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MEDICATIONS FOR TREATMENT OF Opioid use disorder: Why use them and how do they work? MEDICATIONS FOR TREATMENT OF Opioid use disorder: Why use them and how do they work?

MEDICATIONS FOR TREATMENT OF Opioid use disorder: Why use them and how do they work? - PowerPoint Presentation

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Uploaded On 2019-02-03

MEDICATIONS FOR TREATMENT OF Opioid use disorder: Why use them and how do they work? - PPT Presentation

Angeline Stanislaus MD Chief Medical director adult services Missouri Dept of Mental Health How many people are dying each day 115 Overdoses Missouri Total number of opioid related death 2017 ID: 749752

treatment opioid disorder long opioid treatment long disorder risk brain craving overdose medication withdrawal suboxone meet drug work model

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Slide1

MEDICATIONS FOR TREATMENT OF Opioid use disorder: Why use them and how do they work?

Angeline Stanislaus, MD

Chief Medical director- adult services

Missouri

Dept

of Mental HealthSlide2
Slide3

How many people are dying each day?

115Slide4
Slide5

OverdosesSlide6
Slide7

Missouri- Total number of opioid related death 2017

92% Accidental overdose

7% Suicide

951Slide8

Definition of Addiction (NIDA)

Chronic

, relapsing disorder characterized

by

compulsive

drug seeking and use despite adverse consequences.

It

is considered a brain

disorder

because

it

involves functional changes to brain circuits involved in reward, stress, and

self-control

those

changes may last a long time after a person has stopped taking drugs

. Slide9

When does use of a substance become a Substance Use Disorder (SUD)?

An underlying change in brain circuits that may persist beyond detoxification

Behavioral effects of these brain changes include intense drug craving when the person is exposed to drug-related stimuli

Results in repeated relapses Slide10

Interactions of genetic factors and environmentSlide11

Hallmark of Opioid use disorder

Tolerance

Withdrawal

CravingSlide12
Slide13
Slide14

Withdrawal Symptoms

Opioid withdrawal (Dope sick)

Severe nausea/ vomiting

Diarrhea

Muscle aches

FeverLacrimation (tearing)

Pilo

-erection (goosebumps)

Pupils dilated

Yawning

Insomnia Slide15

Management of cravingSlide16
Slide17
Slide18
Slide19

Opioid Use Disorder

Buprenorphine /

Suboxone

Naltrexone XR-NRT (

Vivitrol

) MethadoneSlide20

Phases of treatment for OUD

Induction

Stabilization

Maintenance Slide21

SuboxoneSlide22

BuprenorphineSlide23
Slide24

Suboxone

Not absorbed when taken orally

50% absorption when taken sublingually

Plasma concentration peaks in 1 hour

Long half-life – up to 32 hours

Metabolized by P450 3A4Slide25

Suboxone

Can be given as single dose

More effective as divided doses to manage craving

Very slow to dissociate from opioid receptors -24 to 60 hoursSlide26

Methadone

Full agonist

Very long half-life- 2 days

Available only in specialized OTP

Daily administration for several months. Slide27

Naltrexone XR-NRT (Vivitrol)

Long-acting opioid antagonist (blocker)

Best option for those leaving jails and prisons after period of abstinenceSlide28

How long should they take medications and remain in treatment?Slide29

Medication First model of treatment for OUD

Managing fear of withdrawal

Stabilizes the brain circuits

Better engagement in treatment

Decreased deaths from opioid overdose

Then able to engage better in needed psychosocial treatmentsSlide30

MEdication First model does not mean “medication ONLY” model

Lowers threshold for medication treatment

Meet the client where they are! Slide31

Recovery

The road to recovery is long and windy with several pot holes

Relapses occur despite the best treatment like all chronic illnesses

As long as they are alive, they can work on it again

Kicking them out of the program for minor violations is not helpful

We expect patients to meet us where we are.

If they could, they would have done it!

We need to meet them where they are and help them work their way up. Slide32

NaloxoneSlide33

High risk for opioid overdose

Individuals who have overdosed once are at higher risk of overdosing again

After a period of abstinence and

re-use (less than 5 days of stopping use

tolerance decreases)

Release from jails, prisons, residential facilities

IV users are at higher risk

Household

members of those prescribed opioid pills Slide34

High Risk for opioid overdose

Opioids taken in combination with other sedating substances such alcohol, benzodiazepines

Those who also have medical conditions such as liver and lung disease

Co-morbid psychiatric conditions such as depression, PTSD

– increase risk of suicideSlide35