Medication Assisted Treatment - PowerPoint Presentation

Slide1

Medication Assisted Treatment

John Arthur Muenz, Jr., M.D., FAAPM&R, FABAM, FAAFP

Family Care Partners

jmuenz@familycarepartners.comSlide2

Disclosure

I have no actual or potential conflict of interest in relation to this

program/presentation.Slide3

Medication-assisted treatment (MAT)

is the use of medications with counseling and behavioral therapies to treat substance use disorders and prevent opioid overdose.Slide4

Medication-Assisted Treatment (MAT)

is the use of medications, in combination with 

counseling and behavioral therapies

, to provide a “whole-patient” approach to the treatment of substance use disorders. Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction,

MAT can help sustain recovery.Slide5

MAT is primarily used for the treatment of addiction to

opiates

such as heroin and prescription pain relievers that contain

opioids. Slide6

The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug.Slide7

Medications used in MAT are approved by the Food and Drug Administration (FDA), and MAT programs are clinically driven and tailored to meet each patient’s needs. Slide8

In 2013, an estimated

2.3

million people had an 

opioid use disorder

 related to prescription pain

relievers or heroin. Outpatient MAT

has proved to be clinically effective

to

significantly reduce the need for inpatient detoxification

services. MAT

provides a more comprehensive, individually tailored program of medication and behavioral therapy. Slide9

The ultimate goal of MAT is full 

recovery,

including the ability to live a self-directed life. This treatment approach has been shown to:

Improve patient survival

Increase retention in treatment

Decrease illicit opiate use and other criminal activity among people with substance use disorders

Increase patients’ ability to gain and maintain employment

Improve birth outcomes among women who have substance use disorders and are

pregnantSlide10

Unfortunately, MAT is greatly underused

.

The

slow adoption of these evidence-based treatment options for alcohol and opioid dependence is partly due to misconceptions about substituting one drug for another. Discrimination against MAT patients is also a factor, despite state and federal laws clearly prohibiting it. Other factors include lack of training for physicians and negative opinions toward MAT in communities and among health care professionals.Slide11

A common misconception associated with MAT is that it substitutes one drug for another. Instead, these medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. MAT programs provide a safe and controlled level of medication to overcome the use of an abused opioid. Slide12

Medications Used in MAT

FDA has approved several different medications to treat opioid addiction and alcohol dependence

.

Methadone

Buprenorphine

NaltrexoneSlide13

Methadone

used

in MAT for opioid treatment can only be dispensed through a SAMHSA-certified

OTP.

Buprenorphine/naloxone

can only be prescribed by DEA waivered providers.

Naltrexone

needs no special waiver or certification.Slide14

Opioid Dependency Medications

Methadone, buprenorphine, and naltrexone

are used to treat opioid dependence and addiction

to

opioids such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone. People may safely take medications used in MAT for months, years, several years, or even a lifetime. Plans to stop a medication must always be discussed with a

doctor.Slide15

Methadone

Methadone

has been used for decades to treat people who are addicted to heroin and narcotic pain medicines.

For

optimal results, patients should also participate in a comprehensive medication-assisted treatment (MAT) program that includes counseling and social support.Slide16

Methadone

It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone

.

Methadone is offered in pill, liquid, and wafer forms and is taken once a day.

Patients

taking methadone to treat opioid addiction must receive the medication under the supervision of a

physician in a Federally Certified Program. By

law, methadone can only be dispensed through an 

opioid treatment program (OTP)

 certified by SAMHSA.Slide17

Buprenorphine

Like methadone, buprenorphine suppresses and reduces cravings for the abused drug. It can come in a pill form or sublingual tablet that is placed under the tongue

.

Approved for clinical use in October 2002 by the Food and Drug Administration (FDA), buprenorphine represents the latest advance in medication-assisted treatment (MAT). Medications such as buprenorphine, in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of opioid dependency. When taken as prescribed, buprenorphine is safe and effective.Slide18

Buprenorphine

Unlike 

methadone

 treatment, which must be performed in a highly structured clinic,

buprenorphine

is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access. Under the 

Drug Addiction Treatment of 2000 (DATA 2000) qualified

U.S. physicians can offer buprenorphine for opioid dependency in various settings, including in an office, community hospital, health department, or correctional facility. Slide19

Buprenorphine

Buprenorphine offers several benefits to those with opioid dependency and to others for whom treatment in a methadone clinic is not preferred or is less convenient. The FDA has approved the following buprenorphine products:

Bunavail (buprenorphine and naloxone) buccal film

Suboxone (buprenorphine and naloxone) film

Zubsolv (buprenorphine and naloxone) sublingual tablets

Buprenorphine-containing transmucosal products for opioid dependencySlide20

Buprenorphine

Buprenorphine has unique pharmacological properties that help:

Lower the potential for misuse

Diminish the effects of physical dependency to opioids, such as withdrawal symptoms and cravings

Increase safety in cases of

overdoseSlide21

Training on Providing Buprenorphine

Buprenorphine as an opioid use disorder treatment is carefully regulated. Qualified physicians are required to acquire and maintain certifications to legally dispense or prescribe opioid dependency medications. SAMHSA’s 

Division of Pharmacologic Therapies (DPT)

 makes available required 

buprenorphine training for physicians,

webinars, workshops and summits and publications and research.Slide22

Buprenorphine

The

opioid effects increase with each dose

until,

at moderate

doses,

they level off, even with further dose increases. This “ceiling effect” lowers the risk of misuse, dependency, and side effects. Also, because of buprenorphine’s long-acting agent, many patients may not have to take it every day.

It

is an opioid partial

agonist at the mu receptor.

This means that, like opioids, it produces effects such as euphoria or respiratory depression. With buprenorphine, however, these effects are weaker than those of full

agonists, drugs

such as heroin and methadone.Slide23

Naltrexone

Naltrexone works differently than methadone and buprenorphine in the treatment of opioid dependency. If a person using naltrexone relapses and uses the abused drug, naltrexone blocks the euphoric and sedative effects of the abused drug and prevents feelings of euphoria

.Slide24

Naltrexone

Naltrexone blocks the euphoric and sedative effects of drugs such as heroin, morphine, and

codeine, as well as the semi-synthetic opioids, like oxycodone.

It works differently in the body than 

buprenorphine

 and 

methadone,

which activate opioid receptors in the body that suppress cravings. Naltrexone binds and blocks opioid receptors,

and to

reduce opioid cravings. There is no abuse and diversion potential with naltrexone

.

If a person relapses and uses the problem drug, naltrexone prevents the feeling of getting high. People using naltrexone should not use any other opioids or illicit drugs; drink alcohol; or take sedatives, tranquilizers, or other drugs.Slide25

Naltrexone

Patients on naltrexone may have reduced tolerance to opioids and may be unaware of their potential sensitivity to the same, or lower, doses of opioids that they used to take. If patients who are treated with naltrexone relapse after a period of abstinence, it is possible that the dosage of opioid that was previously used may have life-threatening consequences, including respiratory arrest and circulatory

collapse.

As

with all 

medications used in medication assisted treatment (MAT) naltrexone

is to be prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs.Slide26

Naltrexone for Opioid Use Disorders

Extended-release injectable naltrexone is approved for treatment of people with opioid use disorder. It can be prescribed by any healthcare provider who is licensed to prescribe medications, special training is not required. It is important that medical managed withdrawal (detoxification) from opioids be completed at least 7 to 10 days before extended-release injectable naltrexone is initiated or resumed. 

Research

has shown that naltrexone decreases reactivity to drug-conditioned cues and decreases craving. Slide27

Naltrexone for Alcohol Dependence

When used as a treatment for alcohol dependency, naltrexone blocks the euphoric effects and feelings of intoxication. This allows people with alcohol

dependence

to reduce their drinking behaviors enough to remain motivated to stay in treatment and avoid relapses. Naltrexone is not addictive nor does it react adversely with alcohol.

Long-term naltrexone therapy extending beyond three months is considered most effective by researchers, and therapy may also be used indefinitely.Slide28

Side Effects of Naltrexone

People taking naltrexone may experience side effects, but they should not stop taking the medication. Instead, they should consult their health care provider or substance misuse treatment practitioner to adjust the dose or change the medication. Some side effects include:

Upset stomach or vomiting

Diarrhea

Headache

Nervousness

Sleep problems/tiredness

Joint or muscle painSlide29

Alcohol Use Disorder Medications

Disulfiram

,

Acamprosate

,

and

naltrexone

are the most common drugs used to treat alcohol use disorder. None of these drugs provide a cure for the disorder, but they are most effective in people who participate in a MAT program.Slide30

Disulfiram (Antabuse)

Disulfiram

is a medication that treats chronic alcoholism. It is most effective in people who have already gone through detoxification or are in the initial stage of abstinence. This drug is offered in a tablet form and is taken once a day. Disulfiram should never be taken while intoxicated and it should not be taken for at least 12 hours after drinking alcohol. Unpleasant side effects (nausea, headache, vomiting, chest pains, difficulty breathing) can occur as soon as ten minutes after drinking even a small amount of alcohol and can last for an

hour or more

.Slide31

Acamprosate (Campral)

Acamprosate

is a medication for people in recovery who have already stopped drinking alcohol and want to avoid drinking. It works to prevent people from drinking alcohol, but it does not prevent withdrawal symptoms after people drink alcohol. It has not been shown to work in people who continue drinking alcohol, consume illicit drugs, and/or engage in 

prescription drug misuse and abuse.

The use of

Acamprosate

typically begins on the fifth day of abstinence, reaching full effectiveness in five to eight days. It is offered in tablet form and taken three times a day, preferably at the same time every day. The medication’s side effects may include diarrhea, upset stomach, appetite loss, anxiety, dizziness, and difficulty sleeping.Slide32

Naltrexone (Revia)

When used as a treatment for alcohol dependency,

naltrexone

blocks the euphoric effects and feelings of intoxication. This allows people with alcohol addiction to reduce their drinking behaviors enough to remain motivated to stay in treatment, avoid relapses, and take medications. Slide33

Resources

Substance Abuse and Mental Health Services Administration

5600 Fishers Lane

Rockville, MD

20857

877-SAMHSA-7 (877-726-4727

)

www.

SAMHSA.gov

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.