Treating Alcohol Use Disorders With Prescriptions And Medications
|
|
- Edith Wiggins
- 3 years ago
- Views:
Transcription
1 Medications for Treatment of Substance Use Disorders (SUDs) Karen Drexler, MD Deputy National Mental Health Program Director- Addictive Disorders Office of Patient Care Services Department of Veterans Affairs
2 Disclosures Employed by the Department of Veterans Affairs (VA) No commercial financial conflicts of interest
3 Learning objectives The participant will be able to: Understand substance use disorders as chronic brain diseases. Understand research evidence supporting medications to improve treatment outcome. Become familiar with medications available to treat alcohol use disorders and opioid use disorders- mechanisms of action risks and benefits other clinical considerations
4 Overview Why medications? SUD-specific medications for relapse prevention: Alcohol Opioids
5 Why Medications? SUDs are chronic brain diseases Multifactorial, like other chronic diseases Respond best to comprehensive treatment Medications improve treatment outcome over psychosocial interventions alone Reduce craving and risk of relapse Protect against opioid overdose
6 DSM-5 Substances 10 categories Alcohol Caffeine Cannabis Hallucinogens (PCP) Inhalants Opioids Sedatives, Hypnotics, and Anxiolytics Stimulants (amphetamines, cocaine, etc.) Tobacco Other or unknown 6
7 DSM-5 Substance Use Disorder >/= 2 of the following 11 criteria within 12-months: 1. Taking larger amounts than intended 2. Persistent desire/efforts to cut down or control 3. Great deal of time spent getting the substance, taking it, or recovering 4. Craving, strong desire or urge 5. Failure to fulfill major role obligations due to use 6. Recurrent hazardous use 7. Important activities given up or reduced 8. Continued use despite a psychological or physical problem 9. Continued use despite a social or interpersonal problem 10. Tolerance 11. Characteristic withdrawal 7
8 Compliance and Relapse in Chronic Medical Disorders Insulin-dependent diabetes Compliance with medication <50% Compliance with diet and foot care <30% Retreated within 12 months 30 50% Medication-dependent hypertension Compliance with medication <30% Compliance with diet <30% Retreated within 12 months 50 60% Substance use disorders Compliance with treatment attendance <40% Retreated within 12 months 10 40% O Brien CP, McLellan AT. Lancet. 1996;347:
9 Effectiveness of Treatment in Hypertension +Med A - Med A BP>140/90 BP<120/80 BP>140/90
10 Effectiveness of Treatment in SUD treatment Tx - Tx Daily substance use Abstinence or reduced substance use Daily substance use
11 Interconnected Networks Mediating Motivation and Decision-making George Koob, PhD (2013)
12 Addicting Drugs Hijack Decision-making pathways Mesolimbic dopaminergic pathway Activated by food, sex, threat, and powerfully by addicting drugs Connected to memory circuits Through classical and operant conditioning, cues activate dopamine Through extinction, cues gradually become less activating However, reinstatement is predictable- Food is seasonal Cues, stress, drugs Thus, HALT from AA When a cue signals availability, automatic behavioral cascade is initiated. Cunning, baffling, powerful 12
13 Cocaine Microdialysis in Awake Squirrel Monkeys Howell L
14 Why Medications? Summary Substance use disorders are chronic, brain diseases. Untreated, they lead to premature death and contribute to recidivism. SUDs involve changes in neural pathways involved in motivation, drive and decision-making. These neural changes are enduring, but respond to long-term treatment Similar to treatment of hypertension or Type 2 Diabetes Mellitus Medications and psychosocial treatments can save lives 14
15 Overview Why medications? Relapse prevention: Alcohol Opioids
16 FDA Approved Medications for SUDs Alcohol use disorder: Naltrexone (Revia, Vivitrol ) Disulfiram (Antabuse ) Acamprosate (Campral ) Opioid use disorder: Methadone Buprenorphine/naloxone (Suboxone ) Naltrexone (Vivitrol ) Opioid overdose: Naloxone rescue kits and Evzio
17 Case #1 44 year-old man with 25-year history of severe alcohol use disorder. Unable to abstain from alcohol outside a controlled environment for >30 days. Reported urges to drink alcohol triggered by the sight of empty beer cans on roadside. Began oral naltrexone at the end of inpatient detoxification. Reduction in alcohol craving. Tested medication by driving to favorite bar and sitting outside in parking lot. No craving. Able to drive home without relapsing. 17
18 Naltrexone (ReVia, Vivitrol ) Mu opioid antagonist Craving reduction Decreased euphoria (enhances extinction?) Reduces risk of relapse to heavy drinking if slip occurs Usual dose: Oral - 50 mg 100 mg once daily, Intramuscular mg/month Adverse events: Nausea, abdominal cramps Muscle aches, headache Insomnia, depression, anxiety May precipitate opioid withdrawal in tolerant individuals Renders opioid pain medications ineffective Injection site reactions for injectable form (Vivitrol ) Adverse events tend to occur early, if at all, minimized by establishing alcohol abstinence prior to starting medication.
19 Oral Naltrexone in the treatment of alcohol dependence Volpicelli et al: 1992 Arch Gen Psych 49(11):876-80
20 Oral Naltrexone Supports Abstinence from Alcohol Jonas et al: 2014, JAMA 20
21 Oral Naltrexone Reduces Relapse to Heavy Drinking 21
22 Extended Release Naltrexone Injection Associated with Reduced Mortality and Hospital Readmissions Outcome measure 1 year mortality Odds Ratio for NTX-XR/control 0.30 (p < 0.001) In subset with detox in prior year Subsequent detox episodes 0.80 (p < 0.001) Case-Control design 387 veterans with AUD received NTX-XR 3759 controls Propensity score weighted, mixed-effects logistic regression model for 1-year mortality. For subset with at least one detox episode in previous year, # detox episodes in following year. 1 year mortality 0.78 (p < 0.001) Harris et al Alcohol Clin Exp Res-39:
23 Naltrexone Precautions Contraindications Precautions Drug interactions Use of opioids in last 7 to 10 days Acute opioid withdrawal Anticipated need for opioid analgesics Acute hepatitis or liver failure Hypersensitivity Failed naloxone challenge Acute liver disease Severe kidney failure Monitor for emergence of depression Injection site reactions (extended release injection only) Pregnancy Category C Opioid analgesics (blocks action and can induce withdrawal)
24 Acamprosate (Campral ) Modifies glutamate NMDA receptor function Advantage in patients with liver disease- eliminated through the kidney Helps maintain abstinence in those who have stopped drinking alcohol No benefit in reducing heavy drinking or inducing abstinence Usual dose: 333mg: 2 tablets 3 times daily Adverse events: Rare: suicidal ideation and behavior Common: diarrhea (>10%), Others: insomnia /sleepiness, anxiety
25 Acamprosate Supports Abstinence in Alcohol Use Disorder Jonas et al: 25
26 Acamprosate Precautions Contraindications Precautions Drug interactions Severe kidney disease (CrCl <30mL/min) Moderate kidney disease Depression History of suicide attempts None known
27 Case #2 42 year-old married, full-time mother of two with strong family history of alcohol use disorders. Mother died from her alcoholism when she was a teen. Unable to stay sober after 28-day inpatient treatment program. Naltrexone started after second 28-day program, but had no effect on craving. Relapsed on naltrexone 2 months after starting the medication. Highly motivated for sobriety to save marriage, children. Functional analysis of relapse identified unavoidable risky situations Social functions Family gatherings Discussed risks/benefits of disulfiram. Agreed to have husband monitor her selfadministration. Sober 12 months on disulfiram. 27
28 Disulfiram (Antabuse ) Inhibits aldehyde dehydrogenase build-up of toxin (acetaldehyde) Active for up to 2 weeks. Patients must understand risk of relapse to alcohol. Usual dose: 250 mg once daily Adverse reactions: Common: Metallic or garlicky taste Drowsiness Serious: Alcohol-disulfiram reaction can be fatal Hepatitis Neuropathy Psychosis
29 Disulfiram not different than placebo in double-blind RCTs 29
30 Disulfiram Effective in Open-Label, Not Blinded RCTs 30
31 Disulfiram Best with Supervised Administration 31
32 Disulfiram Precautions Contraindications Precautions Drug interactions Recent alcohol use Cardiovascular disease Allergy to rubber (thiuram) derivatives Liver disease Psychosis Epilepsy Hypothyroidism Diabetes mellitus Kidney disease Carry wallet card Alcohol (cough syrups, mouthwash, wine sauce, etc.) Anticoagulants (Coumadin) Isoniazid Metronidazole Phenytoin
33 Alcohol Medications Summary FDA-approved medications for Alcohol Use Disorder (AUD, DSM5): Acamprosate delayed-release oral tablets (CAMPRAL and generic) Naltrexone oral tablets (REVIA and generics) Naltrexone extended-release suspension for intramuscular injection (VIVITROL) Disulfiram oral tablets (ANTABUSE and generics) None of these medications is consistently superior to the others Overall, they produce small to moderate benefits. Treatment response with the oral agents better in patients who are already abstinent before starting therapy. Abstinence required prior to disulfiram. In clinical trials, AUD-focused pharmacotherapy was usually provided with addiction-focused counseling. 33
34 Opioid Use Disorder High mortality male admits to California Civil Addict Program (CAP) Average age at entry = 25 years 10-year mortality = 14% 20-year mortality = 28% 30-year mortality = 49% Counseling alone modestly effective Therapeutic community Contingency management Medications: Opioid Agonist Therapy (OAT) has strong evidence of effectiveness: Mu opioid agonist (methadone) Mu opioid partial agonist (buprenorphine) Opioid Antagonists have fair evidence of efficacy: Mu opioid antagonist (injectable naltrexone) for relapse prevention Mu opioid antagonist (naloxone) for overdose reversal 1 Hser (2001) Arch Gen Psych 58:
35 Opioid Prescribing Increased Volkow 04/02/ Testimony
36 Case #3 62 year-old man former convicted felon in stable marriage x 12 years. Regular cannabis, tobacco, and alcohol user who became addicted to prescription opioid pain medications prescribed for chronic low back pain. Wife diagnosed with terminal cancer. Presented with suicidal ideation when he took his wife s pain medications to feed his addiction to opioids. Discussed risks/benefits of buprenorphine/naloxone for treatment of opioid use disorder. Agreed to a trial. Able to support wife through hospice care without further diversion of her medication. Negotiated her death and contentious legal battle over her estate without relapse to opioids, alcohol or cannabis. Paranoia secondary to cannabis, resolved when able to abstain from all substances except tobacco. Antipsychotic medications discontinued without recurrent paranoia. Able to control back pain with Tai Chi. 36
37 Methadone versus Buprenorphine on OUD Treatment Outcomes Outcomes Treatment Retention Positive UDT for morphine Self-reported heroin use Relative effect (95% CI) RR = 0.83 (0.75 to 0.95) SMD = ( ) SMD (-0.28 to 0.07) UDT + benzos SMD 0.10 (-0.05 to 0.25) UDT + cocaine SMD 0.05 (-0.09 to 0.18] # of studies (# participants) 11 (1391) 5 double-blind (788) 6 open-label (603) Quality of Evidence High Comments Greater retention in methadone group 8 (1027) Moderate No difference 4 (501) Moderate No difference 6 (919) Moderate No difference 6 (859) Moderate No difference Mattick RP et al: Cochrane Review 2014
38 Methadone Mu opioid agonist Usual dose: mg once daily Efficacy: 1.72 (high dose vs low dose (<60 mg) Must be administered through Federally Regulated Narcotic Treatment Program Daily clinic dosing for first 90 days Adverse reactions: Common: Constipation Drowsiness Low T Hyperalgesia Serious: Cardiac arrhythmias Sudden cardiac death
39 Methadone Precautions Contraindications Precautions Drug interactions Allergy to methadone Heart disease Head injury Sedativesnarcotics, anesthetics, benzodiazepines, phenothiazines CYP3A4 inhibitors may levelsketoconazole, erythromycin, HIV protease inhibitors
40 Buprenorphine/Naloxone (Suboxone ) Partial opioid agonist/parentally active antagonist Usual dose: 4-24 mg of buprenorphine once daily Efficacy: >8mg daily similar to methadone Prescriber must possess DATA 2000 waiver (DEA X-number) Adverse reactions: Common: Drowsiness Constipation Serious: Cardiac arrhythmia- prolongs QTc Cytolytic hepatitis
41 Buprenorphine Precautions Contraindications Precautions Drug interactions Allergies to buprenorphine or naloxone Head injury- may increase intracranial pressure CNS depression- Caution in operating heavy machinery CNS depressantsnarcotics, anesthetics, benzodiazepines, phenothiazines CYP3A4 inhibitors may levelsketoconazole, erythromycin, HIV protease inhibitors
42 Short Buprenorphine Taper versus Extended Buprenorphine Methods: Multisite randomized trial- 2-phase adaptive treatment research design 653 treatment-seeking outpatients dependent on prescription opioids Randomized to Standard Medical Management (SMM) or SMM plus counseling Phase 1: Two week stabilization, 2-week taper, 8-week post-medication follow-up Successful patients exited study; those who returned to opioid use entered Phase 2 Phase 2: Twelve week treatment, 4-week taper, 8-week post-medication follow-up Results: Phase 1: 43 of 653 (6.6%) had successful outcomes Phase 2: 177 of 360 (49%) achieved success at week 12, no group differences 31 of 360 (8.6%) maintained success 8 weeks post-medication Chronic pain did not affect outcome History of heroin use predicted poorer outcome during Phase 2 medication. Weiss R et al: Arch Gen Psychiatry 42
43 Active Buprenorphine Maintenance Improves Odds of Successful Recovery versus No Treatment Weiss R et al: 2011;Arch Gen Psych 43
44 Extended-Release Injectable Naltrexone (Vivitrol ) Mu opioid antagonist Blocks euphoria Reduces risk of overdose, if slip occurs Usual dose: Intramuscular mg/month (4 weeks) Adverse events: Nausea, abdominal cramps Muscle aches, headache Insomnia, depression, anxiety May precipitate opioid withdrawal in tolerant individuals Renders opioid pain medications ineffective Injection site reactions Adverse events (other than injection site) may be less than with oral form.
45 Improved Abstinence from Opioids and Reduced Craving with Extended-Release Naltrexone (XR-NTX) vs Placebo 2011-Krupitsky et al-lancet- 377:
46 Medications for Opioid Use Disorder Summary Methadone and buprenorphine are first-line treatment for opioid use disorders Methadone better for treatment retention Buprenorphine/naloxone more widely available Both opioid agonist therapy (OAT) medications consistently and significantly improve outcome versus placebo, no treatment, or oral naltrexone Extended-release Injectable Naltrexone Superior to placebo in double-blind, randomized clinical trial. Further research needed to directly compare to OAT Due to poor efficacy of psychosocial interventions alone and high mortality associated with opioid overdose, psychosocial interventions alone are not recommended for opioid use disorders. 46
47 Drug Overdoses- Leading Cause of Injury Deaths in US 47
48 NUMBER OF DEATHS 50,000 45,000 Major Causes of Death from Injury, MOTOR VEHICLE ACCIDENTS % CHANGE 2008 to % 40,000 35,000 30,000 SUICIDE FIREARMS + 14% -11% + 6% 25,000 DRUG POISONING 20,000 15,000 HOMICIDE -10% 10,000 5,000 1/ Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released Data for 1999 to 2012 were extracted by ONDCP on December 2, Data for 2013 are from Detailed Tables for the National Vital Statistics Report Deaths: Final Data for 2013 (December 30, 2014). 48
49 Number of Deaths Drug Poisoning Deaths Involving Opioid Analgesics, Cocaine and Heroin: United States, ,000 16,000 % CHANGE 2010 to % 14,000 12,000 10,000 8,000 6,000 4, % +18% 1/2015 2, opioid analgesic 4,030 4,400 5,528 7,456 8,517 9,857 10,92 13,72 14,40 14,80 15,59 16,65 16,91 16,00 16,23 cocaine 3,822 3,544 3,833 4,599 5,199 5,443 6,208 7,448 6,512 5,129 4,350 4,183 4,681 4,404 4,944 heroin* 1,963 1,843 1,784 2,092 2,084 1,879 2,010 2,089 2,402 3,041 3,278 3,036 4,397 5,927 8,260 Note: Not all drug poisoning deaths specify the drug(s) involved, and a death may involve more than one specific substance. The rise in in opioid deaths is related to non-pharmaceutical fentanyl (see *Heroin includes opium. Source: Centers for Disease Control and Prevention, National Center for Health Statistics [NCHS]. Multiple Cause of Death on CDC WONDER Online Database, released Data for 1999 to 2012 were extracted by ONDCP on November 20, Data for 2013 are from unpublished analysis by NCHS December 30, 2014). 49
50 Overdose Risk in Veterans Similar to US civilians, opioid overdose deaths increased among veterans from 2001 to Increase in overdose deaths correlates with increases in opioid prescribing. Variations in state level opioid prescribing correlate with variations in opioid overdose deaths (r = 0.29). Bohnert A et al: JAMA 2011;305(13): Bohnert A et al: Clin J Pain 2014;30(7):
51 Opioid Overdose Signs and Symptoms Opioid drugs activate opioid receptors in the brain and body and causes: Euphoria Pain relief Decreased bowel motility Somnolence High doses of opioid drugs can lead to: Coma Death from stopping breathing Signs of opioid overdose include: Extreme sleepiness, inability to arouse even if shaken. Snoring, gurgling sounds, labored breathing. Slow heart rate, pin point pupils Pale, clammy skin, blue lips and fingernails from lack of oxygen. 51
52 Naloxone (Evzio ) Opioid antagonist (blocker) Naloxone auto-injector (IM or SC) fast-tracked by the FDA for emergency treatment of opioid overdose for administration by laypersons. Approval was based on bioequivalence study with the naloxone syringe; no clinical safety or efficacy studies were required by the FDA. The main advantages of the naloxone auto-injector over naloxone kits include Simplicity of use; Compact size and sturdy case; A retractable needle that may reduce the risks of accidental needle sticks and reuse of the syringe for injection drug use; Potential disadvantages include restriction to IM or SC route of administration, lack of human factor testing in non-english speaking individuals. 52
53 Evzio 53
54 Naloxone Rescue Kit Contents Naloxone Rescue Kit IM Naloxone Rescue Kit Nasal
55 Conclusions Counseling plus medication more effective than counseling alone Medications save lives Imminent risk of opioid overdose death after detoxification Significantly reduced risk of mortality for alcohol Veterans with alcohol and opioid use disorders should receive medication as part of comprehensive treatment for a complex, multifactorial illness.
Medications for Alcohol and Drug Dependence Treatment
Medications for Alcohol and Drug Dependence Treatment Robert P. Schwartz, M.D. Medical Director Rschwartz@friendsresearch.org Friends Research Institute Medications for Alcohol Dependence Treatment Disulfiram
More informationUpdate 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 informationAlcohol Screening and Brief Intervention
Updatedì A POCKET GUIDE FOR Alcohol Screening and Brief Intervention Updated 2005 Edition This pocket guide is condensed from the 34-page NIAAA guide, Helping Patients Who Drink Too Much: A Clinician s
More informationBeyond 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 informationAlcohol Screening and Brief Intervention
Updatedì A POCKET GUIDE FOR Alcohol Screening and Brief Intervention Updated 2005 Edition This pocket guide is condensed from the 34-page NIAAA guide, Helping Patients Who Drink Too Much: A Clinician s
More informationMedications for Alcohol and Opioid Use Disorders
Medications for Alcohol and Opioid Use Disorders Andrew J. Saxon, M.D. Center of Excellence in Substance Abuse Treatment and Education (CESATE) VA Puget Sound Health Care System Alcohol Pharmacotherapy
More informationKaren Drexler, M.D. ALCOHOLISM AND DEPRESSION
Karen Drexler, M.D. for the DUMC Alcohol Awareness Task Force ALCOHOLISM AND DEPRESSION Overview What is major depression? What is alcohol dependence? Does depression lead to alcohol dependence? Does alcohol
More informationTreatment 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 informationSubstance Abuse Treatment. Naltrexone for Extended-Release Injectable Suspension for Treatment of Alcohol Dependence
Spring 2007 Volume 6 Issue 1 ADVISORY News for the Treatment Field Naltrexone for Extended-Release Injectable Suspension for Treatment of Alcohol Dependence What is naltrexone for extendedrelease injectable
More informationLike 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 informationMEDICATIONS USED IN THE MANAGEMENT OF SUBSTANCE USE DISORDERS
MEDIATIONS USED IN THE MANAGEMENT OF SUBSTANE USE DISORDERS Opioid Agonist Therapy (OAT) for Opioid Dependence Methadone (Dolophine, Methadose) Specialty consultation advised. Titrate carefully, consider
More informationTreatment 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 informationThe Results of a Pilot of Vivitrol: A Medication Assisted Treatment for Alcohol and Opioid Addiction
The Results of a Pilot of Vivitrol: A Medication Assisted Treatment for Alcohol and Opioid Addiction James H. Barger, MD SAPC Medical Director and Science Officer Desiree A. Crevecoeur-MacPhail, Ph.D.
More informationDeath 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 informationIntegrating 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 informationTreatment and Interventions for Opioid Addictions: Challenges From the Medical Director s Perspective
Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director s Perspective Dale K. Adair, MD Medical Director/Chief Psychiatric Officer OMHSAS 1 Treatment and Interventions for
More informationIn 2010, approximately 8 million Americans 18 years and older were dependent on alcohol.
Vivitrol Pilot Study: SEMCA/Treatment Providers Collaborative Efforts with the treatment of Opioid Dependent Clients Hakeem Lumumba, PhD, CAADC SEMCA Scott Schadel, MSW, LMSW, CAADC HEGIRA PROGRAMS, INC.
More informationNaltrexone for Opioid & Alcohol Use Disorders
Naltrexone for Opioid & Alcohol Use Disorders Reid K. Hester, Ph.D. Director, Research Division Behavior Therapy Associates, LLC Senior Science Advisor Checkup and Choices, LLC 505.345.6100 reidkhester@gmail.com
More informationAdvanced Treatment for Opioid & Alcohol Dependence. John Larson, M.D. Corporate Medical Director Gateway Foundation
Advanced Treatment for Opioid & Alcohol Dependence John Larson, M.D. Corporate Medical Director Gateway Foundation Background 41 years practicing psychiatry Last 15 in addiction medicine I ve watched a
More informationEPIDEMIC 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 informationPrior Authorization Guideline
Prior Authorization Guideline Guideline: PDP IBT Inj - Vivitrol Therapeutic Class: Central Nervous System Agents Therapeutic Sub-Class: Opiate Antagonist Client: 2007 PDP IBT Inj Approval Date: 2/20/2007
More informationApplicant Webinar for BJA s Drug Court Discretionary Grant Solicitation
Applicant Webinar for BJA s Drug Court Discretionary Grant Solicitation Cynthia Caporizzo, Senior Criminal Justice Advisor, Office of National Drug Control Policy (ONDCP) - Review of the administration
More informationOVERVIEW 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 informationOVERVIEW OF MEDICATION ASSISTED TREATMENT
Sarah Akerman MD Assistant Professor of Psychiatry Director of Addiction Services Geisel School of Medicine/Dartmouth-Hitchcock Medical Center OVERVIEW OF MEDICATION ASSISTED TREATMENT Conflicts of Interest
More informationConsiderations 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 informationOpioid 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 informationMEDICATION 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 informationFrequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction
Frequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction March 3, 2008 By: David Rinaldo, Ph.D., Managing Partner, The Avisa Group In this FAQ What medications are currently
More informationUse of Vivitrol for Alcohol and Opioid Addiction
Use of Vivitrol for Alcohol and Opioid Addiction Ken Bachrach, Ph.D. Clinical Director, Tarzana Treatment Centers, Inc. kbachrach@tarzanatc.org What is Vivitrol? An injectable from of naltrexone, which
More informationAdvances in Addiction Science and Treatment. Mady Chalk, Ph.D., MSW Treatment Research Institute November, 2014
Advances in Addiction Science and Treatment Mady Chalk, Ph.D., MSW Treatment Research Institute November, 2014 Treatment Research Research Institute, Institute, 20132012 Presentation 1. What is driving
More informationMedications Used in the Treatment of Addiction Developed by Randall Webber, MPH. Alcohol Withdrawal
Medications Used in the Treatment of Addiction Developed by Randall Webber, MPH Alcohol Withdrawal MEDICATION Long/intermediateacting benzodiazepines (e.g., chlordiazepoxide/ Librium, diazepam/valium)
More informationDependence 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 informationHow 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 informationOpioids Research to Practice
Opioids Research to Practice CRIT/FIT 2015 May 2015 Daniel P. Alford, MD, MPH, FACP, FASAM Associate Professor of Medicine Assistant Dean, Continuing Medical Education Director, Clinical Addiction Research
More informationCLINICAL POLICY Department: Medical Management Document Name: Vivitrol Reference Number: NH.PHAR.96 Effective Date: 03/12
Page: 1 of 7 IMPORTANT REMINDER This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough review and consideration of generally accepted
More informationMedication Assisted Treatment of Substance Use Disorders
Medication Assisted Treatment of Substance Use Disorders April 8, 2015 We Want To Hear From You! Type questions into the Questions Pane at any time during this presentation Patient-Centered Primary Care
More informationDidactic Series. Office-based Treatment for Substance Abuse Disorder in HIV-infected Patients. Jacqueline Tulsky, MD Pacific AETC June 26, 2014
Didactic Series Office-based Treatment for Substance Abuse Disorder in HIV-infected Patients Jacqueline Tulsky, MD Pacific AETC June 26, 2014 ACCREDITATION STATEMENT: University of California, San Diego
More informationTreatment of Opioid Dependence: A Randomized Controlled Trial. Karen L. Sees, DO, Kevin L. Delucchi, PhD, Carmen Masson, PhD, Amy
Category: Heroin Title: Methadone Maintenance vs 180-Day psychosocially Enriched Detoxification for Treatment of Opioid Dependence: A Randomized Controlled Trial Authors: Karen L. Sees, DO, Kevin L. Delucchi,
More informationMEDICATION 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 informationMedications 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 informationAlcohol Overuse and Abuse
Alcohol Overuse and Abuse ACLI Medical Section CME Meeting February 23, 2015 Daniel Z. Lieberman, MD Professor and Vice Chair Department of Psychiatry George Washington University Alcohol OVERVIEW Definitions
More informationHulpverleningsmodellen 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 informationTriage, 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 informationMedication 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 informationWhat is Addiction and How Do We Treat It? Roger D. Weiss, M.D. Professor of Psychiatry, Harvard Medical School Clinical Director, Alcohol and Drug
What is Addiction and How Do We Treat It? Roger D. Weiss, M.D. Professor of Psychiatry, Harvard Medical School Clinical Director, Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, MA
More informationBuprenorphine/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 informationNeurobiology 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 informationPrior 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 information1. 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 informationCare 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 informationHeroin. 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 informationOne 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 informationHeroin. 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 informationSystematic Review of Treatment for Alcohol Dependence
Systematic Review of Treatment for Alcohol Dependence ALCOHOL ARCUATE NUCLEUS in Hypothalamus, pituitary Beta-endorphin Dynorphin Kappa receptor Nucleus Enkephalins accumbens Delta receptor (+) Mu receptor
More informationMinimum Insurance Benefits for Patients with Opioid Use Disorder The Opioid Use Disorder Epidemic: The Evidence for Opioid Treatment:
Minimum Insurance Benefits for Patients with Opioid Use Disorder By David Kan, MD and Tauheed Zaman, MD Adopted by the California Society of Addiction Medicine Committee on Opioids and the California Society
More informationNaltrexone 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 informationAlcohol Addiction. Introduction. Overview and Facts. Symptoms
Alcohol Addiction Alcohol Addiction Introduction Alcohol is a drug. It is classed as a depressant, meaning that it slows down vital functions -resulting in slurred speech, unsteady movement, disturbed
More informationUsing Drugs to Treat Drug Addiction How it works and why it makes sense
Using Drugs to Treat Drug Addiction How it works and why it makes sense Jeff Baxter, MD University of Massachusetts Medical School May 17, 2011 Objectives Biological basis of addiction Is addiction a chronic
More informationMedication-Assisted Addiction Treatment
Medication-Assisted Addiction Treatment Molly Carney, Ph.D., M.B.A. Executive Director Evergreen Treatment Services Seattle, WA What is MAT? MAT is the use of medications, in combination with counseling
More informationOffice-based Treatment of Opioid Dependence with Buprenorphine
Office-based Treatment of Opioid Dependence with Buprenorphine David A. Fiellin, M.D Professor of Medicine, Investigative Medicine and Public Health Yale University School of Medicine Dr. Fiellin s Disclosures
More informationPolicy #: 457 Latest Review Date: December 2010
Effective for dates of service on or after January 1, 2015 refer to: https://www.bcbsal.org/providers/drugpolicies/index.cfm Name of Policy: Naltrexone (Vivitrol ) Injections Policy #: 457 Latest Review
More informationHeroin. 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 informationThese 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 informationUpdate on Buprenorphine: Induction and Ongoing Care
Update on Buprenorphine: Induction and Ongoing Care Elizabeth F. Howell, M.D., DFAPA, FASAM Department of Psychiatry, University of Utah School of Medicine North Carolina Addiction Medicine Conference
More informationMethamphetamine. 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 informationUCLA-SAPC Lecture Series March 13, 2015. Gary Tsai, M.D. Medical Director Substance Abuse Prevention and Control
UCLA-SAPC Lecture Series March 13, 2015 Gary Tsai, M.D. Medical Director Substance Abuse Prevention and Control Neurobiology 101 Neuroscience of Addiction & Recovery Medication-Assisted Treatment (MAT)
More informationThe Use of Non-Opioid Pharmacotherapies. for the Treatment of Alcohol Dependence
M00K02 Alcohol and Drug Abuse Administration Department of Health and Mental Hygiene The Use of Non-Opioid Pharmacotherapies for the Treatment of Alcohol Dependence Introduction The 2011 Joint Chairmen
More informationDrugFacts: 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 informationNew 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 informationTreatment of Prescription Opioid Dependence
Treatment of Prescription Opioid Dependence Roger D. Weiss, MD Chief, Division of Alcohol and Drug Abuse McLean Hospital, Belmont, MA Professor of Psychiatry, Harvard Medical School, Boston, MA Prescription
More informationA 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 informationMedication Assisted Treatment for Alcohol Use Disorders
Medication Assisted Treatment for Alcohol Use Disorders Jennie Wei, MD, MPH American College of Physicians New Mexico Chapter Scientific Meeting November 7, 2015 Objectives Define Alcohol Use Disorders
More informationDEVELOPING MANUFACTURING SUPPLYING. Naltrexone Implants. Manufactured by NalPharm Ltd WWW.NALPHARM.COM
DEVELOPING MANUFACTURING SUPPLYING Naltrexone Implants Background to Nalpharm NalPharm is a specialist pharmaceutical company supplying proprietary branded medications and generic drugs in the area of
More informationLearning Objectives:
Screening and Treatment for Substance Use Disorders Joseph Sakai, MD Associate Professor Division of Substance Dependence Dept of Psychiatry UCD SOM Learning Objectives: Describe the epidemiology of substance
More informationNaltrexone 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 informationHow To Treat A Drug Addiction
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 informationVIVITROL (EXTENDED-RELEASE INJECTABLE NALTREXONE) MEDICAL PROTOCOL AND PROCEDURES
VIVITROL (EXTENDED-RELEASE INJECTABLE NALTREXONE) MEDICAL PROTOCOL AND PROCEDURES INTRODUCTION This is the protocol and procedures to administer VIVITROL (extended-release naltrexone injection, or XR-NTX)
More informationReintegration. Recovery. Medication-Assisted Treatment for Alcohol Dependence. Reintegration. Resilience
Reintegration Recovery Medication-Assisted Treatment for Alcohol Dependence Reintegration Resilience 02 How do you free yourself from the stress and risks of alcohol dependence? Most people cannot do it
More informationNHS FORTH VALLEY. Guidance on Alcohol Dependence: Maintenance of Abstinence. Contact: Valerie Kippen Area Drug & Therapeutics Committee
NHS FORTH VALLEY Guidance on Alcohol Dependence: Maintenance of Abstinence Approved 06/09/2012 Version 5.0 Date of First Issue February 2008 Review Date 06/09/2014 Current Issue Date 26/11/2012 EQIA Yes
More informationUsing 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 informationTreatment 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 the
More informationMedication treatments for opioid use disorders
Medication treatments for opioid use disorders Summary for counties JUDITH MARTIN, Medical Director of Substance Use Services, San Francisco Department of Public Health Brief history of Methadone and Buprenorphine
More informationStrategies for Addressing Alcohol Dependence
Strategies for Addressing Alcohol Dependence Jennifer McNeely, MD, MS Assistant Professor NYU School of Medicine Disclosures No relevant financial relationships to disclose Current research grant support:
More informationOpioids 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 informationHeroin Overdose Trends and Treatment Options. Neil A. Capretto, D.O., F.A.S.A.M. Medical Director
Heroin Overdose Trends and Treatment Options Neil A. Capretto, D.O., F.A.S.A.M. Medical Director Type date here www.gatewayrehab.org Drug Overdose Deaths Increasing in Allegheny County Roberta Lojak holds
More informationOpiate Addiction in Ohio: An Update on Scope of Problem Ashland Ohio
Governor s Cabinet Opiate Action Team Promoting Wellness and Recovery John R. Kasich, Governor Tracy J. Plouck, Director Opiate Addiction in Ohio: An Update on Scope of Problem Ashland Ohio November 14,
More informationFrequently 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 informationSection 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 informationJoanna L. Starrels. 2 ND YEAR RESEARCH ELECTIVE RESIDENT S JOURNAL Volume VIII, 2003-2004. A. Study Purpose and Rationale
Outpatient Treatment of Opiate Dependence with Sublingual Buprenorphine/Naloxone versus Methadone Maintenance: a Randomized Trial of Alternative Treatments in Real Life Settings Joanna L. Starrels A. Study
More informationAdjunctive 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 informationUse of Pharmacotherapies by Substance Abuse Treatment Facilities
Use of Pharmacotherapies by Substance Abuse Treatment Facilities Cathie E. Alderks, PhD Substance Abuse and Mental Health Services Administration Department of Health and Human Services November 2007 1
More informationAlcohol 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 informationInformation 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 informationSource: National Institute on Alcohol Abuse and Alcoholism. Bethesda, Md: NIAAA; 2004. NIH Publication No. 04-3769.
Diagnosis and Treatment of Alcohol Dependence Lon R. Hays, MD, MBA Professor and Chairman an Department of Psychiatry University of Kentucky Medical Center Defining the Standard Drink A standard drink
More informationThe ABCs of Medication Assisted Treatment
The ABCs of Medication Assisted Treatment J E F F R E Y Q U A M M E, E X E C U T I V E D I R E C T O R C O N N E C T I C U T C E R T I F I C A T I O N B O A R D The ABCs of Medication Assisted Treatment
More informationDRUGS OF ABUSE CLASSIFICATION AND EFFECTS
Drug and Drug use DRUGS OF ABUSE CLASSIFICATION AND EFFECTS A pharmaceutical preparation or a naturally occurring substance used primarily to bring about a change in the existing process or state (physiological,
More informationReforming the Response To Substance Use: A Drug Policy for the 21 st Century
Reforming the Response To Substance Use: A Drug Policy for the 21 st Century 2015 NASADAD MEETING Charleston, SC June 2, 2015 David Mineta, Deputy Director Office of Demand Reduction Office of National
More informationIt is important that you tell your family and the people closest to you of this increased sensitivity to opioids and the risk of overdose.
MEDICATION GUIDE VIVITROL (viv-i-trol) (naltrexone for extended-release injectable suspension) Read this Medication Guide before you start receiving VIVITROL injections and each time you receive an injection.
More informationKAP Keys. For Physicians. Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment. of Opioid Addiction
Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction Knowledge Application Program KAP Keys For Physicians Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine
More informationMedicines To Treat Alcohol Use Disorder A Review of the Research for Adults
Medicines To Treat Alcohol Use Disorder A Review of the Research for Adults Is This Information Right for Me? Yes, this information is right for you if: Your doctor* said you have alcohol use disorder
More information