Worldwide hamsccmethadonepptx Kenneth Anderson HAMS Opioid Substitution Therapy OST Worldwide Yes No Four countries have no data Western Sahara South Sudan North Korea and Greenland ID: 549456
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Medication Assisted Therapy (MAT) in the US and Worldwidehams.cc/methadone.pptx
Kenneth AndersonHAMSSlide2
Opioid Substitution Therapy (OST) Worldwide
Yes
No
Four countries have no data: Western Sahara,
South Sudan, North Korea, and GreenlandSlide3
Three countries have opioid assisted detox but no maintenance, Bahrain, Cyprus, and OmanIn the past decade a substantial number of countries have initiated OST, including Afghanistan (2009 pilot program), Cambodia (2010), Kenya (2014), Kosovo (2012), Morocco (2010), and many more.Slide4Opioid Use Worldwide
Heroin is the primary opioid of abuse in most of the worldHigh rates of non medical use of oxycodone
, hydrocodone, etc. are found primarily in the USMost non medical prescription opioid use outside the US involves methadone, buprenorphine, fentanyl, codeine, darvon, demerol or morphineSlide5
Treatment admissions by primary opioid type US 2013Slide6
Treatment admissions by opioid type in Europe (including Turkey) 2014Slide7
Percentage of treatment entrants reporting an opioid other than heroin as primary drug
In Estonia 86% of admissions are due to fentanylIn Finland 86% of admissions are due to buprenorphine
In the Czech Republic 30% are due to buprenorphine 7% are due to methadone, 48% are due to heroin and 16% to other opioidsSlide8
Australia closed opioid treatment episodes by opioid typeSlide9
Opioids injected in India as reported by clients at 22 needle exchange programsSlide10
Prevalence of heroin and non-medical prescription opioid (NMPO) use in US and Switzerland 2014Slide11
Heroin accounts for 95% of Swiss opioid seizures (stable since 1990)
Swiss court cases since 1990 involving illicit opioids by typeSlide12
2014 Swiss opioid treatment admissions by primary drug for all treatment typesSlide13
MAT in USA, Switzerland, and Australia comparedTreatment of opioid addiction has been a resounding success in Switzerland and also majorly successful in AustraliaTreatment of opioid addiction has been an abysmal failure in the USA
Here’s some reasons whySlide14
Lifetime prevalence of heroin use among young people in Switzerland and US 1992-2012
US rate in 2014 was 1.5Slide15
Drug Misuse-Related Deaths in USA and Switzerland 1995-2013Slide16
Accidental opioid overdose deaths age 15-54 USA Australia 1999-2014
ICD-10 codes F11, F19, X42, X44, T40.0-4, .6 Slide17
All overdose deaths in USA and Australia due to heroin and Prescription Opioids age 15-54
Heroin = T40.0,.1; PO = T40.2-4, .6Slide18
MATMedication Assisted Treatment
SATSubstitution Assisted Treatment
Under control of cantons (states)Uses methadone, SROM
(slow release oral morphine), buprenorphine, and levomethadone (off label)Available from GPs or clinics
HAT
Heroin Assisted Treatment
Under direct Federal control
Uses heroin to treat heroin dependence
Only available in specialty clinics
SwitzerlandSlide19
Swiss admissions for opioid treatment 2014
TypeNumber of clientsPercentage of facilities reporting
outpatient31237%
inpatient150 (main problem)
70%HAT130
100%
MMT
934
12 of 26 cantons
40% of clients (168) in inpatient drug treatment (for any drug) reported also being in substitution therapy
Inpatients reporting opioids as a problem
Heroin
221
Methadone
50
Buprenorphine
6
Fentanyl
3
Other opioids
11Slide20
60% of Swiss SAT is provided by MDs, typically primary care physicians
Clients may pick up their daily dose at the doctor’s office or the drug storeSlide21
Percentage of clients per dosing point Australia 2015Slide22Types of MAT in Switzerland 2014
17,008 people in SAT in 2014
About 1400 people (1649 cases) in HAT in 2014Slide23Types of MAT in AustraliaSlide24
Urine Testing
Switzerland
Patients should be asked about their parallel consumption of other substances. Provided there is no threat of sanctions, their replies are generally reliable. Systematic urine testing does not yield any further benefit in such cases.
USA
42 CFR § 8.12(f) (6).
OTPs
must provide adequate testing or analysis for drugs of abuse, including at least eight random drug abuse tests per year... For patients receiving long-term detoxification treatment, the program shall perform initial and monthly random tests on each patient.Slide25Take-Homes
SwitzerlandAbstinence not required for take homes
“Stable patients can be provided with take-away doses with the specific aim of strengthening the relationship of trust and improving the success of treatment (less parallel consumption, higher retention rate)”USA
42 CFR § 8.12 (h) (4) (i) Unsupervised or “take-home’’ use. (2) (
i) Absence of recent abuse of drugs (opioid or nonnarcotic), including alcoholSlide26Slide27USA
Only 27% of clients admitted to treatment for opioid dependence in the USA receive MAT17 states do not cover methadone under Medicaid and many private insurances also refuse to pay.Many Americans who cannot afford it must pay for methadone out of pocket and it’s often more than their rent
Methadone reduces death rates 75% compared to active use but abstinence based 28 day treatment increases death rates 3,000% over active useSlide28
In Switzerland methadone is FREE!Slide29Conclusion
The US needs to follow the lead of Switzerland and AustraliaWe need to allow GPs to prescribe and dispense methadoneWe need to make pharmacies into dosing points
We need to make all OST freeWe need to stop treating OST patients like criminals and monstershams.cc/methadone.pptx