Buprenorphine Treatment in an Urban Community Health Center: What to Expect

Size: px
Start display at page:

Download "Buprenorphine Treatment in an Urban Community Health Center: What to Expect"

Transcription

1 500 July-August 2008 Family Medicine Clinical Research and Methods Buprenorphine Treatment in an Urban Community Health Center: What to Expect Chinazo Cunningham, MD, MS; Angela Giovanniello, PharmD; Galit Sacajiu, MD, MPH; Susan Whitley, MD; Pamela Mund, MD; Robert Beil, MD; Nancy Sohler, PhD, MPH Background: Despite new opportunities to expand buprenorphine treatment for opioid dependence, use of this treatment modality has been limited. Physicians may question their ability to successfully treat opioid-dependent patients with buprenorphine in a primary care setting. We describe a buprenorphine treatment program and treatment outcomes in an urban community health center. Methods: We conducted retrospective chart reviews on the first 41 opioid-dependent patients treated with buprenorphine/naloxone. The primary outcome was 90-day retention in treatment. Results: Patients mean age was 46 years, 70.7% were male, 58.8% Hispanic, 31.7% black, 57.5% unemployed, and 70.0% used heroin prior to treatment. Twenty-nine (70.7%) patients were retained in treatment at day 90. Compared to those not retained, patients retained in treatment were more likely to have used street methadone (0% versus 37.9%) and less likely to have used opioid analgesics (54.6% versus 20.7%) and alcohol (50.0% versus 13.8%) prior to treatment. Of the 25 patients with urine toxicology tests, 24% tested positive for opioids. Conclusions: Buprenorphine treatment for opioid dependence in an urban community health center resulted in a 90-day retention rate of 70.7%. Type of substance use prior to treatment appeared to be associated with retention. These findings can help guide program development. (Fam Med 2008;40(7):500-6.) In the United States, the rates of opioid abuse and dependence have increased over the last several years. 1-3 However, until recently, treatment options for opioid dependence have been limited. Although maintenance pharmacotherapy with opioid agonists reduces adverse consequences of opioid dependency, 4-10 fewer than 20% of opioid-dependent individuals are enrolled in substance abuse treatment programs. 11,12 Recent legislation and the Food and Drug Administration s approval of buprenorphine (an oral long-acting partial opioid agonist) for treatment of opioid dependence have broadened treatment options for opioid-dependent patients. Physicians who obtain waivers to prescribe buprenorphine to treat opioid dependence can now prescribe buprenophrine outside of restrictive substance abuse treatment settings. From the Montefiore Medical Center/Albert Einstein College of Medicine (Drs Cunningham, Giovanniello, Sacajiu, Whitley, Mund, and Beil); and City University of New York Medical School (Dr Sohler). Despite this new treatment opportunity, prescription of buprenorphine by primary care clinicians has been limited. 13,14 One potential reason for this limited use slow uptake may be physicians caution in adopting a new treatment paradigm with drug users. Few studies have been published that describe the use of buprenorphine for treating opioid dependence outside of substance abuse treatment settings or clinical trials (with strict eligibility criteria and time-intensive treatment protocols). As such, physicians may question their ability to devote sufficient time to treating substance users and be skeptical about the potential for buprenoprhine treatment to be successful. Thus, resources that can help physicians and health care administrators understand how bupreorphine treatment can be integrated into primary care settings without strict eligibility criteria or time-intensive protocols can be helpful in planning and guiding buprenorphine treatment in primary care settings. In this report, we describe treating opioid-dependent patients with buprenorhine in a community health center in the Bronx, NY. Specifically, we describe

2 Clinical Research and Methods Vol. 40, No the buprenorphine treatment program and treatment outcomes. Methods The Buprenorphine Treatment Program Setting. Buprenorphine treatment for opioid dependence was initiated in a federally qualified community health center in the South Bronx. The neighborhood in which the health center is located is one of the poorest in New York City, with 32% 46% of individuals living below the poverty line. 15 Additionally, in this neighborhood, deaths and hospitalizations from drug use and HIV are among the highest in New York City. 16 Of the 15,000 patients at the community health center, the majority are female and black or Hispanic. The study was approved by the Montefiore Medical Center institutional review board. Patients. Adult patients who presented to the health center between November 2004 and January 2007 with opioid dependence (as defined by DSM-IV criteria 17 ) were considered candidates for treatment with buprenorphine and are included in this report. Patients from within and outside of the health center were identified by health care providers, referred from outside organizations, or self-identified. Self-referred patients may have been informed about our program through word of mouth, Internet sites that provide information about buprenorphine treatment providers, or flyers/ brochures placed in the community. In accordance with the Center for Substance Abuse Treatment (CSAT) Guidelines, 18 patients with certain conditions were considered to not be appropriate for buprenorphine treatment at the health center and were referred to a substance abuse treatment center. These conditions included (1) pregnancy, (2) alcohol dependency as defined by DSM-IV criteria, (3) benzodiazepine dependency as defined by DSM-IV criteria, (4) serum transaminase levels more than five times the upper limit of normal, (5) current suicidal ideation, and (6) taking more than 30 mg of methadone daily in a methadone maintenance program in the past 30 days. In November 2006, the last criterion was changed to taking more than 60 mg of methadone daily in a methadone program in the past 14 days. Staffing. Four general internists worked closely with a clinical pharmacist to screen, assess, induce, and maintain patients with buprenorphine treatment. Each general internist was available in the health center on a part-time basis, each providing care for 1 4 half days per week. The clinical pharmacist was available 4 half days per week. Physicians were supported by routine patient care/billing, while the pharmacist was partially supported by a grant. Although one social worker was available for all health center patients, there were no on-site support groups or substance abuse counselors. Limited psychiatric and mental health counseling services were available; however, because these services were funded by the Ryan White CARE Act, they were only offered to HIV-infected patients. Initial Visit. In the initial visit prior to starting buprenorphine treatment, patients were educated about buprenorphine/naloxone, standardized substance abuse histories were taken, and laboratory tests were obtained. The substance abuse history included questions about onset of drug use, heaviest drug use, route of drug use, and amount and frequency of drug use in the previous 30 days for heroin, opioid analgesics, street methadone, prescribed methadone, benzodiazepines, crack/ cocaine, marijuana, alcohol, and other drugs if applicable. Patients were asked about current and previous drug treatment, mental health diagnoses and treatment, and social indicators. Laboratory tests included liver function tests, a urine toxicology test, and a urine pregnancy test if applicable. Eligible patients were scheduled for induction with buprenorphine/naloxone within 1 2 days after the initial visit. Buprenorphine Induction and Stabilization. Buprenorphine induction and stabilization occurred through a joint effort between the physicians and pharmacist. Providers monitored signs of opioid withdrawal using a standardized clinical tool (the Clinical Opiate Withdrawal Scale 19 ) and adjusted buprenorphine/naloxone doses accordingly (Figure 1). Because of our team approach, visits and phone calls occurred with the physician only, the pharmacist only, or both providers. Explicit counseling sessions were not offered at our health center, but psychosocial counseling techniques (eg, motivational interviewing) were often incorporated into medical visits. During the induction and stabilization process, buprenorphine/naloxone was provided on-site by the pharmacist, who dispensed enough medication until the following visit. Patients were provided the physician s and pharmacist s afterhours contact information to facilitate ongoing communication during the induction and stabilization process. The induction period typically occurred on days 1 3 (day 1 represents the first day on which buprenorphine/ naloxone was taken), with patients reaching a stable dose of buprenorphine/naloxone on days 4 7. Buprenorphine Maintenance. Once patients doses were stable, the frequency of their contacts with the physician and pharmacist decreased. The use of urine toxicology tests varied between physicians and was guided by clinical judgment. Buprenorphine treatment was never terminated because of results of urine toxicology tests. Early in the program, all maintenance doses of buprenorphine/naloxone were dispensed by our

3 502 July-August 2008 Family Medicine Figure 1 Flow Chart of Buprenorphine Program pharmacist, but after physicians became more comfortable with buprenorphine treatment, they referred patients to community pharmacies to obtain prescriptions. We considered treatment success to be retention in buprenorphine treatment at day 90 as confirmed by medical records. Data We conducted retrospective chart reviews extracting demographic and clinical information on patients who received at least one dose of buprenorphine/naloxone between November 2004 and January 2007 at our community health center. Data were extracted from standardized substance abuse history forms, clinic visits, and laboratory tests. Because of our small sample size, we present frequencies of our variables and make inferences based on observed trends rather than relying on formal statistical significance testing. COWS Clinical Opiate Withdrawal Scale 19 * Buprenorphine Consensus Statement and unpublished data from VA/NIDA #1018 trial indicates that a first day dose of up to 16 mg can be administered. For comprehensive guidelines on buprenorphine treatment, see: Center for Susstance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opoid Addiction. Treatment Improvement Protocol (TIP) Series 40. Available at Bup%20Guidelines.pdf. Results Over the study period, 74 people inquired about buprenorphine treatment. Four people were ineligible one was not opioid dependent, one was taking >30 mg of methadone (prior to November 2006), and two were taking >60mg of methadone (after November 2006). Twenty-nine eligible patients never returned for a full assessment or buprenorphine induction. The remaining 41 patients took at least one dose of buprenorphine/naloxone and are included in this report. The mean age of the patients was 46 years, and the majority of the patients were male (70.7%), Hispanic (58.8%) or black (31.7%), unemployed (57.5%), and had public health insurance (78.1%) (Table 1). The most common referral source for patients was providers within our community health center (29.3%), followed by a nearby community-based organization/syringe exchange program (19.5%), other sites within our affiliated academic medical center (17.1%), and self-referral (17.1%). The majority of patients (70.0%) reported using heroin within 30 days prior to their initial visit. Other opioids used within 30 days prior to treatment in-

4 Clinical Research and Methods Vol. 40, No Table 1 Baseline and Treatment Characteristics of 41 Patients in the Buprenorphine Treatment Program Total Baseline Characteristics n (%) Age (mean years + SD) Male 29 (70.7) Race/ethnicity Hispanic 24 (58.5) Non-Hispanic black 13 (31.7) Non-Hispanic white 4 (9.8) Insurance Public insurance 32 (78.1) Private insurance 8 (19.5) None 1 (2.4) Employed 17 (42.5) Referral source Community health center 12 (29.3) Community-based organization 8 (19.5) Affiliated academic health center 7 (17.1) Self 7 (17.1) Methadone maintenance program 4 (9.8) Other 3 (7.3) Substance use* Heroin 28 (70.0) Opioid analgesics 12 (30.0) Prescribed methadone 11 (27.5) Street methadone 11 (29.0) Crack/cocaine 17 (42.5) Any alcohol 9 (23.1) Ever injected drugs 22 (56.4) HIV infection 13 (31.7) Hepatitis C Virus antibody positive 21 (52.5) Buprenorphine Treatment Median number of visits Induction and stabilization (days 1-7) 3 (range=1 5) Maintenance (days 8-90) 6 (range=0 17) Median buprenorphine/naloxone dose Induction (day 1) 8 mg (range=2 18 mg) Stabilization (day 7) 10 mg (range=2 32 mg) Maintenance (day 90) 12 mg (range=1 32 mg) Retained in treatment at day (70.7) Urine toxicology test performed 25 (61.0) Positive for opioids 6 (24.0) Positive for any drug 16 (64.0) Because of a few missing data points for some variables, denominators reflect the number of valid responses. * Self-reported substance use 30 days prior to initiation of buprenorphine treatment If patients were not in treatment at 90 days, then the last known dose after day 7 was recorded. Drugs tested included opioids, cocaine, cannabinoids, benzodiazepines, barbiturates, and phencyclidine. cluded prescribed and street opioid analgesics (30.0%), street methadone (29.9%), and prescribed methadone (27.5%). Other substances used prior to treatment included crack/cocaine (42.5%) and any alcohol (23.1%). The majority of patients had a history of injection drug use (56.4%) and positive antibodies to hepatitis C virus (52.5%). Thirteen (31.7%) were infected with HIV. Of the 41 patients who took at least one dose of buprenorphine/naloxone, 29 (70.7%) were induced at our community health center, and 12 were induced elsewhere (eg, in a hospital or drug treatment program). Of those induced in our health center, the median number of visits during the induction and stabilization period (days 1 7) was three visits. For all patients, the median number of visits during the maintenance period (days 8 90) was six visits. The dosing of buprenorphine varied among patients. In general, however, the majority of patients required doses that were in the middle range of approved doses (maximum buprenorphine/naloxone dose recommended is 32 mg/day). On day 1 of induction the median buprenorphine/naloxone dose was 8 mg, with 73.2% of patients receiving a dose between 4 8 mg. On day 7 after stabilization, the median dose was 10 mg, with 63.2% of patients receiving a dose between 8 16 mg. On day 90 (or last day of treatment if not retained), the median dose was 12 mg, with 68.6% of patients receiving a dose between 8 16 mg. Twenty-nine (70.7%) patients were retained in treatment at day 90. Twenty-five (61.0%) patients had at least one urine toxicology test performed after starting buprenorphine treatment. Physicians practices varied with regard to urine toxicology tests: one tested 100% of patients, one tested 75.0%, one tested 41.2%, and one tested no patients (but had treated only one patient). Of these 25 patients with tests, most had two or more tests, with tests occurring at various intervals ranging from day 2 to day 90. Of those with tests, 24% had at least one test positive for opioids, and 64% had at least one test positive for any drug (opioids, cocaine, cannabinoids, benzodiazepines, barbiturates, phencyclidine). The most common drugs present in positive tests were cocaine (32.0%) and cannabinoids (28.0%). Compared to those not retained, patients retained in treatment were more likely to have used street methadone (0% versus 37.9%, P<.05) and less likely to have used opioid analgesics (54.6% versus 20.7%, P<.05) and alcohol (50.0% versus 13.8%, P<.05) prior to treatment (Table 2). Discussion In an urban community health center, patients who sought treatment for opioid dependence with buprenorphine were predominantly male, from racial/ethnic minorities, and heroin users. Overall, the 90-day retention rate was 71%. Our data suggest that compared to those

5 504 July-August 2008 Family Medicine Baseline Characteristics Table 2 Baseline and Treatment Characteristics of 41 Patients Not Retained and Retained in Buprenorphine Treatment Not Retained in Buprenorphine Treatment (n=12) n (%) not retained in buprenorphine treatment, those retained may be more likely to have used street methadone and less likely to have used opioid analgesics and alcohol prior to starting treatment. Of those with urine toxicology tests, 24% had evidence of ongoing opioid use. Our 90-day retention rate of 71% is comparable to that in the few primary care-based buprenorphine treatment programs previously described. Despite having patients with a higher socioeconomic status, one buprenorhpine program in Rhode Island reported a retention rate of 59% at 24 weeks. 20 Another buprenorphine program treating homeless and primary care patients in Boston had retention rates of 77% 93% at 3 months, respectively. 21 However, in that program patients had Retained in Buprenorphine Treatment (n=29) n (%) Male 9 (75.0) 20 (69.0) Hispanic ethnicity 6 (50.0) 18 (62.1) Employed 2 (18.2) 15 (51.7) Substance use* Heroin 9 (81.8) 19 (65.5) Opioid analgesics 6 (54.6) 6 (20.7) Prescribed methadone 3 (27.3) 8 (27.6) Street methadone 0 (0) 11 (37.9) Crack/cocaine 6 (54.6) 11 (37.9) Any alcohol 5 (50.0) 4 (13.8) Ever injected drugs 6 (60.0) 16 (55.2) HIV infection 6 (50.0) 7 (24.1) Buprenorphine treatment Median buprenorphine/naloxone dose Induction (day 1) 8 mg 8 mg Stabilization (day 7) 10 mg 9 mg Maintenance (day 90) 12 mg 12 mg Urine toxicology tests performed 5 (41.7) 20 (69.0) Positive for opioids 1 (20.0) 5 (25.0) Positive for any drug 4 (80.0) 12 (60.0) All percentages signify column percentages. Because of a few missing data points for some variables, denominators reflect the number of valid responses. * Self-reported substance use 30 days prior to initiation of buprenorphine treatment P<.05 If patients were not in treatment at 90 days, then the last known dose after day 7 was recorded Drugs tested included opioids, cocaine, cannabinoids, benzodiazepines, barbiturates, and phencyclidine contacts per person with the nurse case manager in the first month of treatment. Our retention rate is a bit lower than those reported in clinical trials conducted in primary care settings These studies had strict eligibility criteria (eg, no cocaine use), on-site dispensing of buprenorphine up to thrice weekly, and required one three weekly counseling sessions. Retention rates in these trials were 78% 81% at weeks. These types of programs with strict eligibilty criteria and intense protocols may be difficult to implement in many primary care settings. Our data suggest that retention rates may differ by type of substance use prior to initiating buprenorphine treatment. We found that retention rates were higher among those using street methadone and lower among those using opioid analgesics and any alcohol prior to starting buprenorphine. Based on our clinical experience, we hypothesize that patients who were buying street methadone may have been self-treating their opioid dependence. We believe this selftreatment signified the desire to reduce or stop illicit opioid use but without guidance of health care providers. These patients who self-treated with street methadone may have been more motivated than others to remain in a treatment program that was specifically not a methadone maintenance treatment program. Our finding that individuals who used opioid analgesics prior to starting treatment were less likely to be retained in treatment conflicts with findings of a few other studies In these studies, opioid analgesic users differed from heroin users in demographic characteristics and drug treatment histories. Opioid analgesic users may represent a different type of opioid-dependent patient than heroin users. In our clinical experience, many patients who take opioid analgesics do not view their use as problematic, even with DSM-IV diagnoses of opioid dependence. Although alcohol dependence was an exclusion criterion, no patients were excluded for this reason. However, any alcohol use was associated with poor retention. With only nine patients who reported alcohol use, we were unable to separately analyze those with heavy, frequent, or binge drinking. Thus, alcohol use and its associated consequences should be further explored in research focusing on buprenorphine treatment. Although urine toxicology tests were performed in only 61% of patients after starting buprenorphine treatment, 24% tested positive for opioids. However, 64% of those tested had evidence of other drug use, the most common being cocaine and cannibinoids. Of the 16 individuals without urine toxicology tests, nine

6 Clinical Research and Methods Vol. 40, No were retained in treatment and seven were not. Clearly, we cannot be certain whether patients who did not have urine toxicology tests used drugs or not. If all 16 patients continued using opioids, then the proportion of patients with continued opioid use would be 54% (22 of 41) instead of 24% (6 of 25). Thus, in a worst-case scenerio, we would still consider buprenorphine treatment moderately successful. Although not ideal for our evaluation, the lack of systematic collection of urine toxicology tests reflects patient care provided by different health care providers in the community. While obtaining urine toxicology tests is mandatory for methadone maintenance treatment, it is not required for buprenorphine treatment. Physicians decisions on whether to obtain urine toxicology tests is complex and beyond the scope of this discussion. Some may argue that ordering urine toxicology tests may undermine the patient-provider relationship due to confrontation and distrust. However, we believe that if handled in a sensitive way, obtaining urine toxicology tests can be one additional piece of important clinical information that can help improve patient-provider communication and patient care. While the clinical goal for many patients is to eventually achieve abstinence from opioid addiction, providers treating opioid addiction in the primary care setting must recognize that reduction in opioid use should be considered a positive outcome, even if abstinence is not immediately achieved. In line with harm reduction principles, appropriate outcomes for many patients might include less opioid use, less injection drug use, less criminal activity, and more engagment with the health care system. Bringing opioid-dependent patients into primary care settings allows for more opportunities to treat or prevent associated chronic diseases such as HIV and/or hepatitis C virus infections. Further examation into the potential benefits of related outcomes of buprenorphine treatment in the primary care setting is warranted. Limitations There are limitations to our evaluation. Our sample size is small, which reflects the slow uptake of buprenorphine noted in previous studies. 13,14 Because of this we were unable to fully examine factors associated with retention in treatment due to limited power. In addition, because our study was a retrospective chart review, we were unable to collect data that were not systematically recorded in medical records, which may be associated with treatment retention. Finally, similar to other buprenorhpine treatment models based in primary care settings, 25,26 a critical part of our program is our partially grant-funded pharmacist. Although many buprenorphine treatment models in primary care settings have a dedicated nurse in a role similar to our pharmacist, in many primary care settings, filling a similar role with a nurse, nurse practitioner, or pharmacist may not be feasible. Despite these limitations, our findings add to the scant literature published on buprenophrine treatment outside of substance abuse treatment settings and outside of strict, time-intensive clinical trials. Conclusions Buprenorphine treatment for opioid dependence in an urban community health center resulted in a 90-day retention rate of 71%. Type of substance use prior to starting buprenorphine treatment appeared to be associated with retention rates. High retention was associated with street methadone use, and low retention was associated with opioid analgesic and alcohol use prior to treatment. Of patients with urine toxicology tests, less than one fourth had tests positive for opioids. Findings from this evaluation can help physicians and health care administrators guide program development. Acknowledgments: This study was supported by the Health Resources and Services Administration, HIV/AIDS Bureau, Special Projects of National Significance, Grant #6H97HA , and the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center funded by the National Institutes of Health (NIH AI-51519). Dr Cunningham is supported by the Robert Wood Johnson Foundation s Harold Amos Medical Faculty Development Program. These findings were presented, in part, at the 6th International Conference on Urban Health, Amsterdam, Holland, October Conflicts of interest: Dr Whitley gives talks sponsored by Reckitt Benckiser. All other authors have no conflicts of interest. Corresponding Author: Address correspondence to Dr Cunningham, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY Fax: ccunning@ montefiore.org. Re f e r e n c e s 1. Crane E. Narcotic analgesics. The Drug Abuse Warning Network (DAWN) Report, pdf. Accessed November 18, Office of National Drug Control Policy (ONDCP). Drug Policy Information Clearinghouse. Heroin fact sheet, pdf/heroin2.pdf. Accessed November 18, Substance Abuse and Mental Health Services Administration. Office of Applied Studies. Emergency department trends from the Drug Abuse Warning Network, final estimates Rockville, Md: DAWN Series: D-24, DHHS publication no. (SMA) , dawninfo.samhsa.gov/old_dawn/pubs_94_02/edpubs/2002final/files/ EDTrendFinal02AllText.pdf. Accessed November 18, Kakko J, Svanborg KD, Kreek MJ, Heilig M. One-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial. Lancet 2003;361(9358): Effective medical treatment of opiate addiction. National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. JAMA 1998;280(22): Ball JC, Ross A. The effectiveness of methadone maintenance treatment: patients, programs, services, and outcome. New York: Springer-Verlag, Fiellin DA, O Connor PG. Clinical practice. Office-based treatment of opioid-dependent patients. N Engl J Med 2002;347(11): Fudala PJ, Bridge TP, Herbert S, et al. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. N Engl J Med 2003;349(10):

7 506 July-August 2008 Family Medicine 9. Sees KL, Delucchi KL, Masson C, et al. Methadone maintenance versus 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA 2000; 283(10): Johnson RE, Chutuape MA, Strain EC, Walsh SL, Stitzer ML, Bigelow GE. A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. N Engl J Med 2000; 343(18): O Connor PG, Fiellin DA. Pharmacologic treatment of heroin-dependent patients. Ann Intern Med 2000;133(1): Executive Office of the President, Office of National Drug Control Policy. Consultation document on opioid agonist treatment, www. whitehousedrugpolicy.gov/science%5ftech/methadone/metha3.html. Accessed November 18, Kissin W, McLeod C, Sonnefeld J, Stanton A. Experiences of a national sample of qualified addiction specialists who have and have not prescribed buprenorphine for opioid dependence. J Addict Dis 2006; 25(4): Cunningham CO, Kunins HV, Roose RJ, Elam RT, Sohler NL. Barriers to obtaining waivers to prescribe buprenorphine for opioid addiction treatment among HIV physicians. J Gen Intern Med 2007; 22(9): Karpati A, Kerker B, Mostashari F, et al. Health disparities in New York City. New York: New York City Department of Health and Mental Hygiene, Accessed November 18, Olson EC, Van Wye G, Kerker B, Thorpe L, Frieden TR. Take care Highbridge and Morrisania. NYC community health profiles, second edition. Accessed February 3, Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association, Center for Substance Abuse Treatment. Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS publication no. (SMA) Rockville, Md: Substance Abuse and Mental Health Services Administration, Accessed February 5, Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs 2003;35(2): Stein MD, Cioe P, Friedmann PD. Buprenorphine retention in primary care. J Gen Intern Med 2005;20(11): Alford DP, LaBelle CT, Richardson JM, et al. Treating homeless opioid dependent patients with buprenorphine in an office-based setting. J Gen Intern Med 2007;22(2): Fiellin DA, Pantalon MV, Pakes JP, O Connor PG, Chawarski M, Schottenfeld RS. Treatment of heroin dependence with buprenorphine in primary care. Am J Drug Alcohol Abuse 2002;28(2): O Connor PG, Oliveto AH, Shi JM, et al. A randomized trial of buprenorphine maintenance for heroin dependence in a primary care clinic for substance users versus a methadone clinic. Am J Med 1998; 105(2): Sullivan LE, Barry D, Moore BA, et al. A trial of integrated buprenorphine/naloxone and HIV clinical care. Clin Infect Dis 2006;43(suppl 4):S184-S Basu S, Smith-Rohrberg D, Bruce RD, Altice FL. Models for integrating buprenorphine therapy into the primary HIV care setting. Clin Infect Dis 2006;42(5): Sullivan LE, Bruce RD, Haltiwanger D, et al. Initial strategies for integrating buprenorphine into HIV care settings in the United States. Clin Infect Dis 2006;43(suppl 4):S191-S196.

Health Care Law School Attitudes and Beliefs About Buprenorphine

Health Care Law School Attitudes and Beliefs About Buprenorphine 336 May 2006 Family Medicine Clinical Research and Methods Attending Physicians and Residents Attitudes and Beliefs About Prescribing Buprenorphine at an Urban Teaching Hospital Chinazo O. Cunningham,

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

Treatment of Opioid Dependence: A Randomized Controlled Trial. Karen L. Sees, DO, Kevin L. Delucchi, PhD, Carmen Masson, PhD, Amy

Treatment of Opioid Dependence: A Randomized Controlled Trial. Karen L. Sees, DO, Kevin L. Delucchi, PhD, Carmen Masson, PhD, Amy Category: Heroin Title: Methadone Maintenance vs 180-Day psychosocially Enriched Detoxification for Treatment of Opioid Dependence: A Randomized Controlled Trial Authors: Karen L. Sees, DO, Kevin L. Delucchi,

More 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

Treatment of Prescription Opioid Dependence

Treatment of Prescription Opioid Dependence Treatment of Prescription Opioid Dependence Roger D. Weiss, MD Chief, Division of Alcohol and Drug Abuse McLean Hospital, Belmont, MA Professor of Psychiatry, Harvard Medical School, Boston, MA Prescription

More information

American Society of Addiction Medicine

American Society of Addiction Medicine American Society of Addiction Medicine Public Policy Statement on Office-based Opioid Agonist Treatment (OBOT) BACKGROUND Methadone maintenance treatment of opioid addiction was developed in 1965 and implemented

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

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

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

Buprenorphine Pharmacotherapy in the Treatment of Opioid Dependence

Buprenorphine Pharmacotherapy in the Treatment of Opioid Dependence Buprenorphine Pharmacotherapy in the Treatment of Opioid Dependence Summary Prepared by the Committee on the Treatment of Opioid Dependence of CSAM November 27, 2006 Medication Assisted Treatment for opioid

More information

Considerations in Addressing Potential Abuse

Considerations in Addressing Potential Abuse Perspectives Prescription Opioid Abuse and Potential Role of Office- Based Opioid Maintenance Treatment in Integrating Medical and Substance Abuse Care Patrick G. O'Connor, MD, MPH, reviewed issues in

More information

The NJSAMS Report. Heroin Admissions to Substance Abuse Treatment in New Jersey. In Brief. New Jersey Substance Abuse Monitoring System.

The NJSAMS Report. Heroin Admissions to Substance Abuse Treatment in New Jersey. In Brief. New Jersey Substance Abuse Monitoring System. New Jersey Substance Abuse Monitoring System The NJSAMS Report May 2011 Admissions to Substance Abuse Treatment in New Jersey eroin is a semi-synthetic opioid drug derived from morphine. It has a high

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

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

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

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

Jennifer Sharpe Potter, PhD, MPH Associate Professor Division of Alcohol and Drug Addiction Department of Psychiatry

Jennifer Sharpe Potter, PhD, MPH Associate Professor Division of Alcohol and Drug Addiction Department of Psychiatry Buprenorphine/Naloxone and Methadone Maintenance Treatment Outcomes for Opioid Analgesic, Heroin, and Combined Users: Findings From Starting Treatment With Agonist Replacement Therapies (START) Jennifer

More 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

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

In 2010, approximately 8 million Americans 18 years and older were dependent on alcohol.

In 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 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

Opioid Agonist Treatment in Correctional Settings

Opioid Agonist Treatment in Correctional Settings Opioid Agonist Treatment in Correctional Settings Robert P. Schwartz, M.D. Friends Research Institute Open Society Institute - Baltimore Treating Heroin-Addicted Prisoners Opioid agonist treatment is widely

More information

Opioid Addiction & Corrections

Opioid Addiction & Corrections Opioid Addiction & Corrections Medication Assisted Treatment in the Connecticut Department of Correction April 30, 2015--CJPAC Kathleen F. Maurer, MD, MPH, MBA Medical Director and Director of Health and

More information

BUPRENORPHINE TREATMENT

BUPRENORPHINE TREATMENT BUPRENORPHINE TREATMENT Curriculum Infusion Package (CIP) Based on the Work of Dr. Thomas Freese of the Pacific Southwest ATTC Drug Addiction Treatment Act of 2000 (DATA 2000) Developed by Mountain West

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

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

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

Behavioral Health Barometer. United States, 2014

Behavioral Health Barometer. United States, 2014 Behavioral Health Barometer United States, 2014 Acknowledgments This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) by RTI International under contract No.

More information

Buprenorphine (Subutex) and buprenorphine-naloxone

Buprenorphine (Subutex) and buprenorphine-naloxone ORIGINAL ARTICLE Two-year Experience with Buprenorphine-naloxone (Suboxone) for Maintenance Treatment of Opioid Dependence Within a Private Practice Setting James W. Finch, MD, Jonathan B. Kamien, PhD,

More information

The Determinations Report: A Report On the Physician Waiver Program Established by the. Drug Addiction Treatment Act of 2000 ( DATA )

The Determinations Report: A Report On the Physician Waiver Program Established by the. Drug Addiction Treatment Act of 2000 ( DATA ) The Determinations Report: A Report On the Physician Waiver Program Established by the Drug Addiction Treatment Act of 2000 ( DATA ) Submitted by the Center for Substance Abuse Treatment, Substance Abuse

More information

Buprenorphine for Office-Based Treatment of Patients With Opioid Addiction. James J. Manlandro, Jr, DO

Buprenorphine for Office-Based Treatment of Patients With Opioid Addiction. James J. Manlandro, Jr, DO The Drug Addiction Treatment Act of 2000 (DATA 2000) was established to create a new paradigm for medication-assisted treatment of opiate addiction in the United States. Before enactment of DATA 2000,

More information

INSTRUCTIONS AND PROTOCOLS FOR THE IMPLEMENTATION OF MEDICATION-ASSISTED TREATMENT FOR OPIOID/OPIATE DEPENDENCE

INSTRUCTIONS AND PROTOCOLS FOR THE IMPLEMENTATION OF MEDICATION-ASSISTED TREATMENT FOR OPIOID/OPIATE DEPENDENCE 201 Mulholland Bay City, MI 48708 P 989-497-1344 F 989-497-1348 www.riverhaven-ca.org Title: MAT Protocol Original Date: March 30, 2009 Latest Revision Date: December 16, 2013 Approval/Release Date: January

More information

How To Treat Anorexic Addiction With Medication Assisted Treatment

How To Treat Anorexic Addiction With Medication Assisted Treatment Medication Assisted Treatment for Opioid Addiction Tanya Hiser, MS, LPC Premier Care of Wisconsin, LLC October 21, 2015 How Did We Get Here? Civil War veterans and women 19th Century physicians cautious

More information

Substance Abuse During Pregnancy: Moms on Meds. Jennifer Anderson Maddron, M.D LeConte Womens Healthcare Associates

Substance Abuse During Pregnancy: Moms on Meds. Jennifer Anderson Maddron, M.D LeConte Womens Healthcare Associates Substance Abuse During Pregnancy: Moms on Meds Jennifer Anderson Maddron, M.D LeConte Womens Healthcare Associates 2010 National Survey on Drug Use and Health An estimated 4.4% of pregnant women reported

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

The San Francisco Office Based Opiate Treatment (OBOT) Pilot Program

The San Francisco Office Based Opiate Treatment (OBOT) Pilot Program The San Francisco Office Based Opiate Treatment (OBOT) Pilot Program Brad Shapiro, MD Medical Director And Stephen Dominy, M.D. Executive Director With Special Thanks to Dr. Alice Gleghorn and Dr. David

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

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

AMERICAN ACADEMY OF ADDICTION PSYCHIATRY

AMERICAN ACADEMY OF ADDICTION PSYCHIATRY AMERICAN ACADEMY OF ADDICTION PSYCHIATRY BOARD OF DIRECTORS Michael H. Gendel, MD President Elinore F. McCance-Katz, MD, PhD President-Elect Joseph G. Liberto, MD Vice President Laurence M. Westreich,

More information

Testimony of The New York City Department of Health and Mental Hygiene. before the

Testimony of The New York City Department of Health and Mental Hygiene. before the Testimony of The New York City Department of Health and Mental Hygiene before the New York City State Assembly Committee on Alcoholism and Drug Abuse on Programs and Services for the Treatment of Opioid

More information

Best Practices in Opioid Dependence Treatment

Best Practices in Opioid Dependence Treatment Best Practices in Opioid Dependence Treatment Anthony L. Jordan Health Center Linda Clark, MD, MS Medical Director Alana Ramos, BS Suboxone Clinic Manager Case Studies Nicole White female 27 years of age

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

Advances in Addiction Science and Treatment. Mady Chalk, Ph.D., MSW Treatment Research Institute November, 2014

Advances in Addiction Science and Treatment. Mady Chalk, Ph.D., MSW Treatment Research Institute November, 2014 Advances in Addiction Science and Treatment Mady Chalk, Ph.D., MSW Treatment Research Institute November, 2014 Treatment Research Research Institute, Institute, 20132012 Presentation 1. What is driving

More information

State Policies and Adoption of Buprenorphine: Summary Results of Telephone Interviews with State Agency Staff

State Policies and Adoption of Buprenorphine: Summary Results of Telephone Interviews with State Agency Staff State Policies and Adoption of Buprenorphine: Summary Results of Telephone Interviews with State Agency Staff Funding Source: Grant No. 053773 Robert Wood Johnson Foundation Substance Abuse Policy Research

More information

Beyond SBIRT: Integrating Addiction Medicine into Primary Care

Beyond 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 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

TENNESSEE BOARD OF MEDICAL EXAMINERS POLICY STATEMENT OFFICE-BASED TREATMENT OF OPIOID ADDICTION

TENNESSEE BOARD OF MEDICAL EXAMINERS POLICY STATEMENT OFFICE-BASED TREATMENT OF OPIOID ADDICTION TENNESSEE BOARD OF MEDICAL EXAMINERS POLICY STATEMENT OFFICE-BASED TREATMENT OF OPIOID ADDICTION The Tennessee Board of Medical Examiners has reviewed the Model Policy Guidelines for Opioid Addiction Treatment

More 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

Manlandro Using Buprenorphine for Outpatient Opioid Detoxification. James J. Manlandro, Jr, DO

Manlandro Using Buprenorphine for Outpatient Opioid Detoxification. James J. Manlandro, Jr, DO The Drug Addiction Treatment Act of 2000 (DATA 2000) was established to create a new paradigm for medication-assisted treatment of persons with opiate addiction in the United States. Before enactment of

More information

Practice Protocol. Buprenorphine Guidance Protocol

Practice Protocol. Buprenorphine Guidance Protocol Practice Protocol Buprenorphine Guidance Protocol Developed by the Arizona Department of Health Services Division of Behavioral Health Services Effective Date: 02/23/11 Title Buprenorphine Guidance Protocol

More information

Narcotic Replacement Therapy Policy San Mateo County Alcohol and Other Drug Services. Lea Goldstein, Ph.D. Brian Greenberg, Ph.D.

Narcotic Replacement Therapy Policy San Mateo County Alcohol and Other Drug Services. Lea Goldstein, Ph.D. Brian Greenberg, Ph.D. Narcotic Replacement Therapy Policy San Mateo County Alcohol and Other Drug Services Lea Goldstein, Ph.D. Brian Greenberg, Ph.D. The Narcotic Replacement Therapy (NRT) Policy Narcotic replacement programs

More information

BUPRENORPHINE TREATMENT

BUPRENORPHINE TREATMENT BUPRENORPHINE TREATMENT Curriculum Infusion Package (CIP) Based on the Work of Dr. Thomas Freese of the Pacific Southwest ATTC Drug Addiction Treatment Act of 2000 (DATA 2000) Developed by Mountain West

More information

Impact of Systematic Review on Health Services: The US Experience

Impact of Systematic Review on Health Services: The US Experience Impact of Systematic Review on Health Services: The US Experience Walter Ling MD Integrated Substance Abuse Programs (ISAP) UCLA The effectiveness of interventions for addictions: The Drug and Alcohol

More information

Financial Disclosures

Financial Disclosures Opioid Agonist Therapy: To Maintain or Not To Maintain - A Case Discussion PCSS-MAT American Psychiatric Association Drs. Ed Salsitz, John Renner, Timothy Fong April 14, 2015 Financial Disclosures Edwin

More information

Medication-Assisted Treatment for Opioid Addiction

Medication-Assisted Treatment for Opioid Addiction Medication-Assisted Treatment for Opioid Addiction This document contains a general discussion of medications approved by the U.S. Food and Drug Administration (FDA) for use in the treatment of opioid

More information

Substance Abuse Treatment Admissions for Abuse of Benzodiazepines

Substance Abuse Treatment Admissions for Abuse of Benzodiazepines Treatment Episode Data Set The TEDS Report June 2, 2011 Substance Abuse Treatment Admissions for Abuse of Benzodiazepines Benzodiazepines are a class of central nervous system depressant drugs that are

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

Non medical use of prescription medicines existing WHO advice

Non medical use of prescription medicines existing WHO advice Non medical use of prescription medicines existing WHO advice Nicolas Clark Management of Substance Abuse Team WHO, Geneva Vienna, June 2010 clarkn@who.int Medical and Pharmaceutical role Recommendations

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call 1-800-662-HELP(4357)

More 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

Testimony of. Daliah Heller, PhD, MPH Assistant Commissioner Bureau of Alcohol and Drug Use Prevention, Care and Treatment

Testimony of. Daliah Heller, PhD, MPH Assistant Commissioner Bureau of Alcohol and Drug Use Prevention, Care and Treatment Testimony of Daliah Heller, PhD, MPH Assistant Commissioner Bureau of Alcohol and Drug Use Prevention, Care and Treatment New York City Department of Health and Mental Hygiene before the New York City

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

Opiate Addiction in Ohio: An Update on Scope of Problem Ashland Ohio

Opiate Addiction in Ohio: An Update on Scope of Problem Ashland Ohio Governor s Cabinet Opiate Action Team Promoting Wellness and Recovery John R. Kasich, Governor Tracy J. Plouck, Director Opiate Addiction in Ohio: An Update on Scope of Problem Ashland Ohio November 14,

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction [NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call

More information

Magellan Medication-Assisted Treatment Industry Validation Points

Magellan Medication-Assisted Treatment Industry Validation Points Magellan Medication-Assisted Treatment Industry Validation Points The Magellan medication-assisted treatment (MAT) program focuses on increasing the appropriate use of proven medications to treat members

More information

In 2000, the passage of the Drug Addiction Treatment Act enabled. Barriers to Primary Care Physicians Prescribing Buprenorphine

In 2000, the passage of the Drug Addiction Treatment Act enabled. Barriers to Primary Care Physicians Prescribing Buprenorphine Barriers to Primary Care Physicians Prescribing Eliza Hutchinson, BA Mary Catlin, BSN, MPH C. Holly A. Andrilla, MS Laura-Mae Baldwin, MD, MPH Roger A. Rosenblatt, MD, MPH, MFR University of Washington,

More information

Patients are still addicted Buprenorphine is simply a substitute for heroin or

Patients are still addicted Buprenorphine is simply a substitute for heroin or BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module VI: Myths About the Use of Medication in Recovery Patients are still addicted Buprenorphine is simply a substitute

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

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

Appendices to Interim Report on the Baltimore Buprenorphine Initiative. Managed Care Organization Information Pages

Appendices to Interim Report on the Baltimore Buprenorphine Initiative. Managed Care Organization Information Pages Appendices to Interim Report on the Baltimore Buprenorphine Initiative Appendix A Managed Care Organization Information Pages Appendix B Buprenorphine Online Physician Training Information Packet Appendix

More information

Putting Addiction Treatment Medications to Use: Lessons Learned

Putting Addiction Treatment Medications to Use: Lessons Learned Putting Addiction Treatment Medications to Use: Lessons Learned George E. Woody, M.D. Laura McNicholas, M.D., Ph.D. Department of Psychiatry, University of Pennsylvania School of Medicine and Philadelphia

More information

Automated telephone-based CBT to support opioid recovery in methadone maintenance patients

Automated telephone-based CBT to support opioid recovery in methadone maintenance patients Automated telephone-based CBT to support opioid recovery in methadone maintenance patients Brent A. Moore, Ph.D. Yale University School of Medicine Funded by NIDA K01 DA022398 NIDA R01 DA 034678 Brent.Moore@Yale.edu

More information

The Changing Face of Opioid Addiction:

The Changing Face of Opioid Addiction: 9th Annual Training and Educational Symposium September 6, 2012 The Changing Face of Opioid Addiction: A Review of the Research and Considerations for Care Mark Stanford, Ph.D. Santa Clara County Dept

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

New 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 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 information

Expanding access to treatment for opiate addiction: Successes and Barriers

Expanding access to treatment for opiate addiction: Successes and Barriers Expanding access to treatment for opiate addiction: Successes and Barriers Miriam Komaromy, MD Medical Director, Turquoise Lodge Addiction Treatment Hospital, NM Department of Health; and UNM Project ECHO

More information

Resources for the Prevention and Treatment of Substance Use Disorders

Resources for the Prevention and Treatment of Substance Use Disorders Resources for the Prevention and Treatment of Substance Use Disorders Table of Contents Age-standardized DALYs, alcohol and drug use disorders, per 100 000 Age-standardized death rates, alcohol and drug

More information

Table of Contents. I. Introduction... 2. II. Summary... 3. A. Total Drug Intoxication Deaths... 5. B. Opioid-Related Deaths... 9

Table of Contents. I. Introduction... 2. II. Summary... 3. A. Total Drug Intoxication Deaths... 5. B. Opioid-Related Deaths... 9 Table of Contents I. Introduction... 2 II. Summary... 3 III. Charts A. Total Drug Intoxication Deaths... 5 B. Opioid-Related Deaths... 9 C. Heroin-Related Deaths... 11 D. Prescription Opioid-Related Deaths...

More information

Appendix to Tennessee Department of Health: Tennessee Clinical Practice Guidelines for Outpatient Management of Chronic Non- Malignant Pain

Appendix to Tennessee Department of Health: Tennessee Clinical Practice Guidelines for Outpatient Management of Chronic Non- Malignant Pain Appendix to Tennessee Department of Health: Tennessee Clinical Practice Guidelines for Outpatient Management of Chronic Non- Malignant Pain Division of Workers Compensation 04.01.2015 Background Opioids

More information

SUPPORTING WOMEN USING OPIATES IN PREGNANCY: A Guideline for Primary Care Providers May, 2011

SUPPORTING WOMEN USING OPIATES IN PREGNANCY: A Guideline for Primary Care Providers May, 2011 INTRODUCTION SUPPORTING WOMEN USING OPIATES IN PREGNANCY: A Guideline for Primary Care Providers May, 2011 Prevalence of Opiate Use and Impact on Maternal, Fetal, and Neonatal Health: The prevalence of

More information

Substance Abuse Treatment Admissions Involving Abuse of Pain Relievers: 1998 and 2008

Substance Abuse Treatment Admissions Involving Abuse of Pain Relievers: 1998 and 2008 Treatment Episode Data Set The TEDS Report July 15, 010 Substance Abuse Treatment Admissions Involving Abuse of Pain Relievers: 1998 and 008 In Brief The proportion of all substance abuse treatment admissions

More information

METHADONE SUBSTITUTION THERAPY PROGRAM AND TOXICOLOGICAL STUDIES

METHADONE SUBSTITUTION THERAPY PROGRAM AND TOXICOLOGICAL STUDIES METHADONE SUBSTITUTION THERAPY PROGRAM AND TOXICOLOGICAL STUDIES Halina MATSUMOTO, El bieta WO NY, Anna DZIKLIÑSKA, Ma³gorzata ABRAMOWSKA Laboratory of Psychopharmacology, 1st Department of Psychiatry,

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

Opioids for Pain Treatment. Opioids for Chronic Pain and Addiction Treatment. Outline for Today. Opioids for pain treatment

Opioids for Pain Treatment. Opioids for Chronic Pain and Addiction Treatment. Outline for Today. Opioids for pain treatment Opioids for Chronic Pain and Addiction Treatment Joseph Merrill M.D., M.P.H. University of Washington February 24, 2012 Outline for Today Opioids for pain treatment Trends Problems High dose prescribing

More information

Journal of Adolescent Health 40 (2007) 477 482. Clinical observation. Manuscript received August 8, 2006; manuscript accepted November 22, 2006

Journal of Adolescent Health 40 (2007) 477 482. Clinical observation. Manuscript received August 8, 2006; manuscript accepted November 22, 2006 Journal of Adolescent Health 40 (2007) 477 482 Clinical observation Buprenorphine Replacement Therapy for Adolescents with Opioid Dependence: Early Experience from a Children s Hospital-Based Outpatient

More information

Substance Abuse 2014-2015. Chapter 10: Substance Abuse

Substance Abuse 2014-2015. Chapter 10: Substance Abuse Substance Abuse 214-215 Chapter 1: Substance Abuse 265 214-215 Health of Boston Substance Abuse Substance abuse involves the excessive use of alcohol or illicit substances (e.g., marijuana, cocaine, heroin,

More information

Objectives: Perform thorough assessment, and design and implement care plans on 12 or more seriously mentally ill addicted persons.

Objectives: Perform thorough assessment, and design and implement care plans on 12 or more seriously mentally ill addicted persons. Addiction Psychiatry Program Site Specific Goals and Objectives Addiction Psychiatry (ADTU) Goal: By the end of the rotation fellow will acquire the knowledge, skills and attitudes required to recognize

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

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

Presentation to Senate Health and Human Services Committee: Prescription Drug Abuse in Texas

Presentation to Senate Health and Human Services Committee: Prescription Drug Abuse in Texas Presentation to Senate Health and Human Services Committee: Prescription Drug Abuse in Texas David Lakey, MD Commissioner, Department of State Health Services Lauren Lacefield Lewis Assistant Commissioner,

More information

ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;03/13;06/14;07/15

ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;03/13;06/14;07/15 ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;/13;06/14;07/15 WRITTEN BY Jim Johnson Page 1 REVISED BY AUTHORIZED BY Jessica Moeller Debra Johnson I. APPLICATION: THUMB

More information

A Drug Policy for the 21st Century. Office of National Drug Control Policy

A Drug Policy for the 21st Century. Office of National Drug Control Policy A Drug Policy for the 21st Century October 18, 2014 International Nurses Society on Addictions Health Care Reform & Its Impact on Addictions Nursing: Navigating Change through the Rapids David K. Mineta,

More information

Substance Abuse Treatment. Naltrexone for Extended-Release Injectable Suspension for Treatment of Alcohol Dependence

Substance 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 information

Populations at risk for opioid overdose

Populations at risk for opioid overdose Populations at risk for opioid overdose Len Paulozzi, MD, MPH Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention April

More information

Behavioral Health Barometer. United States, 2014

Behavioral Health Barometer. United States, 2014 Behavioral Health Barometer United States, 2014 Acknowledgments This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) by RTI International under contract No.

More information

CASE STUDY: CHICAGO HEALTH OUTREACH Chicago, Illinois

CASE STUDY: CHICAGO HEALTH OUTREACH Chicago, Illinois CASE STUDY: CHICAGO HEALTH OUTREACH Chicago, Illinois This project was funded by a grant from the Health Resources and Services Administration, U.S. Department of Health and Human Services, grant #4H97HA001580201.

More information

Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director s Perspective

Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director s Perspective Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director s Perspective Dale K. Adair, MD Medical Director/Chief Psychiatric Officer OMHSAS 1 Treatment and Interventions for

More information

Heroin Addiction and Overdose: What Can We Do to Address This Growing Problem? Nora D. Volkow, M.D. Director

Heroin Addiction and Overdose: What Can We Do to Address This Growing Problem? Nora D. Volkow, M.D. Director Heroin Addiction and Overdose: What Can We Do to Address This Growing Problem? Nora D. Volkow, M.D. Director Illicit Drugs Marijuana Prescription Drug Misuse/Abuse is a Major Problem in the US Current

More information

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths Joanna G Katzman, M.D., M.S.P.H Director, UNM Pain Center Associate Professor,

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