Treatment of Heroin Addiction in The Netherlands
|
|
- Jodie McKinney
- 8 years ago
- Views:
Transcription
1 Treatment of Heroin Addiction in The Netherlands Wim van den Brink Amsterdam Institute for Addiction Research Academic Medical Center University of Amsterdam Sixth Interdisciplinary Substitution Treatment Symposium Montreal, 3 November 1 December 26 Content General treatment principles in heroin addiction History of heroin addiction in The Netherlands History of substitution treatment in the Netherlands Current situation in The Netherlands * General treatment organization * Methadone maintenance treatment in The Netherlands * Heroin assisted treatment in The Netherlands Remaining problems and potential solutions Conclusions 1
2 Herion Addiction and General Treatment Principles 33 jaar follow-up van heroineverslaafden (Hser et al., 21) Onbekend Dood Gedetineerd Dagelijks gebruik Methadon Onregelmatig gebruik Abstinent % 2% 6% 7% 4% 48% % N Age 24.5 (3.9) 36.8 (5.4) 47.6 (5.1) 57.4 (4.) 2
3 A 33 year FU of narcotic addicts (Hser et al., 21) Unknown Dead Incarcerated Daily use MMT Occasional use Abstinence Theodore Dalrymple 22% 2% 6% 7% 4% 48% % N Age 24.5 (3.9) 36.8 (5.4) 47.6 (5.1) 57.4 (4.) Treatment Career and Treatment Goals General Model TYPE Crisis Intervention Cure Care Palliation GOAL Immediate Survival Stable Abstinence Stabilization Harm Reduction Pain Relieve PROCESS - Reanimation - Motivation - Detoxification - Relapse Prevention - Reduction Illicit Drug Use - Psychosocial Support - Provide Drug of Abuse - Support 3
4 Treatment Career and Treatment Goals Applied General Model TYPE GOAL PROCESS MEDICATION Crisis Intervention Immediate Survival - Reanimation Antagonist Cure Care Stable Abstinence Stabilization Harm Reduction - Motivation - Detoxification - Relapse Prevention - Reduction Ill Drug Use - Support Agonist tapering Part Agonist tapering Symptomatic Antagonist maintenance Agonist maintenance Part Agonist maintenance Palliation Pain Relieve - Provide Abused Drug Agonist maintenence Goals and Interventions Heroin Addiction Type Goal Process Medicine EBM Crisis Intervention Survival Reanimation - Naloxone +++ Cure Abstinence Detoxification Relapse prevention - Methadone reduction Buprenorphine reduction Clonidine/Lofexidine Naltrexone (ROD/UROD) - Naltrexone maintenance (implants/depot) ±/- Care Stabilization Harm reduction Reduction ill drug use Secundary prevention - Methadone maintenance HD LAAM Buprenorphine maintenance Methadone maintenance LD Heroin maintenance Palliation Pain relieve Provide abused drug - Methadone/Heroin na Van den Brink and Haasen, 26; Lingford-Hughes et al., 24, Vocci et al., 25; O Brien, 25 4
5 History of Heroin Addiction in The Netherlands History Heroin Addiction in NL (NL: 16.. inhabitants; Amsterdam: 75.) 1972 Introduction heroin to the Netherlands 1975 Independence of Suriname; n = 2. heroin addicts 1977 n = 1. heroin addicts 1985 n = 2. heroin addicts 1985 HIV introduction to the Netherlands 1995 n = 25. heroin addicts: 4% injectors, 6% smokers 26 n = 25. heroin addicts: 1% injectors, 9% smokers 5
6 Heroin Addicts in Amsterdam (GGD Amsterdam, 25; number ) Age Heroin Addicts in Amsterdam (GGD Amsterdam, 25: 28 yrs 45 yrs, i.e. 17 yrs within 2 years) Heroin addicts = stable, ageing population with few new cases and relatively low mortality 6
7 Mortality Heroine Addicts Amsterdam (GGD Amsterdam, 25) Mortality per 1 MMT patients/year Survival rates heroin addicts (and smokers) Mortality and excess mortality increase with time/age; 5% ever IDU die before 55 Excess mortality among heroin inhalers much lower and LTE better demand for care! History of Substitution Treatment in The Netherlands 7
8 History Substitution Tx in NL 1968 Introduction methadone for Tx of morphine addiction 1972 Introduction of heroin to the Netherlands Methadone reduction and methadone maintenance Experiment with Morphine i.v. (n=37) 1985 Introduction HIV to the Netherlands Low Threshold MMT (low dosages, no sanctions) Experiment with Methadone i.v. (n=3 AIDS patients) Experiment Dextramoramide p.o. (n=53) Experiment High Methadone Doses (n=225: >85 mg/day) Experiment Heroin Assisted Treatment (n=549) Routine treatment with MMT and HAT 26 Registration heroin as a medicinal product? 27 Registration Suboxone as a medicinal product? Substitution Tx coverage in EU (EMCDDA, 22) high estimate low estimate UK POR NOR FIN SWE AUS IT DK GER IRL BE LUX FR NL SP Since
9 Available Treatments in Europe (EMCDDA, 25) Agonist Maintenance Tx in Europe (EMCDDA, 25) In methadone Tx In buprenorphine Tx In substitution Tx Total opioid addicts
10 Methadone Maintenance in Europe (EMCDDA, 23) CEECs = Central and East European Countries Assistance Drug Users Prison in EU (EMCDDA, 22) HIV prevention substitution drug free UK POR NOR FIN SWE AUS IT DK GER IRL BE LUX FR NL SP 1
11 Current Situation in The Netherlands General Treatment Organization Methadone Maintenance Treatment Heroin Assisted Treatment Current Situation in The Netherlands General Treatment Organization Methadone Maintenance Treatment Heroin Assisted Treatment 11
12 General Treatment Organization Netherlands: 16.. inhabitants (41. km 2 ); 25. heroin addicts BNP = 5 billion Health Care Spending 45 billion (9% BNP) Canada: 32.. inhabitants (1.. km 2 ); 9. opioid addicts BNP = 85 billion Health Care Spending 1 billion (12% BNP) Organization Treatment Services 14 regional addiction treatment centers 6. patients in treatment/year 17. heroin addicts in treatment/year Increasing integration addiction and mental health services 12
13 Financial Aspects Treatment Netherlands: BNP = 5 billion 45 billion spent on health care per year (9% 1%) 3.6 billion spent on mental health care per year (8%) 35 million spent on addiction treatment services per year (.8%) 175 million spent on drug addiction treatment per year (.4%) 5 million spent on MMT and 6 million spent on HAT Current Situation in The Netherlands General Treatment Organization Methadone Maintenance Treatment Heroin Assisted Treatment 13
14 Substitution Tx coverage in EU (EMCDDA, 22) high estimate low estimate UK POR NOR FIN SWE AUS IT DK GER IRL BE LUX FR NL SP Since 1968 Methadone dosages NL 24 (LADIS/IVZ, 24) 62% with dosages < 6 mg/day 14
15 Substitution Tx coverage EU (EMCDDA, 22) Amsterdam high estimate low estimate Coverage Amsterdam 7% UK POR NOR FIN SWE AUS IT DK GER IRL BE LUX FR NL SP since 1968 Heroin Addicts in Amsterdam (Capture-Recapture: GGG Amsterdam, 25: ) Buitenlanders NL Allochtoon NL Autochtoon
16 Methadone Tx in Amsterdam (GGD Amsterdam, 25: ) Jellinek GP GGD Jellinek GP GGD MMT Dosages and Compliance (GGD Amsterdam, 25) mg/day mg/day GGD GP Jellinek 54% < 6 mg/day 69% < 6 mg/day 57% < 6 mg/day Compliance better with higher dosages 16
17 IDU, HIV and NE in Amsterdam (GGD Amsterdam, 25) Number of new HIV cases over time Number of exchanged needles x 1. Reductions in IV drug use and prevention measures seem to lead to a lower HIV incidence and reductions in needles exhanged; HIV prelalence Amsterdam = 7% Treatment Heroin Addicts in The Netherlands TOTAL N=24, 15% injectors, 85% smokers In Treatment N=17, Not in Treatment N=7, METHADONE MAINTENANCE N=12,5 DRUGFREE TREATMENT N=4, Integrated N=4,5 Not Integrated N=5, Extremely Problematic N=3, 17
18 Health Council of the Netherlands (1995) Continuation existing programmes * drugfree, methadone reduction, methadon maintenance Improving liaison between legal and treatment system * diversion, drugfree prison programmes Ultrarapid detoxification with/without anesthesia High dosage methadone maintenance Controlled medical prescription of heroin Ultrarapid NTX Assisted Detox (De Jong et al., 25) 24% of patients successfully detoxified with NTX were still abstinent 12 months later Very selective group with no polydrug use and good social integration 18
19 Health Council of the Netherlands (1995) Continuation existing programmes * drugfree, methadone reduction, methadon maintenance Improving liaison between legal and treatment system * diversion, drugfree prison programmes Ultrarapid detoxification with/without anesthesia High dosage methadone maintenance Controlled medical prescription of heroin High dosages of Methadone (Driessen et al., submitted) RCT N=225 Baseline methadone dose: 53 mg/day Exp = > 85 mg/day mean 12 mg/day after 22 months Con = < 85 mg/day mean 66 mg/day after 22 months Daily Illegal Heroin * High Dose 56% 17% - 39% * Low Dose 5% 31% -19% High dose group also better in physical functioning 19
20 Health Council of the Netherlands (1995) Continuation existing programmes * drugfree, methadone reduction, methadon maintenance Improving liaison between legal and treatment system * diversion, drugfree prison programmes Ultrarapid detoxification with/without anesthesia High dosage methadone maintenance Controlled medical prescription of heroin Current Situation in The Netherlands General Treatment Organization Methadone Maintenance Treatment Heroin Assisted Treatment 2
21 Basic Principles Dutch Heroin Trials Separate RCTs for inhalable and intravenous heroin Explicit inclusion and exclusion criteria Standardized assessment procedures Pre-defined measure of effect + pre-specified analysis plan Adequate statistical power Quality assurance according to GCP Design of the Study Phase 1 2 months Randomization Phase 2a 6 months Phase 2b 6 months Phase 3 6 months Target Group 1. Inhaling M (N=375) 1A (N=135) 1B (N=115) 1C (N=125) M M+H (inh) M M M+H (inh) M+H (inh) M+H (inh) appropriate appropriate 2. Injecting M (N=25) 2A (N=135) 2B (N=115) M M+H (iv) M M+H (iv) M+H appropriate M=oral methadone; H=heroin; inh=inhalable; iv=intravenous 21
22 Experimental and Control Treatment Control Treatment oral methadone < 15 mg/day standard psychosocial offer Experimental Treatment oral methadone < 15 mg/day standard psychosocial offer heroin inhalable or intravenous: * -7 days/week * -3 times/day * < 4 mg/administration * < 1 mg/day dosages individually titrated no prescription of other illicit drugs Inclusion and Exclusion Criteria chronic, treatment-resistant heroin addicts Inclusion Criteria Exclusion Criteria DSM-IV heroin dep > 5 yrs registered in MMT last 12 mths >3-5 visits to MMT last 6 mths >5-6 mg meth > 4 wks last 5 yrs (nearly) daily use of heroin poor social integration and/or poor physical and/or mental health age > 25 yrs legal resident in The Netherlands registered in area > 3 yrs willing to be randomized written informed consent not meeting ALL inclusion criteria illness with high safety risk illness or behaviour likely to interfere with study completion pregnant or lactating awaiting long imprisonment other drugs dominating heroin dep short life-time expectancy voluntary abstin > 2 mths past yr requiring > 15 mg oral methadone requiring > 1 mg heroin participating in other study 22
23 Patient Characteristics Age 39 years Female patients 19 % Dutch/Western 86 % Heroin 16 years 26 days Methadone 12 years 29 days Cocaine 1 years (92%) 18 days (86%) Poly drug use 17 years 29 days Physical problems 66 % Psychiatric problems 6 % Social problems 72 % Participation in the trial Injectable heroin: 174 patients randomized (25 planned) Inhalable heroin: 375 patients randomized (375 planned) Injectable heroin: 93% month 12 endpoint assessments Inhalable heroin: 94% month 12 endpoint assessments 23
24 Response definition 4% improvement in physical health or 4% improvement in mental status or 4% improvement in social functioning and no serious deterioration (4% in any domain) and no increase in cocaine (or other drug) use FILM 24
25 Heroin Assisted Treatment in The Netherlands Van den Brink et al. 23, BMJ 1% 12 months methadone 12 months methadone + heroin percentage responders 8% 6% 4% 2% OR= OR= % injectable heroin inhalable heroin percentage multi-domain responders 1% 8% 6% 4% 2% % Effectiveness of heroin assisted traetment multi-domain responders 1 domain 2 domains 3 domains =25% = 23% 32% 57% 25% 48% 5 27 methadone heroin methadone heroin injectable heroin inhalable heroin 25
26 Changes among Responders 2 physical health 1 mental status M A P - HSS score SCL- 9 score = baseline = 12 months 3 illegal activities 3 no contact non-drug users 3 cocaine use num ber of days num ber of days num ber of days Discontinuation completers 217 responders 115 (53%) deteriorated responders 94 (82%) 26
27 Changes among deteriorated responders 2 physical health 1 mental status M A P - HSS score SCL-9 score = baseline = 12 months = 14 months 3 illegal activities 3 no contact non-drug users 3 cocaine use num ber of day s num ber of days num ber of days Long-term course responders (24 months: n = 128; 36 months: n = 95; 48 months: n = 79) MAP-HSS score physical health S CL-9 score mental status = baseline = 12 month exp = 24 months nat = 36 months nat = 48 months nat 3 illegal activities 3 no contact non-drug users 3 cocaine use num ber of day s num ber of day s num ber of day s
28 Cost-Effectiveness HA Treatment Dijkgraaf et al, 25, BMJ Type of Costs M+H Difference M Medical Maintenance Other Health Care Juridical Police, prosecution, jail Damage Victims: persons, companies Total Difference Cost-Effectiveness HA-Treatement Dijkgraaf et al (25), BMJ Better and More Expensive Better and Cheaper Better and Cheaper Cost-Effectiveness Plane 28
29 Current Situation and Plans HAT Approximately 3 patients in 6 cities in HA treatment Registration file for injectable and inhalable heroin under review at Dutch registration authority Approved plans for extension of HA treatment to 8 patients in cities RCT contingency management within contexts of HA treatment to further reduce cocaine abuse and to enhance treatment effectiveness Application for Registration 29
30 heroin assisted treatment units in the Netherlands old centres new centres planned centres 5-7 patients 25-5 patients 25-3 patients Contingency Management Cocaine Heroin-treatment + CM Heroin-treatment alone Experimental group Heroin-treatment randomisation Heroin-treatment alone Heroin-treatment + CM Control group Heroin-treatment Naturalistic comp. group 3
31 Contingency Management Cocaine Contingency Management Cocaine 31
32 Treatment Goals and Modalities in NL Therapeutic Residential Community Treatment ABSTINENCE ORIENTED Inpatient DETOX Psychiatric 4 5 Treatment Drug Free Prison Treatment (VOL) Outpatient Drug Counseling Outpatient DETOX Methadone Reduction Employment Training VOLUNTARY Employment Training 12 5 Methadon Maintenance Budgeting Diversion Motivation Centre Day Care Night Care Needle Exchange Heroin Maintenance HARM Methadone in Prison USER ROOMS REDUCTION Prison TC Drug Free Prison Treatment (COM) Forensic Drug Abuse Treatment COMPULSORY Treatment Goals and Modalities VOLUNTARY ABSTINENCE ORIENTED HARM REDUCTION COMPULSORY 32
33 Agonist treatment and the risk of increased incidence Nordt & Stohler, Lancet, 26 MMT HAT The harm reduction policy of Switzerland and its emphasis on the medicalisation of the heroin problem seems to have contributed to the image of heroin as unattractive for young people. Remaining Problems and Potential Solutions 33
34 Conclusions and Remaining Issues Heroin Addiction Treatment Conclusions Detoxification without RP useless and dangerous Antagonist treatments have very high drop-out rates Naltrexone assisted detox with anesthesia useless and dangerous Maintenance treatments are much more effective than tapering regimens Remaining issues Efficacy heroine, methadone iv, and morphine SR? No consensus about treatment of pregnant heroin addicted women Patient-Treatment Matching unresolved Attention Comorbid drug use Comorbid psychiatric disorders Comorbid somatic disorders Treatment of Drug Addicts in NL (LADIS/IVZ, 25) Opiaten Cocaine Amfetamine Cannabis Reduction heroin, strong increase cocaine, increase cannabis 34
35 Treatment Seeking Cocaine (LADIS?IVZ, 24) 24% Snorting 76% Base Coke/Crack 56% Cocaine + Heroine Beyond Heroin Addiction - Beyond MMT Comorbid drug use (Gossop, 24) Stimulant use 4-9%, stimulant dependence 4-8% Alcohol use 9%, alcohol dependence 2-4% Cannabis use 5-75%, cannabis dependence 1-2% Comorbid psychiatric disorders (Kranzler & Tinsley, 24) Depression 25-4% ADHD 15-2% Psychosis 5-1% Comorbid physical ailments (Sullivan & O Connor, 24) HIV 5-35%; HCV 5-9% Comorbid social problems Housing 35
36 MMT and Comorbid Substance Use Alcohol use 9%, alcohol dependence 2-4% Stimulant use 4-9%, stimulant dependence 4-8% Cannabis use 5-75%, cannabis dependence 1-2% MMT and Alcohol Use/Dependence Findings Alcohol dependence in MMT often is associated with lower abstinence levels from illicit opioids (Gossop et al., 22), with increased levels of criminality (Roszell et al., 1986), and increased risk of a fatal overdose (Darke et al., 1996) BUT Alcohol dependence in MMT sometimes associated with higher heroin abstinence and with increased use of cocaine (Chatham et al., 1997). Primary cocaine dependence? Conclusion Integrated treatment necessary with attention for heroin, stimulant and alcohol dependence (Kipnis et al., 21) Alcohol treatment through CM, CBT, CRA (including disulfiram)? 36
37 MMT and Cocaine Use/Dependence Comorbid cocaine use is a negative predictor for the effect of MMT on illicit opioid use (e.g. Wasserman et al., 1998) MMT is more effective than BMT in patients with comorbid cocaine use: better retention, larger reductions of both illicit opioids and cocaine (Schottenfeld et al., 25; Strain et al., 1994) Inconsistent findings with regard to the effect of higher dosages of methadone or buprenorphine on illicit cocaine use: pos. Peles et al., 26; neg. Schottenfeld et al Positive effects of CM and CBT on illicit heroin and/or cocaine use during MMT (e.g. Silverman et al., 1996, 1999; Rawson et al., 22; Schottenfeld et al., 25; Poling et al., 26; Pierce et al., 26). Positive effects of bupropion, modafinil and disulfiram on cocaine use? Schottenfeld et al., 25 MMT vs BMT with/without CM: retention drug-free urines Treatment retention/reduction drug use better in METH than BUP; short-term effect CM 37
38 Schottenfeld et al, 25 MMT vs BMT with/without CM: cocaine-free urines Positive short-term effects of CM (during increase incentives), but no long-term effects of CM Silverman et al Effect of CM voucher magnitude on cocaine use in MMT max 3 max 3 max CM effective but expensive 38
39 Pierce et al. (26) MMT with/without CM (low-cost/lottery: $ 12/pt) on stimulant and alcohol 39
40 Rawson et al. (22) MMT with/without 16 weeks CM and/or CBT directed at cocaine use 8 7 % of cocaine-free urine samples CBT CM CBT + CM MMT alone weeks 26 weeks 52 weeks CM more short-term effective, CBT more long-term effective MMT and Cannabis Use/Dependence Findings: Most studies show no negative effect of (heavy) cannabis use on retention and outcome in MMT/BMT with or without CM * Saxon et al., 1993; Nirenberg et al., 1996; Budney et al., 1998; Epstein & Preston, 23 Conclusion Cannabis use needs not be a focus of attention from the point of view of MMT. It may be focus in and by itself. 4
41 Epstein & Preston (Addiction, 23) All 3 studies in MMT + CM directed to either illicit opioid or cocaine use % neg urines for targetd drug No effect of (heavy) cannabis use on retention or perc drug-free targets of MMT+CM MMT and Comorbid Mental Disorders Double Trouble Depression 25-4% ADHD 15-2% Psychosis 5-1% 41
42 MMT and Depression Chronic opioid use seems to lead to depression and depression seems to increase opioid use Comorbid depression is a negative predictor in MMT (McLellan et al., 1983, 1997) SSRIs (fluoxetine, sertraline) are not effective in Tx of depression in MMT patients (Petrakis et al., 1998; Dean et al, 22; Carpenter et al., 24) Tricyclics (doxepin, imipramine) might be effective in Tx of depression in MMT patients (Woody et al., 1975; Nunes et al., 1998) Nunes et al. (1998) RCT Imipramine vs Placebo in Depressed MMT patients Imipamine effective for depression (57% vs 7% response), no difference in drug use outcomes 42
43 MMT and ADHD Effect of ADHD on MMT outcome not consistent (Schubiner et al., 2) Methylphenidate reduced effect on ADHD Sx in cocaine dependent patients, and no effect on cocaine use is inconsistent (Levin et al., 1998; Schubiner et al., 22; Carpentier et al., 25) No indications of abuse of prescribed (exetende release) stimulants in addicted patients with ADHD. Methylphenidate and bupropion are NOT affective in the Tx of MMT patients with ADHD (Levin et al., 26) Psycho-education plus higher dosages of methylphenidate or dexamphetamine? Levin et al. (26) Placebo, Methylphenidate, and Bupropion in MMT patients with ADHD No effect of MPH or BRP on ADHD Sx or drug use indicators 43
44 MMT and Schizophrenia Classical anti-psychotics often less effective in schizophrenic patients with substance use disorders and no or negative effect on substance abuse (e.g. Bowers et al., 199; Sokolsky et al., 1994; D Mello et al., 1995; Swofford et al., 2) Atypical anti-psychotics (risperidone, olanzapine, clozapine) generally have a normal positive effect on schizophrenic Sx and sometimes on substance abuse (e.g. Buckley et al., 1994; Kelly et al., 23; Conley et al., 1998; Littrell et al., 21; Albanes et al., 21). Some indications for superiority of clozapine over other atypical antipsychotics (Zimmet et al., 2; Green et al., 23; Brunette et al., 26). Cave epileptic seizures! Integrated psychosocial treatments reduce drug use in patienst with schizophrenia (Barrowclough et al., 21; Bellack et al., 26) Bellack et al. (26) RCT 6 months Integrated vs Separate Substance Abuse Program (no data available in MMT) Intregated program results in better retention and greater reduction of drug use 44
45 Conclusions Conclusions Abstinence oriented Txs are relatively ineffective and should be reserved for small group of stable, well-functioning opioid addicts. MMT is the best studied and most effective first line Tx Not all patients respond favorably to MMT, but other opioid agonists (BUP, SROM, HAT) are good alternatives in these patients Prison = window of opportunity for harm-reduction and maintenance Tx. Agonist maintenance Tx should always be combined with * psychosocial support, CM or CBT if indicated, and * attention to polydrug use, and mental, somatic and social omorbidity 45
46 Selected References van den Brink W, Hendriks VM, van Ree JM (1999) Medical co-prescription of heroin to chronic, treatment-resistant methadone patients in the Netherlands: a randomized clinical trial. Journal of Drug Issues, 29, van den Brink W, Hendriks VM, Blanken P, van Zwieten BJ, van Ree JM (23) Medical prescription of heroin to chronic, treatment-resistant heroin dependent patients: two randomised controlled trials. BMJ, 327, Dijkgraaf MGW, van der Zanden BP, Borgie CAJM, Blanken P, van Ree JM, van den Brink W (25) Cost utility of medical co-prescription of herroin compared with methadone maintenance treatment for chronic, treatment resistant heroin addicts. BMJ, 33, van den Brink W, Haasen C (26) Evidence-based treatment of opioid dependent patients. Canadian Journal of Psychiatry, 51, w.vandenbrink@amc.uva.nl 46
Medical Prescription of Heroin the Dutch trial in the context of a developing treatment system
Medical Prescription of Heroin the Dutch trial in the context of a developing treatment system Wim van den Brink, MD PhD Vincent M Hendriks, PhD Peter Blanken, MA Jan M van Ree, MSc PhD Central Committee
More informationheroin-assisted treatment
results from more than 10 years (inter-) national research Peter Blanken Mexico 14-16 February 2012 Central Committee on the Treatment of Heroin Addicts (CCBH) Parnassia Addiction Research Centre (PARC),
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 informationheroin-assisted treatment
heroin-assisted treatment how to start the debate, with whom? Peter Blanken Central Committee on the Treatment of Heroin Addicts (CCBH) Parnassia Addiction Research Center (PARC) Městská a lokální protidrogová
More informationNon medical use of prescription medicines existing WHO advice
Non medical use of prescription medicines existing WHO advice Nicolas Clark Management of Substance Abuse Team WHO, Geneva Vienna, June 2010 clarkn@who.int Medical and Pharmaceutical role Recommendations
More 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 informationOral Morphine Treatments (in opioid dependence)
Oral Morphine Treatments (in opioid dependence) Gabriele Fischer gabriele.fischer@meduniwien.ac.at Medical University Vienna Biarritz oct 10th, 2013 Conflict of Interest Reckitt Benckiser/Shering Plough
More informationHow To Understand The Benefits Of Heroin Assisted Treatment
Les rencontres de Biarritz ATHS 12 29.09. 02.10.2015 The role and function of heroin-assisted treatment at the system level Ambros Uchtenhagen Swiss Research Institute for Public Health and Addiction WHO
More informationDevelopments in the Norwegian overdose situation
Developments in the Norwegian overdose situation Thomas Clausen Professor (Dr. med) thomas.clausen@medisin.uio.no 16.-18. October 2013 Agenda The overdose-situation Development and trends National responses
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 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 informationDeveloping Medications to Treat Addiction: Implications for Policy and Practice. Nora D. Volkow, M.D. Director National Institute on Drug Abuse
Developing Medications to Treat Addiction: Implications for Policy and Practice Nora D. Volkow, M.D. Director National Institute on Drug Abuse Medications Currently Available For Nicotine Addiction Nicotine
More informationTreatments for drug misuse
Understanding NICE guidance Information for people who use NHS services Treatments for drug misuse NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases and
More informationPowder speed, whiz, velocity - Usually snorted, ingested or injected
Dr Christine Watson Powder speed, whiz, velocity - Usually snorted, ingested or injected -most common -Approximately 10% purity -Generally produced locally Sticky/oily/waxy form Base, paste, point, pure,
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 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 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 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 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 informationImpact of Systematic Review on Health Services: The US Experience
Impact of Systematic Review on Health Services: The US Experience Walter Ling MD Integrated Substance Abuse Programs (ISAP) UCLA The effectiveness of interventions for addictions: The Drug and Alcohol
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 informationEPIDEMIOLOGY OF OPIATE USE
Opiate Dependence EPIDEMIOLOGY OF OPIATE USE Difficult to estimate true extent of opiate dependence Based on National Survey of Health and Mental Well Being: 1.2% sample used opiates in last 12 months
More informationIntegrated Dual Disorder Treatment
Integrated Dual Disorder Treatment In a (Dutch) rapid changing environment Strasbourg May 2010 Bas van der Hoorn b.van.der.hoorn@palier.nl Who s talking? Psychiatrist Head of dual diagnosis treatment facility
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 informationJennifer Sharpe Potter, PhD, MPH Associate Professor Division of Alcohol and Drug Addiction Department of Psychiatry
Buprenorphine/Naloxone and Methadone Maintenance Treatment Outcomes for Opioid Analgesic, Heroin, and Combined Users: Findings From Starting Treatment With Agonist Replacement Therapies (START) Jennifer
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 informationPutting Addiction Treatment Medications to Use: Lessons Learned
Putting Addiction Treatment Medications to Use: Lessons Learned George E. Woody, M.D. Laura McNicholas, M.D., Ph.D. Department of Psychiatry, University of Pennsylvania School of Medicine and Philadelphia
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 informationSROM (oral morphine) an add on medication for the treatment of opioid dependence: risks & benefits. Gabriele Fischer. Medical University Vienna
ATHS Biarritz oct 1 th, 2015 SROM (oral morphine) an add on medication for the treatment of opioid dependence: risks & benefits Gabriele Fischer gabriele.fischer@meduniwien.ac.at Medical University Vienna
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 informationTo detox or not to detox: whose choice is it anyway? Dr Ed Day Senior Lecturer in Addiction Psychiatry University of Birmingham
To detox or not to detox: whose choice is it anyway? Dr Ed Day Senior Lecturer in Addiction Psychiatry University of Birmingham What do people say they want? Luty J (2004) 104 people attending a community
More informationAddiction Pharmacotherapies in Integrated Systems OPIOIDS
Addiction Pharmacotherapies in Integrated Systems OPIOIDS Univ. Prof. Dr.. Gabriele Fischer Department of Psychiatry Addiction clinic Medical University Vienna DELIVERY SYSTEMS FOR SUBSTANCE ABUSE TREATMENT
More informationIN THE GENERAL ASSEMBLY STATE OF. Ensuring Access to Medication Assisted Treatment Act
IN THE GENERAL ASSEMBLY STATE OF Ensuring Access to Medication Assisted Treatment Act 1 Be it enacted by the People of the State of Assembly:, represented in the General 1 1 1 1 Section 1. Title. This
More informationBuprenorphine: what is it & why use it?
Buprenorphine: what is it & why use it? Dr Nicholas Lintzeris, MBBS, PhD, FAChAM Locum Consultant, Oaks Resource Centre, SLAM National Addiction Centre, Institute of Psychiatry Overview of presentation
More informationReaching the Hardest to Reach Treating the Hardest-to-Treat
Reaching the Hardest to Reach Treating the Hardest-to-Treat Summary of the Primary Outcomes of the the North American Opiate Medication Initiative (NAOMI) The NAOMI Study Team October 17, 2008 NAOMI Summary
More informationdrug treatment in england: the road to recovery
The use of illegal drugs in England is declining; people who need help to overcome drug dependency are getting it quicker; and more are completing their treatment and recovering drug treatment in ENGlaND:
More informationResources for the Prevention and Treatment of Substance Use Disorders
Resources for the Prevention and Treatment of Substance Use Disorders Table of Contents Age-standardized DALYs, alcohol and drug use disorders, per 100 000 Age-standardized death rates, alcohol and drug
More informationPain, 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 informationJohn R. Kasich, Governor Orman Hall, Director
John R. Kasich, Governor Orman Hall, Director 2 3 Epidemics of unintentional drug overdoses in Ohio, 1979-2011 1,2,3 1800 1600 1400 1200 1000 800 Prescription drugs are causing a larger overdose epidemic
More informationPsychosocial interventions in pharmacotherapy of opioid dependence: a literature review
Psychosocial interventions in pharmacotherapy of opioid dependence: a literature review Professor D. Colin Drummond Miss Katherine Perryman Section of Addictive Behaviour, Division of Mental Health St
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 informationOutcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlandsadd_2754 300..
RESEARCH REPORT doi:10.1111/j.1360-0443.2009.02754.x Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlandsadd_2754 300..308 Peter Blanken
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 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
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 1-800-662-HELP(4357)
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 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 informationTreatment of Methamphetamine Dependence: A brief overview
Treatment of Methamphetamine Dependence: A brief overview Richard A. Rawson, Ph.D Adjunct Associate Professor Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine University
More informationHeroin Addicted Offenders. Centre for Clinical Research
Legally Coerced Treatment for Heroin Addicted Offenders Wayne Hall and Jayne Lucke University of Queensland Centre for Clinical Research Outline What is legally coerced addiction treatment? Case for such
More informationMedical 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 informationMedications 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 informationOpioid Addiction & Corrections
Opioid Addiction & Corrections Medication Assisted Treatment in the Connecticut Department of Correction April 30, 2015--CJPAC Kathleen F. Maurer, MD, MPH, MBA Medical Director and Director of Health and
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 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 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 informationTENNESSEE 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 informationDMRI Drug Misuse Research Initiative
DMRI Drug Misuse Research Initiative Executive Summary Dexamphetamine Substitution as a Treatment of Amphetamine Dependence: a Two-Centre Randomised Controlled Trial Final Report submitted to the Department
More informationHeroin & injecting rooms
Heroin & injecting rooms Tom Carnwath Sheffield 2003 Parliamentary committee 2002 We recommend that an evaluated pilot programme of safe injecting houses for heroin users is established without delay.
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 informationTreatment of Opioid Use Disorders in Jails and Prisons Why, When, and How
Treatment of Opioid Use Disorders in Jails and Prisons Why, When, and How Kevin Fiscella, MD, MPH Professor, Family Medicine, Public Health Sciences, Community Health University of Rochester School of
More informationPrescriber Behavior, Pain Treatment and Addiction Treatment
Prescriber Behavior, Pain Treatment and Addiction Treatment Mary Fleming, M.S. Director, Office of Policy, Planning, and Innovation Substance Abuse and Mental Health Services Administration NGA Policy
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 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 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 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 informationTreatment for Addiction in the Community Reduces Drug Use, Crime and Recidivism
Treatment for Addiction in the Community Reduces Drug Use, Crime and Recidivism Richard A. Rawson, Ph.D, Professor Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine University
More informationThe story of drug treatment
EFFECTIVE TREATMENT CHANGING LIVES www.nta.nhs.uk www.nta.nhs.uk 1 The story of drug treatment The use of illicit drugs is declining in England; more and more people who need help with drug dependency
More informationHelping physicians diagnose and treat addiction to prescription drugs
Helping physicians diagnose and treat addiction to prescription drugs Adam Bisaga M.D. Division on Substance Abuse New York State Psychiatric Institute, New York, USA Clinical Pharmacology Leading medication
More informationDevelopment of the guidelines on the pharmacotherapy of addiction case study Croatia
Development of the guidelines on the pharmacotherapy of addiction case study Croatia Croatia Marina Kuzman Dragica Katalinic Croatian National Institute of Public Health Cyprus, 2009. Drug use and drug
More informationThe VEdeTTE cohort study: Effectiveness of treatments for heroin addiction in retaining patients and reducing mortality
The VEdeTTE cohort study: Effectiveness of treatments for heroin addiction in retaining patients and reducing mortality Federica Vigna-Taglianti www.oed.piemonte.it Piedmont Centre for Drug Addiction Epidemiology
More informationUsing Buprenorphine in an Opioid Treatment Program
Using Buprenorphine in an Opioid Treatment Program Thomas E. Freese, PhD Director of Training, UCLA Integrated Substance Abuse Programs Director, Pacific Southwest Addiction Technology Transfer Center
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 informationCannabis treatment in the Netherlands
Improving Mental Health by Sharing Knowledge Cannabis treatment in the Netherlands Margriet van Laar, PhD Head Drug Monitoring department EMCDDA meeting European exchange on the policies and practices
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 informationOpioid/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 informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE SPECIAL HEALTH AUTHORITY TENTH WAVE WORK PROGRAMME DRUG MISUSE. Psychosocial interventions in drug misuse
Attachment B NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE SPECIAL HEALTH AUTHORITY TENTH WAVE WORK PROGRAMME DRUG MISUSE Psychosocial interventions in drug misuse On 16 th June 2004 the Department of Health
More informationH-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 informationCo-morbid physical disorders e.g. HIV, hepatitis C, diabetes, hypertension. Medical students will gain knowledge in
1.0 Introduction Medications are used in the treatment of drug, alcohol and nicotine dependence to manage withdrawal during detoxification, stabilisation and substitution as well as for relapse prevention,
More informationTREATMENT-RESISTANT DEPRESSION AND ANXIETY
University of Washington 2012 TREATMENT-RESISTANT DEPRESSION AND ANXIETY Catherine Howe, MD, PhD University of Washington School of Medicine Definition of treatment resistance Failure to remit after 2
More informationThe 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 informationADVANCED 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 informationPredictors of Substance Abuse Treatment Engagement among Rural Appalachian Prescription Drug Users
Predictors of Substance Abuse Treatment Engagement among Rural Appalachian Prescription Drug Users Jennifer R. Havens, PhD, MPH Carrie B. Oser, PhD Carl G. Leukefeld, PhD Study Objective The objective
More informationOpioid Agonist Therapy: The Duration Dilemma Edwin A. Salsitz, MD, FASAM Mount Sinai Beth Israel, New York, NY March 10, 2015
Q: I have read 40 mg of methadone stops withdrawal, so why don t we start at 30mg and maybe later in the day add 10mg? A: Federal Regulations stipulate that 30mg is the maximum first dose in an Opioid
More informationREVIEW OF DRUG TREATMENT AND REHABILITATION SERVICES: SUMMARY AND ACTIONS
REVIEW OF DRUG TREATMENT AND REHABILITATION SERVICES: SUMMARY AND ACTIONS 1. INTRODUCTION 1.1 Review Process A Partnership for a Better Scotland committed the Scottish Executive to reviewing and investing
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 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 informationCharacteristics Table for The Clinical Question: Intensities of multimodal care packages
Drug misuse psychosocial (full guideline) Appendix 14e 1 Characteristics Table for The Clinical Question: Intensities of multimodal care packages 04/01/2007 18:18:00 Comparisons Included in this Clinical
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 informationIssues around Naltrexone Implants
Issues around Naltrexone Implants Dr Lucy Cockayne Consultant Addiction Psychiatrist. Lanarkshire Primary Care Trust Maintenance with antagonists? the great disproportion seen in favour of programmes with
More informationBuprenorphine Therapy in Addiction Treatment
Buprenorphine Therapy in Addiction Treatment Ken Roy, MD, FASAM Addiction Recovery Resources, Inc. River Oaks Hospital Tulane Department of Psychiatry www.arrno.org Like Minded Doc What is MAT? Definition
More informationFRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma
FRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma Background A growing opiate abuse epidemic has highlighted the need for effective treatment options. This study documents
More information24 Elisad annual meeting Arezzo 11-13 October 2012
24 Elisad annual meeting Arezzo 11-13 October 2012 From addiction to consumption: The evolution of the phenomenon and the interventions of services The big change:back to the late 90 and the zero decade
More informationTriage, 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 informationAdoption of medication treatment for adolescent and young adult opioid dependence
Adoptionofmedicationtreatmentforadolescent andyoungadultopioiddependence 1,2 1 MarcFishman,LawangeenKhan,ShannonGarrett1,LawrenceO Neill1, LaurenHiken1,SyedShah1,AsadBokhari1 1.MountainManorTreatmentCenter
More informationThe German project of heroin assisted treatment of opiate dependent patients. Short description of the study design
The German project of heroin assisted of opiate dependent patients Short description of the study design The German project of heroin assisted of opiate dependent patients addresses drug addicts who were
More informationDiscontinuation: Involuntary Discharge
Discontinuation: Involuntary Discharge TYPICALLY A PROCESS NOT AN EVENT Objectives 2 Review indications for discharge. Develop a therapeutic approach, in the context of the nature of Substance Use Disorders.
More informationThe prevalence of use of psychotropic drugs, buprenorphine and methadone on the streets, the polyuse of substances in Finland
The prevalence of use of psychotropic drugs, buprenorphine and methadone on the streets, the polyuse of substances in Finland Hannu Alho, Professor Unit on Prevention and Treatment of Addictions, National
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 informationDisclosure. 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 informationJoel Millard, DSW, LCSW Dave Felt, LCSW
Joel Millard, DSW, LCSW Dave Felt, LCSW 1. Provide an overview of the effectiveness of medication assisted treatment, to include a discussion of the different types of medications and how they are used
More information