medically assisted treatment - nacm midyear...
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Medically Assisted Treatment
Orman HallSupreme Court of Ohio
NACM Annual ConferenceJuly 12 – 16, 2015
Important Opiate Effects
•Analgesia•Euphoria•Respiratory Depression•Rapid Increase in Tolerance•Rapid Decrease in Tolerance•Overdose
Distribution Rates of Prescription Opioids in Grams per 100,000 population, Ohio, 1997-20111-3
Opioid analgesic grams distributed
Unintentional Drug Overdoses & Distribution Rates of Prescription Opioids in Grams per 100,000 population,
Ohio, 1997-20111-3
Epidemics of Unintentional Drug Overdoses in Ohio, 1979-20121,2,3
Source: 1WONDER (NCHS Compressed Mortality File, 1979-1998 & 1999-2005) 22006-2011 ODH Office of Vital Statistics, 3Change from ICD-9 to ICD-10 coding in 1999 (caution in comparing before and after 1998 and 1999)
Prescription drugs led to a larger overdose epidemic than illicit drugs ever have. Prescription
Pain Medication (Opioids)
Crack Cocaine
Heroin
Heroin & Rx Opioids
MethadoneFull Agonist MedicationLicensed in early 1970’sThe most regulated and researched addiction treatment in history, andThe most misunderstood treatment ever.
What’s a good Methadone Program?Release of information for all providers,Frequent urine or other tox screening,CounselingFlexible treatment plan that embraces harm reduction or abstinenceDiscourage use of other controlled substancesIncreasing intnesity of treatment over time if patient is not compliant
Buprenorphine
Partial Agonist MedicationLicensed in 2002Combined with Naloxone to discourage abuseCeiling Effect Overdose less likely than Methadone
What’s a good Buprenorphine Program?Release of information for all providers,Frequent urine screens,Counseling,Dose <=16mgNo other controlled substances should be allowedIncreasing intensity of treatment over time if non-adherent.Accepts insurance payments for visits.
Naltrexone
Antagonist MedicationAvailable in oral and extended release shot (Vivitrol)Blocks opiate effectsHas no opiate effects
Extended Release AdvantagesApproved for alcohol dependence in 2006 and opiate dependence in 2010Most useful for motivated patients who have undergone detoxification and need support to avoid relapseOnce monthly injection
100
90
80
70
60
50
40
30
20
10
0-10 -9 -8 -7 -6 -5 -4
%Efficacy
Log Dose of Opioid
Full AgonistMorphine, Oxycodone
METHADONE
Partial AgonistBuprenorphine
AntagonistNaloxone, Naltrexone
Opioid Intrinsic Activity
Opioid effect Analgesia Sedation Respiratory
depression
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