2015 OPSC Annual Convention. syllabus. February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California

Transcription

1 2015 OPSC Annual Convention syllabus February 4-8, 2015 Hyatt Regency Mission Bay San Diego, California

2 FRIDAY, FEBRUARY 6, 2015: 9:30am - 10:30am Opioid Addiction and Buprenorphine Use * Presented by Mark Eastman, DO * California Pain / End-of-Life Care

3 PRESENTATION Learning Objectives and Self ASSESSMENT questions LEARNING OBJECTIVES 1. Recognize opioid addiction is a real problem 2. Recognize addiction is a disease 3. Recognize the scope of the crisis 4. Recognize those patients in your practice who are struggling with addiction 5. Learn what are the treatment options SELF ASSESSMENT QUESTIONS 1. The number of prescription opioid overdose fatalities from has. a. stayed the same b. doubled c. tripled d. quadrupled 2. In 2012 the number of people reported to abuse or be dependent on opioids was. a. 500K b. 1M c. 1.5M d. over 200M 3. The number of prescription opioids written increased in 1991 from 75.5M to in 2010 a. 100M b. 150M c. 180M d. over 200M 4. True/False: The DAST-10 is a diagnostic test for opioid addiction 5. True/False: The DSM-5 is a screening test for opioid addiction 6. True/False: All of the following are used to treat opioid addiction a. methadone b. counseling c. In-patient treatment programs d. 12 step programs e. office based treatment 7. True/False: Any physician with a license to practice medicine and has a DEA number can prescribe buprenorphrine OPSC s 54th Annual Convention and Exposition Syllabus 395

4 Opioid Addiction and Buprenorphine Use The very real disease with proven treatments By: Mark Eastman D.O. OPSC s 54th Annual Convention and Exposition Syllabus 396

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6 Opioid Addiction- A Disease? Opioid dependence is a physical addiction to prescription painkillers and heroin. It affects many people in the US more so than that of addiction to cocaine or methamphetamine. In 2013 there were nearly 2.4 million reports of people that had abused or were dependent on opioids or prescription painkillers. OPSC s 54th Annual Convention and Exposition Syllabus 398

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8 Common Types of Opioids Hydrocodone or Vicodin/Norco Oxycodone or Oxycontin/Percocet Fentanyl or Actiq Heroin Codeine Hydromorphone or Dilaudid Morphine Methadone OPSC s 54th Annual Convention and Exposition Syllabus 400

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10 How to Identify Opioid Addiction 1). Recognize in Your Practice 2). Screen 3). Diagnose 4). Treat OPSC s 54th Annual Convention and Exposition Syllabus 402

11 Recognize- Look for the Signs Psychosocial Signs Recurrent use resulting in a failure to fulfill obligations at work or home. Continued use resulting in interpersonal problems caused by the effects of opioids. Lack of Interest in social, occupational, or recreational activities. Physical Signs Pupillary Constriction Dry Mouth and Nose Irritation of Nasal Mucosa Perforated Nasal Septum Track Marks with or without Signs of Cellulitis OPSC s 54th Annual Convention and Exposition Syllabus 403

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13 Screen Drug Abuse Screening Test or DAST-10 OPSC s 54th Annual Convention and Exposition Syllabus 405

14 Screen Continued Discuss opioid addiction with your patients as you would any other medical condition without judgment. Because of the stigma of addiction this can be a very difficult conversation for the patient but vitally important. Let the patient know it is a chronic medical condition with available treatments such as counseling, in-patient treatment, and in-office treatment one-on-one with a physician. Convey hopefulness- your patient is not alone OPSC s 54th Annual Convention and Exposition Syllabus 406

15 Diagnose The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the criteria to diagnose opioid addiction by identifying problematic patterns of behavior This can help you specify the extent of the opioid addiction in your patients life and the aspects of their lives being hindered by their opioid addiction. OPSC s 54th Annual Convention and Exposition Syllabus 407

16 DSM-5 OPSC s 54th Annual Convention and Exposition Syllabus 408

17 Treatment Types In a clinic with methadone- a medicationassisted treatment used to block euphoria or high associated with other opioids Counseling- addresses psychological and behavioral aspects of addiction In-patient treatment programs- highly structered programs in hospitals and residential treatment centers that offer around-the-clock support OPSC s 54th Annual Convention and Exposition Syllabus 409

18 Treatment Types Continued Twelve Step Programs- based on a set of guiding principles thst outline a course of action to work towards recovery In-Office Medication-Assisted Treatmentprescription medications are used to help suppress withdrawal symptoms and decrease cravings, along with counseling and other support. OPSC s 54th Annual Convention and Exposition Syllabus 410

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20 Buprenorphine One type of medication-assisted treatment used alongside counseling and psychosocial support is buprenorphine. Buprenorphine allows for less euphoria and physical dependence, has a lower potential for misuse and has a relatively mild withdrawal profile. It is used to suppress symptoms of opioid withdrawal, decrease cravings for opioids, and block the effects of other opioids. OPSC s 54th Annual Convention and Exposition Syllabus 412

21 Buprenorphine Continued Different name brands of buprenorphine include Subutex, Suboxone, and Zubsolv. This medication is used to treat opioid addiction in the privacy of the physicain s office. It can be dispensed for take-home use of prescription OPSC s 54th Annual Convention and Exposition Syllabus 413

22 Naloxone A special narcotic drug that reverses the effects of other narcotic medicines used to treat pain or used during surgery. Also can be used to treat narcotic drug overdose. This can be used in combination with buprenorphine to treat opiate addiction. Brands that use the dual agent drug are Suboxone and Zubsolv. OPSC s 54th Annual Convention and Exposition Syllabus 414

23 Who can Prescribe Buprenorphine? Any physician with a special X number issed by the DEA. Doctors who wish to prescribe buprenorphine for opioid addiction must take an 8-hour class on addiction treatment and apply for the special DEA #. OPSC s 54th Annual Convention and Exposition Syllabus 415

24 Become Waivered Complete training provided by either the American Academy of Addiction Psychiatry, American Osteopathic Academy of Addiction Medicine, American Society of Addiction Medicine, or American Psychiatric Association. Physicians must submit a Waiver Notification Form to the Center for Substance Abuse Treatment (CSAT) to begin treating. You may treat up to 30 patients at once during the first year after which you can apply to raise the cap to 100. OPSC s 54th Annual Convention and Exposition Syllabus 416

25 References OPSC s 54th Annual Convention and Exposition Syllabus 417

26 RETURN TO TABLE OF CONTENTS OPSC s 54th Annual Convention and Exposition Syllabus 418