How To Treat Anorexic Addiction With Medication Assisted Treatment

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1 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 about prescribing Early 20th Century addiction increased with immigration Legislation decrease opium trade WWII opioid addiction shifts with attitude Addiction and crimes increases; upsets legal and medical communities Dr s Dole and Nyswander use methadone to treat opioid addiction s NIDA promulgated standards for methadone clinics and created SOTAs. Opioid Treatment Programs Today Today there are 1200 SAMHSA approved OTPs in 48 states, 2 territories and D.C. DEA, SAMHSA (CSAT) and individual state rules regulate these OTPs. All OTPs are also accredited by CARF or COA. Provide medication assisted treatment for opioid addiction stops cravings and withdrawal symptoms. 1

2 Medication Assisted Treatment MAT Medication-Assisted Treatment (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 SAMHSA Methadone, Buprenorphine (Suboxone) and Naltrexone (Vivitrol) Methadone Methadone is a schedule II narcotic used to treat pain and symptoms of addiction. Methadone is safe when utilized in therapeutic doses. Methadone does not cause impairment in driving, cognitive functioning, intelligence or employability. Methadone is not sedating or intoxicating when at a therapeutic dose. Patients still feel pain and experience emotions. Like ANY opioid, methadone can cause death if too much is taken or mixed with other CNS depressants, i.e. alcohol. Can only be utilized for addiction treatment in and OTP. Buprenorphine Schedule III narcotic medication; buprenorphine/naloxone combinations Opioid partial agonist its maximal effects are less than those of full agonists= low doses needed. At moderate doses they reach a plateau or ceiling effect. Thus, buprenorphine carries a lower risk of abuse, addiction, and side effects compared to full opioid agonists Formulations for opioid addiction treatment are in the form of sublingual tablets Because of its ceiling effect and poor bioavailability, buprenorphine is safer in overdose than opioid full agonists. No evidence of significant disruption of cognitive or psychomotor performance with buprenorphine maintenance dosing. Certified physician only allowed to prescribe in an OTP or outpatient setting. SAMHSA.GOV 2

3 Naltrexone Naltrexone is a non-opioid medication that is approved for the treatment of opioid dependence. Opioid receptor antagonist; it binds to opioid receptors, but instead of activating the receptors, it effectively blocks them. It prevents opioid receptors from being activated by agonist compounds, such as heroin or prescription pain killers, and is reported to reduce craving and prevent relapse. As opposed to other medications used for opioid dependence (methadone and buprenorphine), naltrexone can be prescribed by any individual who is licensed to prescribe medicine (e.g., physician, doctor of osteopathic medicine, physician assistant, and nurse practitioner). Both the oral daily form and the monthly injectable monthly extended-release form (Vivitrol ) are FDA approved for treatment of opioid dependence. SAMHSA.GOV Wisconsin OTPs 16 private, for profit OTPs owned by 4 different companies serving 6,000 patients. Cost of treatment ranges from $16.00-$20.00; Medicaid and insurance will pay for treatment. Wisconsin rules more stringent than Federal. Patients attend daily and receive medication, counseling; provide UA for illicit testing. Take home doses are allowed when the clinics are closed and as the patient progresses in treatment. No more than 14 doses may leave the clinic at any one time. Wisconsin OTPs To be admitted into an OTP, patients must be: :Addicted to opioids per DSM IV criteria; :18 years or older; :Able to tolerate methadone treatment; :Wisconsin resident; :Reside within 50 miles of the nearest clinic 3

4 Medication Assisted Treatment MAT with methadone is only allowed at the 16 OTPs. Medication is only part of the treatment counseling is the other. Patient s must submit to random UA s to check for illicit substances. A medical team (physician and nursing) monitor the patients dose and symptoms. Blood draws done to test for level of methadone in system. Stages of MAT Induction start low and go slow; 30 mg initial dose. Maintenance dose is stable; counseling is focus of treatment. Tapering no specific treatment timeline. Patients can taper at any time. Slow taper equals less withdrawal symptoms. *Some people stay on methadone forever. Take Home Dose Criteria Take home privileges follow Federal 8 point criteria: 1. Absence of recent drug abuse; 2. Regularity of clinic attendance; 3. Absence of serious behavioral problems at the clinic; 4. Absence of known recent criminal activity; 5. Stability of the patient s home environment; 6. Length of time in treatment; 7. Assurance that the medication can be stored appropriately; 8. Rehabilitative benefit to the patient derived from decreasing the frequency of clinic attendance outweighs the potential risks of diversion. 4

5 OTPs Phases of Treatment Phase 1 First 90 days; 1 TH dose Phase 2 Second 90 days; 2 TH doses Phase 3 Third 90 days; 3 TH doses Phase 4 Fourth 90 days; 4 TH doses Phase 5 1 year of treatment; 6 TH doses Phase 6 2 years of treatment; 13 TH doses OTPs Methadone is dispensed and not prescribed. Methadone is in liquid form only. Utilized for addiction only; not pain. Pain Clinics Methadone is prescribed and not dispensed. Methadone is in pill form only. Utilized for pain; not addiction. The End 5