Presented by NJATOD Officers Barbara Schlichting NJATOD Secretary Somerset Treatment Services Christie Hanvey NJATOD Vice President Spectrum Healthcare Center Maiysha Ware NJATOD President The ID: 673149
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Slide1
MEDICATION ASSISTED TREATMENT (MAT)
Presented by:
NJATOD Officers
Barbara
Schlichting
, NJATOD Secretary, Somerset Treatment Services
Christie
Hanvey
, NJATOD Vice President, Spectrum Healthcare Center
Maiysha
Ware, NJATOD President, The
Lennard
ClinicSlide2
WHAT IS MEDICATION ASSISTED TREATMENT?
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment defines MAT as:
A
ny treatment for
opioid
addiction that includes a medication (e.g., methadone,
buprenorphine
,
naltrexone
) approved by the U.S. Food and Drug Administration (FDA) for
opioid
addiction detoxification or maintenance treatment. MAT may be provided in an OTP or an OTP medication unit (e.g., pharmacy, physician’s office) or for
buprenorphine
a physician’s office or other healthcare setting. Comprehensive maintenance, medical maintenance, interim maintenance, detoxification, and medically supervised withdrawal are types of MAT. Slide3
MAT is…
MAT
combines the use of medication and behavioral therapy to treat substance use disorder.
FDA approved medications used in MAT: Methadone, Buprenorphine & Naltrexone.
MAT combines counseling with medications that block opioids’ euphoric effects and relieve relapse inducing cravings.
MAT increase patient engagement and retention in treatment, decrease drug use, infectious disease transmission and criminal activity. Slide4
Methadone
What is methadone?
Methadone is an opioid medication. Methadone reduces withdrawal symptoms in people addicted to heroin or other narcotic drugs without causing the "high" associated with the drug addiction. Methadone is used as part of drug addiction detoxification or maintenance program.
FDA Approved since 1947.
Pregnancy Category “C” Safe to use during pregnancy.
Half-life of Methadone is between 12-18 hours.
The effects of Methadone last between 24-36 hours.
Methadone is a full agonist, it fully binding to the mu receptors in the brain alleviating symptoms of withdrawal and or cravings, while blocking the effects of other opioids (when at blocking dose). Slide5
Buprenorphine
What is Buprenorphine (Suboxone)?
Suboxone contains a combination of buprenorphine and naloxone. Buprenorphine is an opioid medication. Naloxone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse. Buprenorphine is approved for use in both induction and maintenance treatment of opioid dependence in appropriate patients.
FDA Approved for clinical use since 2002.
Pregnancy Category “C” Safe to use during pregnancy.
Buprenorphine is a partial agonist, it is a combination of an agonist and antagonist. As a partial agonist it binds to the mu receptor in the brain and can alleviate withdrawal and or craving, but has the added antagonist properties of preventing other opioids from stimulating the receptor. Partial agonist are less likely to be abused. Slide6
Naltrexone
What is Naltrexone (Vivitrol)?
Vivitrol is the first and only non-addictive, once-monthly medication that, when combined with counseling, is proven to help prevent relapse to opioid dependence, after detox. Vivitrol blocks opioid receptors in the brain while you work with the psychological aspects of counseling.
Vivitrol injection is used to prevent relapse in people who became dependent on opioid medicine and then stopped using it. Naltrexone can help keep you from feeling a "need" to use the opioid.
Vivitrol injection is also used to treat alcoholism by reducing your urge to drink alcohol. This may help you drink less or stop drinking altogether.
FDA Approved for OUD in 2010.
Pregnancy Category “C” Safe to use during pregnancy.
The effects of Naltrexone last for 28 days.
Naltrexone is a antagonist, antagonists bind to the mu opioid receptors but don’t stimulate the production of endorphins. Antagonist prevent other opioids from stimulating the mu receptors. Slide7
Medication Comparisons
Methadone and buprenorphine are both safe and effective for mothers and babies
Buprenorphine use results in milder NAS symptoms, shorter hospital stays, and less morphine in tapering.
Methadone has a significantly higher retention rate during pregnancy and after childbirth, and longer recovery outcomes for the mother.
Methadone’s impact on children’s health has been studied for 40 years with no developmental impact detected.
There is inadequate data on buprenorphine’s long-term effect on children. Slide8
A few more…
Methadone does not have a “ceiling effect” like buprenorphine. Buprenorphine is effective only to 16mgs. Anything above that is a placebo.
Methadone is cheaper.
Methadone is only available through the OTP.
Buprenorphine is available through both an OTP and a private physician.
Methadone treatment is highly structured with both medical and clinical components
.
Methadone
is associated with better treatment outcomes because of the high activity at the mu receptor, flexible dosing and the ability to adjust to the needs of
an individual. Slide9
APPROPRIATE MODALITY
Physicians should consider:
Treatment history (poor response to buprenorphine in the past)
History of diversion
Severity of drug use
Patient reliability
Financial resources
Family support
Transportation issuesSlide10
Other Services provided:
Case management services
Individual Counseling
Group Counseling
Intensive Outpatient Services
Women’s Intensive Outpatient Services
Alcohol and Drug Education
Skills Development
Relapse Prevention
Assertiveness
Training
Stress and Anger Management
AA and NA Education and Developing a non-using support system
Urinalysis Screening
Referrals for Community Support Services
Transportation Needs
Co-occurring Disorders
HIV Testing and Counseling
Hepatitis C Testing and ReferralSlide11
Benefits of MAT
Medication-Assisted Treatment (MAT) with methadone, buprenorphine, or naloxone, has been proven to help patients recover from opioid addiction.
These medications are:
Safe
Cost-effective
Reduce the risk of overdose
Increase treatment retention
Improve social functioning
Reduce the risks of infectious disease transmission
Reduce criminal activity
*
When
researchers studied heroin-overdose deaths in Baltimore between 1995 and 2009, they found an association between increasing availability of MAT (methadone and buprenorphine) and an approximately 50% decrease in the number of fatal heroin overdoses.Slide12
Challenges of MAT
Negative stigma of MAT particularly methadone
Affects the attitudes of medical and healthcare professionals; social service agencies and workers; paraprofessionals
;
employers, families, and friends of persons who are opioid addicted; and others who formerly abused substances. Stigma has also influenced criminal justice policies, created political opposition and limited funding and space for OTPs.
Lack of access to opioid maintenance treatment.
Only
10 percent of the 23 million Americans with addictions and substance use disorders (SUD) receive any care in a given year. The lack of treatment access is also significant for justice-involved individuals – those in the courts, incarcerated, reentering society, or under community supervision like probation. Of the 2.4 million people currently in prison, an estimated 65 percent are clinically addicted to drugs or alcohol, but only 11 percent receive any professional treatment while
incarcerated.
In addition, more than half of those on parole or probation continue to go untreated
.
Lack of training and education about MAT and its benefitsSlide13
More Challenges…
Medication-assisted treatment has saved many lives, but it is still not often accepted by the public
.
Patients seeking MAT for opioid use disorder sometimes find that their healthcare providers may have a negative opinion of MAT despite medical evidence of its many benefits.
Limited
number of licensed physicians prescribing buprenorphine.
While it can be dispensed in sublingual form in a physician’s office, unlike methadone, which requires patients to seek out treatment in a qualified methadone treatment center, it is not linked to counseling and other treatment services which are used to provide better outcomes for the patient. Slide14
MAT: Myths and FAQs
MAT just trades one addiction for
another
MAT bridges the biological and behavioral components of addiction. Research indicates that a combination of medication and behavioral therapies can successfully treat SUDs and help sustain recovery
.
MAT is only for the short
term.
Research
shows that patients on MAT for at least 1-2 years have the greatest rates of long-term success. There is currently no evidence to support benefits from cessation.
Patients
with long-term abstinence can follow a slow taper schedule under a physician’s direction, when free of stressors, to attempt dose reduction or total cessation.
“I’ve known a few people who could stop using opioids without help from any kind of medication. MAT is only for the weak. “
Though opioid abuse may begin with a series of poor judgments, addiction involves real, physical changes in the brain. While some people are eventually able to quit using opioids on their own, the majority of patients go though many dangerous cycles of relapse and recovery. MAT can make the recovery process much safer, and has saved many lives by preventing death from overdose or dangerous behaviors associated with “street” drug use.Slide15
MAT: Myths and FAQs
My patient’s condition is not severe enough to require MAT.
MAT
utilizes a multitude of different medication options (agonists, partial agonists and antagonists) that can be tailored to fit the unique needs of the
patient.
MAT
increases the risk for overdose in
patients.
MAT
helps to prevent overdoses from occurring. Even a single use of opioids after detoxification can result in a life-threatening or fatal overdose. Following detoxification, tolerance to the euphoria brought on by opioid use remains higher than tolerance to respiratory depression
.
Providing MAT will only disrupt and hinder a patient’s recovery process.
MAT has been shown to assist patients in recovery by improving quality of life, level of functioning and the ability to handle stress. Above all, MAT helps reduce mortality while patients begin recovery. Slide16
MAT: Myths and FAQs
There
isn’t any proof that MAT is better than
abstinence.
MAT
is evidence-based and is the recommended course of treatment for opioid addiction. The National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration, National Institute on Alcohol Abuse and Alcoholism, Centers for Disease Control and Prevention, and other agencies emphasize MAT as first line treatment.
MAT is not effective because it does not immediately end drug dependence.
Opioid
use disorder or Addiction is not “cured” by the use of MAT. Addiction is a “chronic” (long-lasting) disease. Medical treatment for addiction can be
compared
to medical treatment for other common chronic diseases like diabetes or high blood pressure. Just as diabetes is not “cured” by the use of insulin, and people with high blood pressure often continue taking medications for many years, so people with opioid addiction are not “cured” but instead well-managed by MAT
.Slide17
MAT: Myths and FAQs
How long will I need to be on methadone,
suboxone
or
vivitrol
?
The length of treatment can vary from patient to patient. The decision to discontinue therapy with these medications after a period of maintenance should be made as part of a comprehensive treatment plan. It is up to you, your doctor, and your therapist or counselor to decide on the appropriate length of treatment.
Does
methadone,
suboxone
or
vivitrol
interact with other drugs or medications?
If you are taking any other prescription medications for physical or psychological reasons, make your physician aware prior to starting these medications. It is possible for these medications to negatively interact with other medications; therefore, it is important to discuss the use of other medications to avoid any adverse interactions. Slide18
MAT: Myths and FAQs
What if I no longer wish to take methadone? Can I stop or switch to a different medication?
Every individual who takes methadone is going to take it for a different length of time. If during your treatment, you wish to no longer take methadone or want to switch to a different medication, your treatment provider can assist you in tapering off methadone or prescribe another medication that can meet your needs. This process is necessary to prevent patients from experiencing adverse effects or withdrawal during this process. To learn more about ceasing the use of methadone or changing prescriptions, it is important to have a conversation with the doctor.
Most insurance plans don’t cover MAT.
As of May 2013, 31 state Medicaid FFS programs covered methadone maintenance treatment provided in outpatient programs. State Medicaid agencies vary as to whether
buprenorphine
is listed on the Preferred Drug List (PDL), and whether prior authorization is required (a distinction often made based on the specific
buprenorphine
medication type). Extended-release
naltrexone
is listed on the Medicaid PDL in over 60 percent of states. Slide19
MAT Success Stories and Outcomes
Outcome data
for
STS
MAT population
includes:
70%
R
eduction
in substance abuse
78%
C
ompliance
with treatment plan
goals
94%
R
eduction
of criminal
activity
Leonard’s recovery journey…
"Leonard" came into our agency in 2012, using 15-20
bags of
heroin intravenously on a daily basis. He was
unemployed and
living with an opiate-addicted woman. He had
various legal
charges, including an old DUI. Leonard had
been incarcerated
previously. After his admission to MAT, he still
used some
heroin sporadically during the first year. However, after a
year, he
began attending IOP services on a regular basis
. He
then attended weekly groups as well as individual
counseling. Leonard
has now been abstinent from illicit drugs for over two
and
a half years. He is also gainfully employed and has
purchased a
home, in which he lives with a new girlfriend, who is also drug
free. Leonard
has chosen to utilized the available treatment tools of MAT, IOP, etc
. to
help him find a path toward successful long-term recovery.Slide20
MAT Success Stories and Outcomes
TLC Overall
Outcomes &
Reputation
*as of 12/31/17
70
%
of
respondents would recommend TLC to others.
81.5
%
of
respondents report life has improved since entering the program
.
71.5
%
of
UDS are negative of illicit drugs.
45%
of
patients have of length of stay of 2 years or more.
57.2%
of patients have
2 or more take home bottles
Ron’s recovery journey…
“Ron” came
to treatment on March 21,
2016. He is
a 73 Black male with (2) previous unsuccessful treatment that he admitted leaving AMA due to his withdrawals and not being able to pay for treatment.
He
receives SSD; he has Medicare which does not pay for OTP.
He came
to
TLC
and
requested admission
on the MATOP program because he suffers from COPD and Emphysema and his health was deteriorating due to his substance use disorder.
He started pulmonary treatment
regularly and since being on the MATOP his health has
improved. He receives
oxygen tanks weekly and
is now able
to have some mobility.
He
struggled with becoming drug free for the first 6 months in treatment
however since
then he has submitted
consecutive
negative urine drug screens.
Ron
has one sister that lives out of state which visits him regularly, reminding him that she is proud of him.
Ron is
grateful for the MATOP
program for giving
him a chance to become drug free, he is a Phase
5
client and comes to the clinic
2 times
a week and has his Individual Counseling Sessions 2 times a month.
Counselor has a cohesive relationship with medical professionals involved in
Ron’s care
and works collaboratively with them to ensure
he
can live a productive and healthy life.
He feels
a sense of accomplishment and hope, thanks to the efforts of the MATOP program and in particular his counselor and his sister who has been instrumental in his treatment
progress.Slide21
MAT Success Stories and Outcomes
Joe’s recovery journey…
“Joe” came
into treatment on December 29, 2015.
He
stated he came to treatment after hearing from some friends that
TLC
had a free program called MATOP.
Joe
was living with his mother in her living room couch before reconciling with his ex-wife.
He was
taking illicit substances such as Xanax,
Klonopin
and other illicit substances that were not prescribed to him.
He was
given a referral to our in-house psychiatrist and our psychotherapist.
Joe
was prescribed psychotropic medication and met with the mental health team weekly, which he reported he has helped him cope with major trauma he experienced with his father and other family members.
Joe’s wife
filed for divorce due to his addiction and losing the family business they had for
years.
Joe
has more than
20
months drug free since coming into treatment.
He has
been addressing his addiction, health and mental health issues. Recently
he was
diagnosed with Cirrhosis of the liver, and is currently on medication.
He
stated he is getting better with his
treatment and
was able to
establish
and amend his relationship with his ex wife who is very supportive of him now that he been drug free.
Joe recently
lost with mother due to her battle with cancer and dementia; he was there for her every step of the way through her transition last month.
Joe’s
ex-wife, which he lives with was recently diagnose with Lou Gehrig
disease
aka known as ALS.
He
has been accompanying her to her appointments in New York City at least two times a month.
While Joe has
been going through a lot
within the last 9 months, he
has chosen not to pick up any illicit substances to deal with life on life’s terms.
Joe
is currently a 6 take-home bottle
carrier
and comes to the clinic 1x per week with Individual Counseling Sessions 2x per month.
His counselor
has a cohesive relationship with the medical professionals involved in
his
care and works collaboratively with them to ensure
he can
live a productive and healthy life.
Joe
feels a sense of accomplishment and hope, thanks to the efforts of the MATOP program and in particular his primary counselor and medical professionals who have been instrumental in his treatment progress.
Joe
and his ex-wife are hoping to re marry by the beginning of the year.