Medication-Assisted Addiction Treatment

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1 Medication-Assisted Addiction Treatment Molly Carney, Ph.D., M.B.A. Executive Director Evergreen Treatment Services Seattle, WA

2 What is MAT? MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substanceuse disorders, a combination of medication and behavioral therapies is most successful. Medication assisted treatment (MAT) is clinically driven with a focus on individualized patient care.

3 ADDICTION INVOLVES MULTIPLE FACTORS Biology/Genes Environment DRUG Brain Mechanisms Addiction

4 Drug Dependence: A Chronic Medical Illness Genetic Heritability twin studies Disease % heritable Disease % heritable Hypertension 25-50% Nicotine 61% (M+F) Diabetes (1) 30-55% Alcohol 55% (M) Diabetes (2) 80% Marijuana 52% (F) Asthma 36-70% Heroin 34% (M) Choice personality and environment Pathophysiology neurochemical adaptations Treatment Response Medications effectiveness and compliance Behavioral interventions

5 If addiction is a chronic disease: Addiction treatment doesn t cure the disease. The goal of treatment is to: Give pts tools to help manage addiction medications are among those tools Teach pts how to use tools to achieve and maintain recovery

6 Drug vs. Medication Drug: used to enhance or change reality Repeated use may lead to addiction Craving Tolerance Loss of control over use Medication: help individual participate in reality Physical withdrawal symptoms possible Dependence lacks the psychological component of addiction

7 Neurotransmitter Action Release of NT Reuptake Receptor

8 How do Medications for Opioid Addiction Work? Opioid Effect Full Agonist (e.g., methadone) Dose of Opioid Partial Agonist (e.g. buprenorphine) Antagonist (e.g. Naloxone)

9 How do Medications for Opioid Addiction Work? Medications that block the high : 1. Agonists produce opioid effects (methadone) 2. Partial Agonists produce moderate opioid effects (buprenorphine/subutex) 3. Antagonists block opioid effects (Naloxone)

10 Methadone for Opioid Dependence Methadone binds to the same receptor sites as other opioids Orally effective Slow onset of action Long duration of action (24-36 hours) Slow offset of action Kreek MJ, (1992). Rationale for maintenance pharmacotherapy of opiate dependence. Research publications - Association for Research in Nervous and Mental Disease, 70,

11 Methadone for Opioid Dependence Cost: Bundled rate of $14/day (comprehensive services) Dosing: Typically once per day observed dosing Tablet or liquid Admission criteria: Psychosocial assessment Medical (sick) intake Must demonstrate physical withdrawal from opioids to be admitted

12 Methadone for Opioid Dependence Random, observed UAs Weekly counseling Daily dosing After 90 days, may start earning take home dose privileges Prescription Monitoring Program checks Regular medical provider appointments

13 Treatment Outcome Data: Methadone Reductions: Death rate (8-10x) Drug use Criminal activity Spread of HIV Improvements: Socially productive roles; Family and social function Employment Physical and mental health Excellent treatment retention

14 Percent IV Users Relapse to IV Drug Use after MMT: n=105 male pts who left treatment Treatment Months Since Stopping Treatment SOURCE: Adapted from Ball & Ross (1991). The Effectiveness of Methadone Maintenance Treatment.

15 NIH: Effective Medical Treatment of Opiate Addiction NIH Consensus Panel (1997): 12 members, multi-disciplinary testimony from 25 experts reviewed 941 research reports Of the various treatments available, MMT, combined with attention to medical, psychiatric, and socioeconomic issues, as well as drug counseling, has the highest probability of being effective. Adapted from JAMA, Dec 9, (22),

16 Take Away Points FDA labeling on medications is clear: Medications should be used in combination with behavioral treatments for addiction Best treatment is holistic, integrated and multifaceted Physical, behavioral and spiritual well-being of the individual. Medications can help take care of the physical we need to help patient do the rest

17 Take Away Points Not all medications work for all patients Similar to other medical problems Hypertension Depression Important for communities to have an array of treatment options Identify the treatment approach that works best for each patient

18 Key Resources McLellan, A.T., et.al., Drug Dependence, a Chronic Medical Illness Journal of the American Medical Association 284: , 2000 FAQs on Methadone Treatment for Opioid Addiction: Medication-Assisted Treatment for Opioid Addiction: Facts for Families and Friends (SAMHSA-CSAT website) Getting Started with Medication-Assisted Treatment (http://www.niatx.net/pdf/niatx- MAT-Toolkit.pdf)

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