. Cristina Cusi MD. Regional Health Perugia

Alcohol and Drug. A Cochrane Handbook. losief Abraha MD. Cristina Cusi MD. Regional Health Perugia Alcohol and Drug A Cochrane Handbook losief Abraha MD Regional Health Perugia of Cristina Cusi MD Outpatient Services - Neurology Clinical Institutes of Specialisation Milan Italy A John Sons, Ltd., THE

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

Nurse Practitioner Controlled Substances Post Survey Analysis. May, 2013

Nurse Practitioner Controlled Substances Post Survey Analysis. May, 2013 Nurse Practitioner Controlled Substances Post Survey Analysis May, 2013 Contents Table of Figures... 1 Executive Summary... 2 Nurse Practitioner Controlled Substances Post Survey Analysis... 3 Background...

More information

Martha Brewer, MS, LPC,LADC. Substance Abuse and Treatment

Martha Brewer, MS, LPC,LADC. Substance Abuse and Treatment Martha Brewer, MS, LPC,LADC Substance Abuse and Treatment What is a substance use disorder? Long-term and chronic illness Can affect anyone: rich or poor, male or female, employed or unemployed, young

More information

Identifying and Managing Substance Use During Pregnancy

Identifying and Managing Substance Use During Pregnancy Identifying and Managing Substance Use During Pregnancy Joseph B. Landwehr, Jr., MD Director, Perinatal Center IU Health Ball Memorial Hospital OBJECTIVES Overview of illicit drug use in pregnant women

More information

Implementing Prescribing Guidelines in the Emergency Department. April 16, 2013

Implementing Prescribing Guidelines in the Emergency Department. April 16, 2013 Implementing Prescribing Guidelines in the Emergency Department April 16, 2013 Housekeeping Note: Today s presentation is being recorded and will be provided within 48 hours. Two ways to ask questions

More information

Produced and Published by The Cabin Chiang Mai, Alcohol and Drug Rehab Centre. Copyright 2013. and How is it Treated?

Produced and Published by The Cabin Chiang Mai, Alcohol and Drug Rehab Centre. Copyright 2013. and How is it Treated? and How is it Treated? 1 About this book This E-book has been produced as a guide to help explain some of the fundamental things you need to understand about addiction and its treatment, starting with

More information

Doc Dial-in Discussion Series

Doc Dial-in Discussion Series Doc 2 Doc Dial-in Discussion Series Session 4: Detox: What it is, What it isn t, and the Role of Primary Care Learning Objectives Learn how to conduct a differential evaluation to know when specialized

More information

Why Do I Need to Stay Abstinent

Why Do I Need to Stay Abstinent Chapter 12 Why Do I Need to Stay Abstinent From ALL Alcohol and Other Drugs? T After some time in recovery I decided that my problem was drugs and not alcohol and I started to drink socially. It wasn t

More information

Aberrant Drug-taking Behaviors: What Do We Know?

Aberrant Drug-taking Behaviors: What Do We Know? Aberrant Drug-taking Behaviors: What Do We Know? Steven D. Passik, PhD Associate Attending Psychologist Memorial Sloan Kettering Cancer Center New York, NY Where Will The Pendulum Stop? Avoidance Will

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

TREATMENT MODALITIES. May, 2013

TREATMENT MODALITIES. May, 2013 TREATMENT MODALITIES May, 2013 Treatment Modalities New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) regulates the addiction treatment modalities offered in New York State.

More information

Table of Contents. I. Introduction... 2. II. Summary... 3. A. Total Drug Intoxication Deaths... 5. B. Opioid-Related Deaths... 9

Table of Contents. I. Introduction... 2. II. Summary... 3. A. Total Drug Intoxication Deaths... 5. B. Opioid-Related Deaths... 9 Table of Contents I. Introduction... 2 II. Summary... 3 III. Charts A. Total Drug Intoxication Deaths... 5 B. Opioid-Related Deaths... 9 C. Heroin-Related Deaths... 11 D. Prescription Opioid-Related Deaths...

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

Opioid/Opiate Dependent Pregnant Women

Opioid/Opiate Dependent Pregnant Women Opioid/Opiate Dependent Pregnant Women The epidemic, safety, stigma, and how to help. Presented by Lisa Ramirez MA,LCDC & Kerby Stewart MD The prescription painkiller epidemic is killing more women than

More information

Prescription Drug Abuse

Prescription Drug Abuse Prescription Drug Abuse Introduction Most people take medicines only for the reasons their health care providers prescribe them. But millions of people around the world have used prescription drugs for

More information

MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT

MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT June, 2014 Dean L. Babcock, LCAC, LCSW Associate Vice President Eskenazi Health Midtown Community Mental Health Centers Why is Evidence-Based

More information

DrugFacts: Treatment Approaches for Drug Addiction

DrugFacts: Treatment Approaches for Drug Addiction DrugFacts: Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please

More information

Methamphetamine. Like heroin, meth is a drug that is illegal in some areas of the world. Meth is a highly addictive drug.

Methamphetamine. Like heroin, meth is a drug that is illegal in some areas of the world. Meth is a highly addictive drug. Methamphetamine Introduction Methamphetamine is a very addictive stimulant drug. 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

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

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction [NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call

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

MEDICALLY SUPERVISED OPIATE WITHDRAWAL FOR THE DEPENDENT PATIENT. An Outpatient Model

MEDICALLY SUPERVISED OPIATE WITHDRAWAL FOR THE DEPENDENT PATIENT. An Outpatient Model MEDICALLY SUPERVISED OPIATE WITHDRAWAL FOR THE DEPENDENT PATIENT An Outpatient Model OBJECTIVE TO PRESENT A PROTOCOL FOR THE EVALUATION AND TREATMENT OF PATIENTS WHO ARE CHEMICALLY DEPENDENT ON OR SEVERLY

More information

H-SOAP STUDY. Hospital-based Services for Opioid- and Alcohol-addicted Patients

H-SOAP STUDY. Hospital-based Services for Opioid- and Alcohol-addicted Patients H-SOAP STUDY Hospital-based Services for Opioid- and Alcohol-addicted Patients Meldon Kahan, Anita Srivastava, Kate Hardy, Sarah Clarke Canadian Society of Addiction Medicine 2014 October 17, 2014 1 Few

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

Intake Consultation and Assessment Before Detox. What Happens During Drug Detox?

Intake Consultation and Assessment Before Detox. What Happens During Drug Detox? What Happens During Drug Detox? Many addicts and alcoholics believe they can quit using substances on their own. But after a few painful and confidence-crushing failed attempts, the need for an inpatient

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

Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids

Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids Pik-Sai Yung, M.D. Staff Psychiatrist Center for Counseling at Walton Background and Rationale Alprazolam is

More information

PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications

PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications Primary Care & Specialist Prescribing Guidelines Introduction Partnership HealthPlan is a County Organized Health System covering

More information

Benzodiazepine Detoxification and Reduction of Long term Use

Benzodiazepine Detoxification and Reduction of Long term Use Benzodiazepine Detoxification and Reduction of Long term Use Malcolm Lader 1 Model of general drug misuse and dependence. Tactical interventional options Social dimension Increasing breaking of social

More information

P3 / PERSONAL ASPECTS. Drugs

P3 / PERSONAL ASPECTS. Drugs P1 / DRUGS An addiction treatment facility such as Delray Recovery Center often treats patients who are addicted to more than one drug. P2 / SUBSTANCES Learn about Alcohol and Amphetamines, including the

More information

THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES

THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES PURPOSE: The goal of this document is to describe the

More information

Substance Use Disorder Overview. Presented By Ecole J. Barrow-Brooks M.Ed & Darlene D. Owens MBA, LBSW, CADC, ADS

Substance Use Disorder Overview. Presented By Ecole J. Barrow-Brooks M.Ed & Darlene D. Owens MBA, LBSW, CADC, ADS Substance Use Disorder Overview Presented By Ecole J. Barrow-Brooks M.Ed & Darlene D. Owens MBA, LBSW, CADC, ADS 1 National Issue There continues to be a large treatment gap in the U.S. In 2013, an estimated

More information

About drugs. Psychoactive drugs. Drugs are substances that change a person s physical or mental state.

About drugs. Psychoactive drugs. Drugs are substances that change a person s physical or mental state. 1 About drugs Drugs are substances that change a person s physical or mental state. The vast majority of drugs are used to treat medical conditions, both physical and mental. Some, however, are used outside

More information

What is Addiction? DSM-IV-TR Substance Abuse Criteria

What is Addiction? DSM-IV-TR Substance Abuse Criteria Module 2: Understanding Addiction, Recovery, and Recovery Oriented Systems of Care This module reviews the processes involved in addiction and what is involved in recovering an addiction free lifestyle.

More information

Naltrexone And Alcoholism Treatment Treatment Improvement Protocol (TIP) Series 28

Naltrexone And Alcoholism Treatment Treatment Improvement Protocol (TIP) Series 28 Naltrexone And Alcoholism Treatment Treatment Improvement Protocol (TIP) Series 28 Executive Summary and Recommendations Psychosocial treatments for alcoholism have been shown to increase abstinence rates

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

Pain Management Regulations Affect More Than Pain Management Specialists January 2012. Of counsel to

Pain Management Regulations Affect More Than Pain Management Specialists January 2012. Of counsel to Pain Management Regulations Affect More Than Pain Management Specialists January 2012 LINDA A. KEEN MSN, JD, LHCRM LAW OFFICE OF LINDA A. KEEN P.A. TALLAHASSEE, FL Of counsel to Pain Management Regulations

More information

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN ISSUE DATE SUBJECT EFFECTIVE DATE MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Opiate Dependence Treatments Pharmacy Service Leesa M. Allen, Deputy Secretary Office of Medical

More information

Opioid Agreement for Center for Pain Management S.C.

Opioid Agreement for Center for Pain Management S.C. Opioid Agreement for Center for Pain Management S.C. Patient Name: DOB: I am the patient named above. I have agreed to use pain medication as part of my treatment for chronic pain. I understand that these

More information

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE Brief Coverage Statement Outpatient Substance Use Disorder (SUD) Fee-For-Service (FFS) Treatment Services are available for the treatment of substance

More information

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour. Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,

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