Naltrexone: (Vivitrol )
|
|
- Alvin Dennis
- 8 years ago
- Views:
Transcription
1 Naltrexone: Injectable Formulation (Vivitrol ) 1
2 Opioid Receptors and Alcohol Dependence 4 1. Gianoulakis C. Alcohol Health Res World. 1998;22: Woodward JJ. Principles of Addiction Medicine. 3rd ed. 2003: Opioid Receptors and Alcohol Dependence The mechanism by which VIVITROL exerts its effects in alcohol dependent patients is not entirely understood VIVITROL [full prescribing information]. Cambridge, MA: Alkermes, Inc; May Oswald LM et al. Physiol Behav. 2004;81: Kenna GA et al. Am J Health Syst Pharm. 2004;61: Gianoulakis C. Alcohol Health Res World. 1998;22: Dosage and Administration Epidermis Vivitrol is given as an intramuscular (IM) gluteal injection every 4 weeks or once a month Vivitrol should not be given subcutaneously or in the adipose layer Dermis Vivitrol it must not be administered i d Adipose intravenously Muscle Vivitrol should be administered by a healthcare professional, into alternating buttocks each month Vivitrol should be injected into the upper outer quadrant of the buttock, deep into the muscle not the adipose tissue (fat) 6 2
3 Vivitrol Pharmacokinetics: Alcohol Dependence and the Liver Vivitrol is given as an intramuscular injection Reduces first pass hepatic metabolism compared to oral naltrexone Delivers ¼ the total monthly dose of oral naltrexone (380 mg vs.1500 mg) Naltrexone s boxed warning came from the use of oral naltrexone given in excessive doses Patients in study received greater than 5 times the recommended dose Vivitrol does not appear to be a hepatotoxin at the recommended dose Available only in 1 dose (380 mg) Dispensed in single dose cartons Administered by a healthcare professional Patients who experience symptoms and/or signs of acute hepatitis should seek medical attention and discontinue use of Vivitrol 7 3
4 Campral (acamprosate) Campral: Patient Selection Diagnosis of alcohol use disorder Anxiety/insomnia during periods of abstinence which, by the patient s history, leads to relapse Patients who report relief of negative emotional states when they drink alcohol Patients who desire to be in recovery, are willing to engage in treatment, and endorse the goal of total abstinence 4
5 Pharmacokinetics (cont.) Special Populations No pharmacokinetic differences due to gender No pharmacokinetic differences in alcohol dependent subjects No dose adjustment necessary with mild to moderate hepatic (liver) impairment or mild renal (kidney) disease Dose adjustment is necessary in moderate renal disease (i.e., creatinine clearance, ml/min) Contraindicated in severe renal disease (i.e., creatinine clearance, 30 ml/min) Effects of Alcohol on Neural Circuits Glutamate System Administration of Alcohol Acute Alcohol Effect Inhibits NMDA receptors Effect: anxiety, sedation Chronic Alcohol Use Alcohol Free CNS Equilibrium Withdrawal Increased glutamatergic activity Effect: Acute: dysphoria, hallucinations Post acute: sleep/mood NMDA = N-methyl-D-aspartate. disturbances Source: Littleton J. Alcohol Health Res World. 1998;22: Adaptation # and/or function of NMDA receptors on neurons Balances acute alcohol effect Effect: tolerance, dependence Removal of Alcohol Pathophysiology of Potential Relapse Ca 2+ Glutamate NMDA Receptor mglur5 5
6 Balancing Pathophysiology Campral (acamprosate calcium) C Reduction in glutamate release C Reduction in postsynaptic effects Glutamate C Campral C C NMDA Receptor C mglur5 Neuroadaptation: Potential for Relapse Normal Acute Alcohol Intake Tolerance Alcohol Alcohol Adaptation Inhibition (GABA) Excitation (Glutamate) Acute Withdrawal Adaptation Post Acute Withdrawal and Cue Induced Responses C Campral (acamprosate calcium) may balance glutamate over activity, thus reducing the potential for relapse Acamprosate 48 and 52 Week Clinical Trials: % Days Abstinent of Days ent Percentage Abstine % P<.001* 74% 48-Week Study 67% P<.001* 85% 52-Week Study n=136 n=136 n=177 n=173 (1332/1998 mg/d) (1998 mg/d) ACAMP Placebo 6
7 Acamprosate Common Spontaneously Reported Adverse Events in Placebo Controlled Trials Event Diarrhea Asthenia Nausea Pruritus Flatulence Acamprosate (n=2019) 16% 6% 4% 4% 3% Placebo (n=1706) 10% 5% 3% 3% 2% Dosage and Administration Initiate as soon as possible after alcohol withdrawal when patient achieves abstinence Maintain treatment if patient relapses Recommended dose: two 333 mg tablets taken 3 times a day Patients with moderate renal impairment should have a starting dose of 1 x 333 mg 3 times daily Patients with severe renal impairment should not be given Campral (acamprosate) Can be taken with or without meals Monthly Cost of Medications Antabuse ~ $100 Oral naltrexone ~ $ Vivitrol ~ $750 1,500 Campral ~ $
8 Anticonvulsants Anticonvulsants Topamax (topiramate), Tegretol (carbamazepine), and Depakote (divalproex) have increasingly been of interest, with one study confirming topiramate as being beneficial. These medications act as GABA agonists and glutamate antagonists (similar to acamprosate). Preliminary studies show superiority to placebo in reductions in drinks/day, drinks/drinking day, drinking days, and GGTP reduction levels. Topiramate shows the greatest amount of research support, and should be initiated in a slowly increasing dosage (maximum 300 mg/day). Topiramate: Patient Selection Diagnosis of alcohol use disorder Patents with co occurring bipolar disorder Persons with high reward from alcohol or who use it to relieve negative emotional states 8
9 Topiramate: Mechanism of Action GABA ergic agent (facilitates GABA functioning via action on a non benzodiazepine site on the GABA A receptor) Also inhibits dopamine release in the limbic system, thus attenuating alcohol lreward and craving for alcohol l May decrease obsessional thoughts and compulsions about drinking Topiramate: Dosing Morning Dose Evening Dose Week 1 25 mg 25 mg Week 2 50 mg 50 mg Week 3 75 mg 75 mg Week mg 100 mg Week mg 150 mg Topiramate: Adverse Effects Sedation/somnolence, fatigue Dizziness Tingling of arms and legs Cognitive clouding Decreased appetite and weight loss Funny tastes, nausea Decreased sweating, increased body temperature 9
10 Topiramate: Adverse Effects Acute secondary angle glaucoma (acute eye pain and myopia) Metabolic acidosis via decreased serum bicarbonate (symptoms of hyperventilation, tiredness, loss of appetite, irregular heartbeat, decreased alertness) Kidney stone formation Must warn about pregnancy complications or increase in suicidal thinking Other Agents Other Agents Lioresal (baclofen) antispasmodic with GABA B agonist activity. However, there is evidence of misuse, overdose, delirium sufficient to recommend more research prior to use in alcoholism. SSRI agents aents inconsistent findings with no likely benefit in alcohol dependent patients without co morbid depression. Zofran (ondansetron) serotonin receptor (5 HT3) antagonist selectively reduced drinking among some patients with early onset of problem drinking, but more studies are needed before differentiating treatment by alcohol dependence subtypes. 10
11 Medication Assisted Therapy for Sedative Hypnotic Addiction Agents for Sedative Hypnotic Dependence No medications have been approved or found to be effective specifically for sedative hypnotic dependence (usually benzodiazepines taken for anxiety or imidazopyridines [e.g.: Ambien] for sleep). Phenobarbital (used for acute tedetoxification) may be used for treatment of the protracted withdrawal syndrome beyond the initial withdrawal phase. Campral (acamprosate) theoretically should have efficacy for sedative hypnotic dependence due to it s effect on the GABA and glutamate receptor systems (similar to its effects for alcohol dependence). Break Time 11
12 Opiate Use Disorders 12
13 Progression of Opioid Abuse and Addiction Dopamine System and Drug Misuse Early Phase (Use) LIKE Pleasure circuit Middle Phase (Abuse) WANT Desire and urge circuit Late Phase (Addiction) NEED Pathologic desire and demand circuit Opioid Withdrawal Patients worst nightmare a major barrier to beginning treatment It doesn t kill, you, just makes you wish you were dead Objective, subjective, acute and protracted withdrawal symptoms 13
14 Opioid Withdrawal Syndrome Acute and protracted phases Can occur after even two weeks of opioid use Duration of acute withdrawal is dependent upon the half lifeofthe drug used: Peak of withdrawal occurs 36 to 72 hours after last dose Acute symptoms subside over 3 to 10 days Protracted symptoms may linger for weeks or months Opioid Withdrawal Acute symptoms (generally last 3 10 days) Autonomic symptoms (Physiologic) Rebound increased norepinephrine activity from the locus coeruleus Increase blood pressure and heart rate, peristalsis (intestinal cramps and diarrhea), diaphoresis (sweating), irritability, anxiety, etc. Affective symptoms (Subjective) Suppressed in the dopaminergic reward pathways Depression, anxiety, anhedonia, craving, anergia Protracted Opioid Withdrawal Can persist for 3 6 months Anergia Anhedonia Sleep disturbance, poor appetite Emotional lability/dysphoria Stress over sensitivity Drug cravings and obsessive thoughts of drugs Deep muscle aches and pains Reduced libido, impotence, anorgasmia 14
15 Comprehensive Treatment of Opiate Addiction 15
Update and Review of Medication Assisted Treatments for Opiate and
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 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 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 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 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 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 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 informationAlcohol Withdrawal Syndrome & CIWA Assessment
Alcohol Withdrawal Syndrome & CIWA Assessment Alcohol Withdrawal Syndrome is a set of symptoms that can occur when an individual reduces or stops alcoholic consumption after long periods of use. Prolonged
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 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 informationNeurobiology and Treatment of Alcohol Dependence. Nebraska MAT Training September 29, 2011
Neurobiology and Treatment of Alcohol Dependence Nebraska MAT Training September 29, 2011 Prior treatment episodes for persons starting treatment for alcohol dependence, 2009 Percent 50 45 40 35 30 25
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 informationMAT: Medication Assisted Treatment for Alcohol Dependence
MAT: Medication Assisted Treatment for Alcohol Dependence Maritza Lagos, MD, DABAM WMU Homer Stryker MD, School of Medicine - Psychiatry February 2015 Case 44 y.o. Divorced, Caucasian male with strong
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 informationBrain Damage & Recovery: The Resilience of the Brain, Addiction Impact & Therapeutic Repair. Michael Fishman, MD Director of Young Adult Program
Brain Damage & Recovery: The Resilience of the Brain, Addiction Impact & Therapeutic Repair Michael Fishman, MD Director of Young Adult Program How Addiction Takes Hold Large & rapid upsurges in dopamine
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 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 informationNaltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance
Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Introduction Indication/Licensing information: Naltrexone is licensed for use as an additional therapy, within
More informationAssessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal
Assessment and Management of Opioid, Benzodiazepine, and Sedative-Hypnotic Withdrawal Roger Cicala, M. D. Assistant Medical Director Tennessee Physician s Wellness Program Step 1 Don t 1 It is legal in
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 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 informationPhilip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth
Philip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth I. II. Background A. AWS can occur in anyone who consumes alcohol B. Risk correlates
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 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 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 informationWithdrawal Symptoms: How Long Do They Last?
Withdrawal Symptoms: How Long Do They Last? Posted by First Step Medical Detox on November 24, 2015 When considering stopping drugs or alcohol, many addicts and alcoholics are concerned about the withdrawal
More informationCauses of Alcohol Abuse and Alcoholism: Biological/Biochemical Perspectives
Causes of Alcohol Abuse and Alcoholism: Biological/Biochemical Perspectives Neurobehavioral Aspects of Alcohol Consumption Source: Eighth Special Report to the U.S. Congress on Alcohol and Health Secretary
More informationAlcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol
Pharmacologic Effects of Alcohol Alcohol Withdrawal Kristi Theobald, Pharm.D., BCPS Therapeutics III Fall 2003 Inhibits glutamate receptor function (NMDA receptor) Inhibits excitatory neurotransmission
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 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 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 informationUltram (tramadol), Ultram ER (tramadol extended-release tablets); Conzip (tramadol extended-release capsules), Ultracet (tramadol / acetaminophen)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.02.35 Subject: Tramadol Acetaminophen Page: 1 of 8 Last Review Date: September 18, 2015 Tramadol Acetaminophen
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 informationAlcohol Abuse and Dependence in Native Americans
Alcohol Abuse and Dependence in Native Americans Its link to suicide and medication treatment options Addiction Psychiatrist Objectives Will discuss alcohol s role in suicide with the limited data we have.
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 informationAlkermes, Inc. 852 Winter Street Waltham, MA 02451 1-800-848-4876
Initial REMS Approved: March 2010 Most Recent Modification: July 2013 NDA 21-897 VIVITROL (naltrexone for extended-release injectable suspension) Opioid Antagonist Alkermes, Inc. 852 Winter Street Waltham,
More informationMaintenance of abstinence in alcohol dependence
Shared Care Guideline for Prescription and monitoring of Acamprosate Calcium Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist, Alcohol Services Dr Donnelly
More informationAmphetamines Addiction
Introduction Amphetamines, which are classified as stimulants, work by using the dopamine reward system of the brain. When these drugs are used, the user s central nervous system is simulated which causes
More informationIdentification, treatment and support for individuals with Alcohol & Drug Addiction in the Community
Identification, treatment and support for individuals with Alcohol & Drug Addiction in the Community Dr David Jackson Clinic Medical Officer The Hobart Clinic Association Drugs In tonight s context, drugs
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 Department of Psychiatry University of Kentucky Medical Center Defining the Standard Drink A standard drink = 14
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 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 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 informationThis module reviews the following: Opioid addiction and the brain Descriptions and definitions of opioid agonists,
BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module II Opioids 101 Goals for Module II This module reviews the following: Opioid addiction and the brain Descriptions
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 informationAlcohol Abuse and Addiction Management Protocol
Alcohol Abuse and Addiction Management Protocol All Team Members: Patient Self-Management Education and Support Alcohol is the most commonly abused drug in the United States. About 18 million people in
More informationWhat you should know about treating your pain with opioids. Important information on the safe use of opioid pain medicine.
What you should know about treating your pain with opioids Important information on the safe use of opioid pain medicine. If your healthcare provider has determined that opioid therapy is right for you,
More informationPrescription Drug Abuse
Prescription Drug Abuse Introduction Most people take medicines only for the reasons their health care providers prescribe them. But millions of people around the world have used prescription drugs for
More informationPotential Effects Of Significant Alcohol Withdrawal And Surgeries
Alcohol Use Dates Back 7,000 to 10,000 Years Though Scientists Still Debate the Mechanisms of Hangovers Proposed Causes of Hangovers Acute ethanol withdrawal Ethanol can alleviate symptoms Acetaldehyde
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 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 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 informationDowners/Depressants (pages 40-50)
Downers/Depressants (pages 40-50) Read pages 49-54, 59-60, and 78-79 of the booklet, Street Drugs. Pages 40-50 of the text. Narcotics: Prescription Origin: Southeast Asia, Southwest Asia, and in the Western
More informationObjectives. Why pharmacotherapy is required? Neuro-biology of Alcohol addiction 5/21/2013
Muhammad A. Ghazi MD Fellow Addiction Medicine University at Buffalo Objectives Understand the basic patho-physiology of Alcohol addiction Enlist the drugs available for alcohol dependence detoxification
More informationPrescription Drug Addiction
Prescription Drug Addiction Dr Gilbert Whitton FAChAM Clinical Director Drug & Alcohol Loddon Mallee Murray Medicare Local Deniliquin 14 th May 2014 Prescription Drug Addiction Overview History Benzodiazepines
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 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 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 informationHow To Use Naltrexone Safely And Effectively
Naltrexone And Alcoholism Treatment Treatment Improvement Protocol (TIP) Series 28 Executive Summary and Recommendations Psychosocial treatments for alcoholism have been shown to increase abstinence rates
More informationWhat Can Science Contribute to the Treatment of Alcoholism?
What Can Science Contribute to the Treatment of Alcoholism? George F. Koob, Ph.D. Director National Institute on Alcohol Abuse and Alcoholism National Institutes of Health Flow of Talk 1. Conceptual Framework
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 informationDERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) SHARED CARE AGREEMENT FRAMEWORK
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) SHARED CARE AGREEMENT FRAMEWORK ACAMPROSATE CALCIUM (Campral EC) for alcohol abstinence ESCA: Adjunct in the treatment of chronic alcohol dependence (under
More informationTitle: How to manage risky drinkers in Primary Health Care. Authors: Acknowledgements:
Title: How to manage risky drinkers in Primary Health Care Authors: Acknowledgements: This guide has been writen in accordance with the criteria of the PHEPA Training Programme on identification and brief
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 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 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 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 informationGuidelines for the use of unlicensed and off label medication within NHS Fife Addiction Services
NHS Fife Community Health Partnerships Addiction Services Guidelines for the use of unlicensed and off label medication within NHS Fife Addiction Services Intranet Procedure No. A11 Author Dr A. Baldacchino
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 informationDrinking Patterns. Harmless Use At-Risk. Abuse. 4% Dependence. Financial Disclosures. Alcoholism: Recognition and Management.
Alcoholism: Recognition and Management Timothy W. Fong MD UCLA Addiction Psychiatry PRI-MED West Current Clinical Issues March 2014 Financial Disclosures Speaker Bureau Reckitt Benckiser Research Support
More informationSubstance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP
Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP Medical assessment of patient with Alcohol Use Disorder Identification patients suitable for home detox Process for referral to inpatient
More informationNALTREXONE INDUCED DETOXIFICATION FROM OPIOIDS A METHOD OF ANTAGONIST INITIATED TREATMENT
NALTREXONE INDUCED DETOXIFICATION FROM OPIOIDS A METHOD OF ANTAGONIST INITIATED TREATMENT Opioid dependence is a devastating and frequently fatal medical condition. It is a manifestation of addictive disorder
More informationAlcohol withdrawal A challenge in caring for patients after heart surgery
Abteilung Praxisentwicklung Pflege Alcohol withdrawal A challenge in caring for patients after heart surgery Wolfgang Hasemann, RN, PhD Deborah Leuenberger, MScN.cand. June 2015 Content Alcohol consumption
More informationMEDICAL ASSISTANCE BULLETIN
ISSUE DATE SUBJECT EFFECTIVE DATE MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Opiate Dependence Treatments Pharmacy Service Leesa M. Allen, Deputy Secretary Office of Medical
More 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 informationAddiction Medicine 2014
Addiction Medicine 2014 Update on Current/New/Anticipated Medications for Alcohol Use Disorders J.C. Garbutt, MD Department of Psychiatry and Bowles Center for Alcohol Studies School of Medicine, University
More informationMedications for chronic pain
Medications for chronic pain When it comes to treating chronic pain with medications, there are many to choose from. Different types of pain medications are used for different pain conditions. You may
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 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 informationMEDICAL ASSISTANCE BULLETIN
ISSUE DATE September 4, 2015 SUBJECT EFFECTIVE DATE September 9, 2015 MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Opiate Dependence Treatments, Oral Buprenorphine Agents - Pharmacy
More 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 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 informationPOST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics
POST-TEST University of Wisconsin Hospital & Clinics True/False/Don't Know - Circle the correct answer T F D 1. Changes in vital signs are reliable indicators of pain severity. T F D 2. Because of an underdeveloped
More informationUse of Buprenorphine in the Treatment of Opioid Addiction
Use of Buprenorphine in the Treatment of Opioid Addiction Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Executive Summary Which of the following is an
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 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 informationSUMMARY OF RECOMMENDATIONS
SUMMARY OF RECOMMENDATIONS FOR THE LONG- TERM TREATMENT OF RLS/WED from AN IRLSSG TASK FORCE Members of the Task Force Diego Garcia- Borreguero, MD, Madrid, Spain* Richard Allen, PhD, Baltimore, MD, USA*
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 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 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 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 informationBenzodiazepines: A Model for Central Nervous System (CNS) Depressants
Benzodiazepines: A Model for Central Nervous System (CNS) Depressants Objectives Summarize the basic mechanism by which benzodiazepines work in the brain. Describe two strategies for reducing and/or eliminating
More informationBenzodiazepine Detoxification and Reduction of Long term Use
Benzodiazepine Detoxification and Reduction of Long term Use Malcolm Lader 1 Model of general drug misuse and dependence. Tactical interventional options Social dimension Increasing breaking of social
More 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 informationMedication-Assisted Treatment for Alcohol Dependence. Misti Storie, MS, NCC Director of Training, NAADAC
Medication-Assisted Treatment for Alcohol Dependence Misti Storie, MS, NCC Director of Training, NAADAC Seminar Objectives List barriers to taking pharmacotherapies and strategies to overcome these barriers.
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 informationPsychotherapeutic Medications: What Every Counselor Should Know
Psychotherapeutic Medications: What Every Counselor Should Know Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Antipsychotics/Neuroleptics Antipsychotics,
More informationRelapse prevention clinic
Relapse prevention clinic Doncaster drug and alcohol services RDaSH Substance Misuse Services Relapse Prevention Clinic Sinclair House 29-31 Thorne Road Doncaster DN1 2EZ Tel: 01302 303900 Treatment, support
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 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 information