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
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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 HealthSlide2Slide3
How many people are dying each day?
115Slide4Slide5
OverdosesSlide6Slide7
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
CravingSlide12Slide13Slide14
Withdrawal Symptoms
Opioid withdrawal (Dope sick)
Severe nausea/ vomiting
Diarrhea
Muscle aches
FeverLacrimation (tearing)
Pilo
-erection (goosebumps)
Pupils dilated
Yawning
Insomnia Slide15
Management of cravingSlide16Slide17Slide18Slide19
Opioid Use Disorder
Buprenorphine /
Suboxone
Naltrexone XR-NRT (
Vivitrol
) MethadoneSlide20
Phases of treatment for OUD
Induction
Stabilization
Maintenance Slide21
SuboxoneSlide22
BuprenorphineSlide23Slide24
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