SUBOXONE for Opioid Addiction Medication Assisted Therapy. Dr. Jennifer Melamed MBChB, ABAM, CISAM, CCSAM

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "SUBOXONE for Opioid Addiction Medication Assisted Therapy. Dr. Jennifer Melamed MBChB, ABAM, CISAM, CCSAM"

Transcription

1 N SUBOXONE for Opioid Addiction Medication Assisted Therapy Dr. Jennifer Melamed MBChB, ABAM, CISAM, CCSAM

2 CONTENTS Part 1 Introduction to N SUBOXONE Part 2 Pharmacology of N SUBOXONE Part 3 Pharmacokinetics of N SUBOXONE Part 4 Minimizing Risk with N SUBOXONE Part 5 Managing Patients on N SUBOXONE Part 6 Pain and Opioid Dependence Part 7 Treatment of Pain in Patients Maintained on N SUBOXONE

3 Part 1 Introduction to N SUBOXONE

4 INDICATIONS For medication assisted treatment of opioid drug dependence Within a framework of medical, social, and psychological treatment For people age 18+ who have agreed to be treated for opioid dependence In order to prescribe Suboxone in BC: Valid Methadone exemption Online course Not approved in Canada in pain control

5 Collaborative Prescribing Agreement (CPA) Criteria Treatment of opioid dependence where Methadone is contraindicated (e.g. for patients at high risk of, or with, QTc prolongation or those with a hypersensitivity to Methadone) OR where there is an inadequate response or intolerance to Methadone. CPA signed = Automatic coverage In order for patients to pay privately for N SUBOXONE, the following needs to be written on duplicate prescription SUBMIT AT ZERO COST TO PHARMACARE CONFUSION ++

6 Why the Benefit of Another Option: About 25% of Canada s estimated 80,000 illegal opioid users on methadone in Popova S, Rehm J and Fischer B. Public Health 2006;120: About 33% of opioid dependent persons have no desire to be in a methadone program. Fischer B et al. Substance use and misuse 2002;37(4): Over 50% wished some other ideal treatment was available. Fischer B et. al. Journal of Urban Health 2005;82(2): Methadone difficult to access in non-urban areas McCarty et al. Journal Subt Abuse Treat 2004;26:

7 IDENTIFICATION & INGREDIENTS Sublingual tablet Contains a fixed combination of buprenorphine and naloxone in a 4:1 ratio in 1 tablet 2 strengths: Buprenorphine 2 mg/naloxone 0.5 mg Buprenorphine 8 mg/naloxone 2 mg Efficacy and safety equivalent to buprenorphine with lower potential for misuse

8 N SUBOXONE vs. N SUBUTEX Rationale Developed to deliver the same efficacy as Buprenorphine while reducing potential for misuse Naloxone, an opioid antagonist, added to deter misuse Parenteral version of antagonist naltrexone; used to reverse overdose Naloxone undergoes extensive first-pass metabolism and is not absorbed into the systemic circulation when taken orally or sublingually However, injection allows naloxone to enter systemic circulation and compete with buprenorphine for receptor occupancy which results in symptoms of opiate withdrawal Narcan 0.4mg needed to reverse full agonists in overdose Narcan 10-15mg needed for Buprenorphine overdose

9 Relative contraindication CONTRAINDICATIONS to N SUBOXONE Pregnant women (Naloxone) Breastfeeding women Uncontrolled alcoholism Allergy to any of the components of N SUBOXONE Acute severe respiratory illness Paralytic ileus Severe liver dysfunction? Increased transaminases > 3-5x upper limit normal

10 Part 2 Pharmacology of N SUBOXONE

11 BUPRENORPHINE: A PARTIAL MU OPIOID RECEPTOR AGONIST Semi-synthetic highly lipophilic Opioid Primary activity in man: Partial mu opioid agonist Kappa receptor antagonist (Inhibits dysphoria) High affinity (moderate efficacy) for mu receptor Will displace other high efficacy opiates, if present, and induce withdrawal symptoms Dissociates slowly from the receptors Ceiling on agonist effects Narcan 0.4mg needed to reverse full agonists in overdose Narcan 10-15mg needed for Buprenorphine overdose Johnson RE, et al. Drug Alcohol Depend; 2003.

12 ACTIVITY OF BUPRENORPHINE MU RECEPTOR: Partial Agonist In absence of full agonist (heroin), buprenorphine binds to receptors and causes reinforcing effect Feeling normal If full agonist (heroin) is present, buprenorphine displaces agonist and causes withdrawal symptoms Center for Substance Abuse Treatment; DHHS; 2004.

13 BUPRENORPHINE: A SAFE CEILING Unlike full agonists, agonist effects of buprenorphine reach a ceiling Less likely to cause respiratory depression in overdose Ceiling can be compromised by concomitant alcohol or other central nervous system depressants, (BENZODIAZEPINES) or when buprenorphine is misused 1 Johnson RE, et al. Drug Alcohol Depend; N SUBOXONE Product Monograph.

14 Pharmacology & Pharmacokinetics Main effect NSUBOXONE (Semi-Synthetic) Methadone (Synthetic) Mu partial agonist Kappa agonist Mu full agonist NMDA antagonist Peak plasma levels 1-3 hours 2-4 hours Bio-availability 50% SL 70%-80% Oral Half-life 37 hours 28 hours Elimination Renal, fecal Renal, fecal Clinically apparent drug interactions Selected ARVs (minimal effect) Active metabolites Norbuprenorphine None Optimal dose 8-16mg (16mg = 92% receptors bound) Rifampin, phenytoin, several ARVs mg (?target dose) Adapted from: Gavin Bart MD, FACP, FASAM (2012): Maintenance Medication for Opiate Addiction: The Foundation of Recovery, Journal of Addictive Diseases, 31:3,

15 Regulation of Stress Response Short acting opiates result in: Suppression of ACTH, cortisol Blunted diurnal variation of ACTH, cortisol Increased ACTH, cortisol in withdrawal Result: Dysregulated pain perception + hyperalgesia Kindling effect: Worsening withdrawal symptoms, increased cravings and risk of relapse These stress response markers normalized in Suboxone-maintained patients Failure to normalize correlates with craving and relapse

16 Regulation of Stress Response Thus: MAT IS NOT SIMPLY REPLACEMENT OF ILLICITLY USED OPIATE FOR A MEDICALLY SUPERVISED OPIATE MAT corrects many of the micro-biological processes contributing to relapse

17 Regulation of Stress Response Source: Gavin Bart MD, FACP, FASAM (2012): Maintenance Medication for Opiate Addiction: The Foundation of Recovery, Journal of Addictive Diseases, 31:3,

18 Part 3 Pharmacokinetics of N SUBOXONE

19 BUPRENORPHINE ABSORPTION Plasma levels increase proportionally with sublingual N SUBOXONE dose Peak plasma levels in 90 minutes Plasma distribution t½ ~2 to 5 hours, but note long duration of action due to slow dissociation from receptors ( 24 hours) Addition of naloxone does not alter pharmacokinetic properties of buprenorphine

20 METABOLISM & ELIMINATION Metabolism Mediated by liver cytochrome P-450 3A4 isoenzyme Severe hepatic impairment may warrant dose adjustment Elimination Buprenorphine: feces (70%), urine (30%) Naloxone: primarily in urine Buprenorphine: Mean plasma elimination t½ 32 hours Naloxone 1.2 hours

21 Part 4 Minimising Risk with N SUBOXONE

22 USE OF N SUBOXONE WITH ALCOHOL AND OTHER CNS DEPRESSANTS Misuse of N SUBOXONE in combination with excessive use of alcohol or other CNS depressants CAN BE FATAL sedative effect of buprenorphine Dizziness, drowsiness, impaired thinking Can respiratory depression Limit use with benzodiazepines Death due to respiratory depression of central origin Tightly regulate benzodiazepine doses, especially where misuse is suspected

23 OBSERVATIONS INTERACTION OF BUPRENORPHINE & BENZODIAZEPINES Clinical data from France deaths: Buprenorphine present Benzodiazepines and/or other CNS depressants present in 99.3% (136/137 cases) BENZODIAZEPINES ATTENUATE THE CEILING EFFECT OF BUPRENORPHINE In presence of Benzodiazepines, N SUBOXONE can no longer be assumed to be partial agonist resembles full agonist with associated risks

24 USE OF N SUBOXONE WITH ANTIRETROVIRAL DRUGS N SUBOXONE can be administered with non nucleoside reverse transcriptase inhibitors (NNRTIs) without dose adjustment N SUBOXONE can be administered with protease inhibitors (PIs) without dose adjustment Only Ritonavir had significant effect on buprenorphine pharmacokinetics

25 Part 5 Managing Patients on N SUBOXONE

26 PHARMACOTHERAPY PHASES IN N SUBOXONE TREATMENT Therapy divided into 4 phases Induction Stabilization Maintenance Medically supervised withdrawal

27 PHASE 1 INDUCTION First appointment: Assessment - Determine patient is a suitable candidate for N SUBOXONE Treatment contract to be signed Urine to screen for opiates, Benzodiazepines, Stimulants Remember Oxycontin, Hydromorphone need to be requested

28 PHASE 1 INDUCTION Second appointment - Induction Patient needs to be in mild to moderate withdrawal prior to initiation of N SUBOXONE Time from last drug use Depends on half-life of opiate used Immediate release opioids - First dose min 6-8 hrs after last use Delayed release opioids - First dose min 12-24hrs after last use Methadone First dose 36 hrs or longer after last use Precipitate withdrawal can occur if N SUBOXONE therapy is started too soon after last opioid dose DO NOT GUESS USE CLINICAL OPIATE WITHDRAWAL SCALE (COWS)

29 Assessing Signs and Symptoms of Withdrawal Ways to assess withdrawal Written scales (eg, COWS) Clinical experience Signs and symptoms The National Alliance of Advocates for Buprenorphine treatment. f

30 INDUCTION DAY 1 INITIAL DOSING Goal: Safely suppress opioid withdrawal as rapidly as possible with adequate doses of N SUBOXONE Initial dose: 2-4 mg of N SUBOXONE Assess patient after 1 hour to ensure no precipitate withdrawal Monitor 1-2 hrs further. May require 2-4mg further if still in withdrawal Additional 2-4mg may be sent home with patient for use in first 24hrs Maximum 8-12mg buprenorphine on Day 1 (16mg?) Contact to be maintained with patient in first 24hrs

31 INDUCTION DAY 2 FOLLOW UP DOSING Patient to be seen in office If no signs of withdrawal = continue dose used in last 24 hrs If withdrawal = add 2-4mg Suboxone to a maximum of 16mg over 24 hrs PATIENT MAY NEED TO BE SEEN ON DAY 3 IF DOSE MANIPULATION WAS REQUIRED ON DAY 2 Induce rapidly! Rapid induction is key to early treatment retention 1 Titrate doses rapidly according to clinical response Review frequently 1 Doran C, et al. Heroin Add & Rel Clin Probl; 2005.

32 INDUCTION DAY.Methadone Decrease methadone to 30 mg/day before starting N SUBOXONE 1 Patients can be transferred from higher doses of methadone to N SUBOXONE 2 Seek consultation Treat any withdrawal symptoms with non-opioid medications Clonidine, loperamide, sleep aids, NSAIDs, etc. 1N SUBOXONE Product Monograph 2 DiPetta G et al. Heroin Add & Rel Clin Probl; 2005.

33 DOSING TO CLINICAL EFFECT Past a certain point, higher doses do not decrease receptor availability Receptor availability: 16mg: 92% reduction 32mg: 98% reduction NOT statistically significant 16mg & 32mg: Similar blockade of 24mg IM Hydromorphone 3mg SL N SUBOXONE = 1mg N SUBOXONE = 30-50mg Parenteral Morphine Greenwald M.K. et al Journal of Neuropsychopharmacology 2003; 28 (11):

34 PHASE 2 & 3 STABILIZATION & MAINTENANCE: FINE-TUNING THE DOSE Goal: Find the dosage necessary to keep patient comfortable and adherent Goals: Prevent opioid withdrawal symptoms Suppress opioid cravings Prevent use of self-administered opioids Address goals of rehabilitation with each patient Duration: Months to years, up to a lifetime Dispensing: N SUBOXONE is taken on a daily basis Daily witness for 2 months. Recommended by Health Canada unless stability is achieved sooner (CAMH states there is no evidence identified supporting this for buprenorphine/naloxone) Any deviation to be documented in chart

35 PHASE 4 MEDICALLY SUPERVISED WITHDRAWAL No scientific evidence that medical withdrawal is effective treatment Patients are at high risk for relapse during withdrawal 1,2 If the patient and physician decide to take this approach: Titrate downward using N SUBOXONE 2 mg and 8 mg doses Ensure that the patient has immediate access to maintenance treatment at all times Monitor patients on an ongoing basis for relapse Mild withdrawal can occur 1 Kakko J, et al. Lancet; Center for Substance Abuse; DHHS, 2004.

36 N SUBOXONE KEY TAKE Home POINTS: RISK MINIMIZATION Dose adequately Provide patients with counseling Monitor patients progress during therapy Use urine sampling if necessary Store supplies securely Keep out of the reach of children Use with care in patients with hepatic impairment Do not use in pregnant women or allow breastfeeding during use Educate patients to: Take as directed Avoid misuse with CNS depressants

37 Part 6 Pain and Opioid Dependence

38 N SUBOXONE Mechanism of Action Salient feature - extended duration of action Presumably related to slow dissociation from mu opioid receptors in the brain (HIGH AFFINITY) N SUBOXONE plasma concentrations are time dependent and correlate highly with mu opiate receptor availability (does not correlate with level of analgesia) Hydromorphone 24mg increased agonist symptoms only when 2/3 of receptors unoccupied (> 52 hrs) Time Post 16 mg Dose Receptor Availability 4 hours 30% 28 hours 54% 52 hours 67% 72 hours 82%

39 Optimal Full Agonist Pain Control Definitions Affinity Measure of the tightness that a drug binds to a receptor Intrinsic Activity (IA) Measure of the ability of a drug once bound to the receptor to generate an effect activating stimulus and produce a change in cellular activity. IA affects the MAGNITUDE of the response Drug Affinity Intrinsic Activity N SUBOXONE High Low Fentanyl Low Highest Hydromorphone Low High Fentanyl has been shown to have the best effect in pain control with patients on Suboxone

40 Pain Control Opioid addiction creates an opioid-induced hyperalgesia i.e. neuroplastic change in pain perception resulting in increased pain sensitivity to painful stimuli & decreased analgesic effect of opioids Patients traumatized by pain Treat aggressively in first hrs

41 Misconceptions Treatment of acute pain in patients on MAT 1. Maintenance dose provides analgesia 2. Use of opioids for analgesia may result in addiction relapse 3. Additive effect of analgesia and MAT may cause respiratory and CNS depression 4. Pain reporting is manipulation or drug seeking

42 Misconception 1 Maintenance Dose Provides Analgesia N SUBOXONE has a duration of action for analgesia of 4-8 hours Opioid withdrawal suppression lasts hours Analgesic tolerance develops due to neuroplastic changes (physical changes in the brain) that yield an increase in pain sensitivity

43 Misconception 2 Risk of Relapse No evidence that exposure to opioid analgesics in presence of acute pain increases rate of relapse in MAT maintained patient In fact, stress associated with unrelieved pain is more likely to be a trigger for relapse Acute pain decreases euphorogenic qualities of the opiate

44 Misconception 3 Respiratory & CNS Depression Tolerance develops rapidly to the respiratory and CNS depressive effects of opioids not to the constipating effect Beware polydrug dependance: Stimulant Crash

45 Misconception 4 Manipulation or Drug Seeking Physicians are fearful of providing opioids as they feel they are being manipulated Baseline dose of MAT typically blocks most euphoric effects of added opioids. Theoretical reduction of opioid analgesic abuse

46 Addiction vs Pseudo-Addiction Addiction diagnosed prospectively Aberrant behavior gets worse with rational treatment plan Pseudo-Addiction diagnosed retrospectively Aberrant behavior normalizes with rational plan

47 Part 7 Treatment of Pain in Patients Maintained on N SUBOXONE

48 Approach to Analgesia in OAT Similar in principle to non-mat patients Guidelines are an opinion based upon clinical experience from several acute pain services and literature recommendations Options employed should be chosen on the basis of the anticipated duration of pain, treatment setting and allowing for modification depending on response to chosen option

49 Questions?

Substitution Therapy for Opioid Dependence The Role of Suboxone. Mandy Manak, MD, ABAM, CCSAM Methadone 101-Hospitalist Workshop, October 3, 2015

Substitution Therapy for Opioid Dependence The Role of Suboxone. Mandy Manak, MD, ABAM, CCSAM Methadone 101-Hospitalist Workshop, October 3, 2015 Substitution Therapy for Opioid Dependence The Role of Suboxone Mandy Manak, MD, ABAM, CCSAM Methadone 101-Hospitalist Workshop, October 3, 2015 Objectives Recognize the options available in treating opioid

More information

Treatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone )

Treatment 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 information

One example: Chapman and Huygens, 1988, British Journal of Addiction

One 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 information

Update on Buprenorphine: Induction and Ongoing Care

Update 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 information

Integrating 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 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 information

Opioid Addiction and Methadone: Myths and Misconceptions. Nicole Nakatsu WRHA Practice Development Pharmacist

Opioid Addiction and Methadone: Myths and Misconceptions. Nicole Nakatsu WRHA Practice Development Pharmacist Opioid Addiction and Methadone: Myths and Misconceptions Nicole Nakatsu WRHA Practice Development Pharmacist Learning Objectives By the end of this presentation you should be able to: Understand how opioids

More information

Prior Authorization Guideline

Prior 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 information

Considerations 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 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 information

Using Buprenorphine to Treat Acute Opioid Withdrawal in the ED

Using 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 information

Care Management Council submission date: August 2013. Contact Information

Care 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 information

MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION

MEDICATION 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 information

Treatment of opioid use disorders

Treatment 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 information

Acute Pain Management in the Opioid Dependent Patient. Maripat Welz-Bosna MSN, CRNP-BC

Acute Pain Management in the Opioid Dependent Patient. Maripat Welz-Bosna MSN, CRNP-BC Acute Pain Management in the Opioid Dependent Patient Maripat Welz-Bosna MSN, CRNP-BC Relieving Pain in America (IOM) More then 116 Million Americans have pain the persists for weeks to years $560-635

More information

Methadone. Buprenorphine 10/9/2015

Methadone. Buprenorphine 10/9/2015 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 information

Objectives. Dosing Methadone and Suboxone 2016. Methadone. Methadone

Objectives. Dosing Methadone and Suboxone 2016. Methadone. Methadone Objectives The Pharmacokinetics and Pharmacodynamics of methadone and buprenorphine Therapeutic implications Why we dose the way we do Dosing and Suboxone 2016 Does Not Have a Sense of Humor A long acting,

More information

Medication Assisted Therapy and Pregnancy: An Introduction

Medication Assisted Therapy and Pregnancy: An Introduction Medication Assisted Therapy and Pregnancy: An Introduction Deborah A. Orr, Ph.D. The Center For Drug Free Living Adapted from the NIDA Blending Initiative Curriculum Presentation Objectives Define opioids

More information

ARCHIVED BULLETIN. Product No. 2004-L0424-013 SEPTEMBER 2004 U. S. D E P A R T M E N T O F J U S T I C E

ARCHIVED BULLETIN. Product No. 2004-L0424-013 SEPTEMBER 2004 U. S. D E P A R T M E N T O F J U S T I C E BULLETIN INTELLIGENCE Product No. 2004-L0424-013 SEPTEMBER 2004 U. S. D E P A R T M E N T O F J U S T I C E NDIC Within the past 2 years buprenorphine a Schedule III drug has been made available for use

More information

OVERVIEW OF MEDICATION ASSISTED TREATMENT

OVERVIEW 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 information

Acute & Chronic Pain Management (requiring opioid analgesics) in Patients Receiving Pharmacotherapy for Opioid Addiction

Acute & Chronic Pain Management (requiring opioid analgesics) in Patients Receiving Pharmacotherapy for Opioid Addiction Acute & Chronic Pain Management (requiring opioid analgesics) in Patients Receiving Pharmacotherapy for Opioid Addiction June 9, 2011 Tufts Health Care Institute Program on Opioid Risk Management Daniel

More information

Section Editor Andrew J Saxon, MD

Section 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 information

Opioid Dependence Treatment with Buprenorphine/Naloxone: An Overview for Pharmacists and Physicians

Opioid Dependence Treatment with Buprenorphine/Naloxone: An Overview for Pharmacists and Physicians Opioid Dependence Treatment with Buprenorphine/Naloxone: An Overview for Pharmacists and Physicians Phyllis A. Grauer, PharmD, CGP, CPE Clinical Pharmacist Legislation Passed Enabling Office Based Treatment

More information

MEDICATION ASSISTED TREATMENT (MAT)

MEDICATION ASSISTED TREATMENT (MAT) MEDICATION ASSISTED TREATMENT (MAT) STATISTICS: ALCOHOL AND OPIOID USE Last year 33 Iowans died from opioid overdose deaths; an additional 19 individuals died of a heroin overdose. The number of drug overdose

More information

Dosing Guide. For Optimal Management of Opioid Dependence

Dosing Guide. For Optimal Management of Opioid Dependence Dosing Guide For Optimal Management of Opioid Dependence KEY POINTS The goal of induction is to safely suppress opioid withdrawal as rapidly as possible with adequate doses of Suboxone (buprenorphine HCl/naloxone

More information

Information for Pharmacists

Information 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 information

Medication-Assisted Treatment (MAT) & What It Means Long-Term Gary K. Byrd., M.Ed., MAC, CCS, CAMS Methadone is the Gold Standard for treatment of chronic heroin addiction Gary Byrd 2015 1 Gary Byrd 2015

More information

OPIOIDS. Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School

OPIOIDS. Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School OPIOIDS Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School Rutgers New Jersey Medical School Fundamentals of Addiction Medicine Summer Series Newark, NJ July 24, 2013

More information

EPIDEMIOLOGY OF OPIATE USE

EPIDEMIOLOGY 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 information

BUPRENORPHINE: A GUIDE FOR NURSES

BUPRENORPHINE: A GUIDE FOR NURSES BUPRENORPHINE: A GUIDE FOR NURSES Technical Assistance Publication (TAP) Series 30 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance

More information

Death 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 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 information

Buprenorphine: what is it & why use it?

Buprenorphine: 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 information

Opioids Research to Practice

Opioids 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 information

IN 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 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 information

Update and Review of Medication Assisted Treatments

Update 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 information

Abstral Prescriber and Pharmacist Guide

Abstral Prescriber and Pharmacist Guide Abstral Prescriber and Pharmacist Guide fentanyl citrate sublingual tablets Introduction The Abstral Prescriber and Pharmacist Guide is designed to support healthcare professionals in the diagnosis of

More information

Neurobiology and Treatment of Opioid Dependence. Nebraska MAT Training September 29, 2011

Neurobiology 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 information

Buprenorphine Therapy in Addiction Treatment

Buprenorphine 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 information

Using Buprenorphine in an Opioid Treatment Program

Using 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 information

Applicant Webinar for BJA s Drug Court Discretionary Grant Solicitation

Applicant 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 information

8/1/2014. Who We Are. BHG s Medical Mission. BHG Company Overview

8/1/2014. Who We Are. BHG s Medical Mission. BHG Company Overview Who We Are BHG s Medical Mission BHG Company Overview Behavioral Health Group (BHG) is a leading provider of opioid addiction treatment services. Our treatment centers provide pharmacotherapeutic maintenance

More information

Prior Authorization Guideline

Prior 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 information

The 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 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 information

Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling

Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling Patients with a substance misuse history are at increased risk of receiving inadequate

More information

Case Studies: Acute pain management in patients with opioid addiction. Shannon Levesque, PharmD Clinical Pharmacist

Case Studies: Acute pain management in patients with opioid addiction. Shannon Levesque, PharmD Clinical Pharmacist Case Studies: Acute pain management in patients with opioid addiction Shannon Levesque, PharmD Clinical Pharmacist Disclosure I have no financial relationships with industry to disclose Objectives Misconceptions

More information

Program Assistance Letter

Program Assistance Letter Program Assistance Letter DOCUMENT NUMBER: 2004-01 DATE: December 5, 2003 DOCUMENT TITLE: Use of Buprenorphine in Health Center Substance Abuse Treatment Programs TO: All Bureau of Primary Health Care

More information

MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION

MEDICATION 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 information

Opioid overdose can occur when a patient misunderstands the directions

Opioid overdose can occur when a patient misunderstands the directions Facts About Opioid Overdose How Does an Overdose Occur? Opioid overdose can occur when a patient misunderstands the directions for use, accidentally takes an extra dose, or deliberately misuses a prescription

More information

Opioid Treatment Services, Office-Based Opioid Treatment

Opioid 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 information

A 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 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 information

The ABCs of Medication Assisted Treatment

The 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 information

OFFICE-BASED BUPRENORPHINE THERAPY FOR OPIOID DEPENDENCE:

OFFICE-BASED BUPRENORPHINE THERAPY FOR OPIOID DEPENDENCE: OFFICE-BASED BUPRENORPHINE THERAPY FOR OPIOID DEPENDENCE: IMPORTANT INFORMATION FOR PRESCRIBERS BUPRENORPHINE-CONTAINING TRANSMUCOSAL PRODUCTS I. INTRODUCTION The purpose of this brochure is to provide

More information

MEDICAL ASSISTANCE BULLETIN

MEDICAL 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 information

Developing 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 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 information

Using 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 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 information

MEDICATIONS USED IN THE MANAGEMENT OF SUBSTANCE USE DISORDERS

MEDICATIONS 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 information

Review of Pharmacological Pain Management

Review of Pharmacological Pain Management Review of Pharmacological Pain Management CHAMP Activities are possible with generous support from The Atlantic Philanthropies and The John A. Hartford Foundation The WHO Pain Ladder The World Health Organization

More information

Medications for Alcohol and Opioid Use Disorders

Medications 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 information

Considerations in Medication Assisted Treatment of Opiate Dependence. AOAAM OMED Education Program Sunday, October 7, Stephen A. Wyatt, D.O.

Considerations in Medication Assisted Treatment of Opiate Dependence. AOAAM OMED Education Program Sunday, October 7, Stephen A. Wyatt, D.O. Considerations in Medication Assisted Treatment of Opiate Dependence AOAAM OMED Education Program Sunday, October 7, 2012 Stephen A. Wyatt, D.O. Addiction Psychiatrist Middlesex Hospital Middletown, Connecticut

More information

Medication-Assisted Addiction Treatment

Medication-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 information

Treating Opioid Dependence with Suboxone

Treating Opioid Dependence with Suboxone SCSU10606_HCP_Mono_13.qxd 12/13/06 3:20 PM Page a A PRACTICAL GUIDE FOR HEALTHCARE PROFESSIONALS Treating Opioid Dependence with Suboxone SCSU10606_HCP_Mono_13.qxd 12/13/06 3:20 PM Page b SCSU10606_HCP_Mono_13.qxd

More information

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Although prescription pain medications are intended to improve the lives of people with pain, their increased use and misuse

More information

Opiate Addiction and the Prescription Drug Crisis. Paul Updike, MD Medical Director of Chemical Dependency Services, Catholic Health System

Opiate Addiction and the Prescription Drug Crisis. Paul Updike, MD Medical Director of Chemical Dependency Services, Catholic Health System Opiate Addiction and the Prescription Drug Crisis Paul Updike, MD Medical Director of Chemical Dependency Services, Catholic Health System Objectives Define what addiction is Describe what opiates are

More information

Opioid/Opiate Dependent Pregnant Women

Opioid/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 information

Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients

Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients Clinical Algorithm & Preferred Medications to Treat Pain in Dialysis Patients Developed by the Mid Atlantic Renal Coalition and the Kidney End of Life Coalition September 2009 This project was supported,

More information

MEDICALLY SUPERVISED OPIATE WITHDRAWAL FOR THE DEPENDENT PATIENT. An Outpatient Model

MEDICALLY SUPERVISED OPIATE WITHDRAWAL FOR THE DEPENDENT PATIENT. An Outpatient Model MEDICALLY SUPERVISED OPIATE WITHDRAWAL FOR THE DEPENDENT PATIENT An Outpatient Model OBJECTIVE TO PRESENT A PROTOCOL FOR THE EVALUATION AND TREATMENT OF PATIENTS WHO ARE CHEMICALLY DEPENDENT ON OR SEVERLY

More information

Hospital Management of Opioid Dependence. Dependence. Disclosure. Pharmacologic Management. Methadone Utilization. Hospital Management of Opioid

Hospital Management of Opioid Dependence. Dependence. Disclosure. Pharmacologic Management. Methadone Utilization. Hospital Management of Opioid Disclosure Hospital Management of Opioid Dependence Attended Buprenorphine advisory board meeting (Schering Canada) May 2007, but personal honorarium/compensation was declined Dr. Alex Chan alexchchan@hotmail.com

More information

Tufts Health Care Institute Program on Opioid Risk Management Pharmacotherapy for Prescription Opioid Addiction: Implications for Pain Management

Tufts Health Care Institute Program on Opioid Risk Management Pharmacotherapy for Prescription Opioid Addiction: Implications for Pain Management Tufts Health Care Institute Program on Opioid Risk Management Pharmacotherapy for Prescription Opioid Addiction: Implications for Pain Management June 10 and 11, 2011 Executive Summary Introduction Opioid

More information

Heroin 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 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 information

STATISTICS. Opiate Substitution Therapy for Opiate Dependence. Alan Shein, M.D.

STATISTICS. Opiate Substitution Therapy for Opiate Dependence. Alan Shein, M.D. Opiate Substitution Therapy for Opiate Dependence Alan Shein, M.D. OH #1-1 STATISTICS Prevalence of Specific Drug Abuse and Vulnerability to Develop Addictions National Household Survey and Related Surveys

More information

1. According to recent US national estimates, which of the following substances is associated

1. 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 information

Conceptualizing and Integrating Medication Assistant Treatment into your Court s Armamentarium

Conceptualizing and Integrating Medication Assistant Treatment into your Court s Armamentarium Conceptualizing and Integrating Medication Assistant Treatment into your Court s Armamentarium Ted Parran JR. M.D. FACP Carter and Isabel Wang Professor of Medical Education CWRU School of Medicine tvp@case.edu

More information

Use of Vivitrol for Alcohol and Opioid Addiction

Use 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 information

Frequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction

Frequently 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 information

Medications for Alcohol and Drug Dependence Treatment

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 information

Medication Assisted Treatment

Medication Assisted Treatment Medication Assisted Treatment Tanya Hiser, MS, LPC State Opioid Treatment Authority Bureau Of Prevention, Treatment, & Recovery State of Wisconsin Elizabeth Collier, MSW, CSAC, ICS, LCSW TANF Best Practice

More information

Naloxone treatment of opioid overdose

Naloxone treatment of opioid overdose Naloxone treatment of opioid overdose Opioids Chemicals that act in the brain to relieve pain, often use to suppress cough, treat addiction, and provide comfort After prolonged use of opioids, increasing

More information

MAT Counselor Education Course Exam Questions Packet Part 1

MAT Counselor Education Course Exam Questions Packet Part 1 MAT Counselor Education Course Exam Questions Packet Part 1 Course No: Course Title: Course Objective: MA-1901P1 Medication-Assisted Treatment (MAT) Counselor Education Course Part 1 Includes primer on

More information

Joanna L. Starrels. 2 ND YEAR RESEARCH ELECTIVE RESIDENT S JOURNAL Volume VIII, 2003-2004. A. Study Purpose and Rationale

Joanna 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 information

Use of Buprenorphine in the Treatment of Opioid Addiction

Use 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 information

KAP Keys. For Physicians. Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment. of Opioid Addiction

KAP 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 information

CLINICAL POLICY Department: Medical Management Document Name: Vivitrol Reference Number: NH.PHAR.96 Effective Date: 03/12

CLINICAL 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 information

Blueprint for Prescriber Continuing Education Program

Blueprint for Prescriber Continuing Education Program CDER Final 10/25/11 Blueprint for Prescriber Continuing Education Program I. Introduction: Why Prescriber Education is Important Health care professionals who prescribe extended-release (ER) and long-acting

More information

Opioid Agonist Therapy: The Duration Dilemma Edwin A. Salsitz, MD, FASAM Mount Sinai Beth Israel, New York, NY March 10, 2015

Opioid 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 information

Quick Guide. For Physicians. Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment. of Opioid Addiction TIP

Quick Guide. For Physicians. Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment. of Opioid Addiction TIP Buprenorphine Clinical Guide Quick Guide For Physicians Based on TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment Clinical Guidelines for the Use of Buprenorphine in the Treatment

More information

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN MANAGEMENT OF CHRONIC NON MALIGNANT PAIN Introduction The Manitoba Prescribing Practices Program (MPPP) recognizes the important role served by physicians in relieving pain and suffering and acknowledges

More information

Opioids Research to Practice

Opioids 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 information

SUBOXONE Film, SUBOXONE Tablets, and SUBUTEX Tablets. Risk Evaluation and Mitigation Strategy (REMS) Program

SUBOXONE Film, SUBOXONE Tablets, and SUBUTEX Tablets. Risk Evaluation and Mitigation Strategy (REMS) Program SUBOXONE Film, SUBOXONE Tablets, and SUBUTEX Tablets Risk Evaluation and Mitigation Strategy (REMS) Program Office-Based Buprenorphine Therapy for Opioid Dependence: Important Information for Pharmacists

More information

Office-based Treatment of Opioid Dependence with Buprenorphine

Office-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 information

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE INTRODUCTION High dose sublingual buprenorphine (Subutex) tablets are available in the following strengths 0.4 mg, 2 mg, and 8 mg. Suboxone tablets,

More information

Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence

Buprenorphine/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 information

Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction. Frequently Asked Questions

Naltrexone 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 information

MEDICAL ASSISTANCE BULLETIN

MEDICAL 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 information

The Baltimore Buprenorphine Initiative

The Baltimore Buprenorphine Initiative The Baltimore Buprenorphine Initiative CLINICAL GUIDELINES FOR BUPRENORPHINE TREATMENT OF OPIOID DEPENDENCE IN THE BALTIMORE BUPRENORPHINE INITIATIVE Revised June 2013 Baltimore Substance Abuse Systems,

More information

DISPENSING OR SELLING NALOXONE. Guidance for pharmacy professionals when dispensing or selling naloxone as a Schedule II drug.

DISPENSING OR SELLING NALOXONE. Guidance for pharmacy professionals when dispensing or selling naloxone as a Schedule II drug. DISPENSING OR SELLING NALOXONE Guidance for pharmacy professionals when dispensing or selling naloxone as a Schedule II drug. UPDATED ON: August 10, 2016 Purpose The intent of this document is to provide

More information

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

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 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 information

Minimum 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 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 information

Heroin. How is Heroin Abused? What Other Adverse Effects Does Heroin Have on Health? How Does Heroin Affect the Brain?

Heroin. 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 information

Buprenorphine/Naloxone Training Workshop for Medical Practitioners

Buprenorphine/Naloxone Training Workshop for Medical Practitioners Buprenorphine/Naloxone Training Workshop for Medical Practitioners Program developed by Dr Nicholas Lintzeris MBBS, PhD, FAChAM (RACP) Turning Point Alcohol and Drug Centre, Melbourne, Australia Federation

More information

Heroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health?

Heroin. 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 information

Substance Abuse lifestyle Concern for mother - fetus - and - neonate

Substance Abuse lifestyle Concern for mother - fetus - and - neonate OBJECTIVES Learn about types of opioids and associated withdrawal symptoms Learn what medications are available to treat opioid addiction Understand the pros and cons associated with each medication Understand

More information

Southlake Psychiatry. Suboxone Contract

Southlake Psychiatry. Suboxone Contract Suboxone Contract Thank you for considering Southlake Psychiatry for your Suboxone treatment. Opiate Addiction is a serious condition for which you may find relief with Suboxone treatment. In order to

More information