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Medication Assisted Treatment for Opioid Use Disorder-Myths and Facts PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Medication Assisted Treatment for Opioid Use Disorder: Myths and Facts" by Audrey Hazelbaker, LMSW, to learn about the myths and facts about Medication Assisted Treatment for Opioid Use Disorder. Medication-Assisted Treatment (MAT) for Opioid Use Disorder (OUD) is an evidence-based approach that combines the use of medications with counseling and behavioral therapies to treat opioid addiction. MAT is considered to be the most effective treatment for OUD and can help individuals achieve and maintain recovery from addiction.

Tags : Medication Assisted Treatment, Opioid Use Disorder, MAT, OUD, opioid addiction, addiction, myths, facts

Published on : Mar 14, 2023 | Views : 802 | Downloads : 3

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Medication Assisted Treatment for Opioid Use Disorder: Myths and Facts Audrey Hazelbaker, LMSW
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Michigan Opioid Collaborative is funded by: Michigan Department of Health and Human Services Substance Abuse and Mental Health Services Administration
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PredictableChronicBrain Disease ADDICTION NOT a moral failing
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What is Addiction As defined by the American Society of Addiction Medicine (ASAM),addiction is “a primary, chronic disease of brain reward, motivation, memory, and related circuitry” It is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission
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DSM-5 diagnosis of opioid use disorder Use in larger amounts/longer periods than intended Unsuccessful efforts to cut down Excessive time spent taking drug Failure to fulfill major obligations Continued use despite problems Important activities given up Recurrent use in physically hazardous situations Continued use despite social consequences Craving Tolerance* Withdrawal* *This is not considered to be met for those taking opioids solely under appropriate medical supervision. Mild: 2-3 Moderate: 4-5 Severe: 6 or more
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We have an opioid epidemic
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What is Medication Assisted Treatment (MAT) These medications help reduce cravings and withdrawal symptoms that come from stopping opioid use. The medications approved for MAT are methadone, buprenorphine, and naltrexone The goal of medication-assisted treatment is to recover from addiction. It does NOT replace one addictive drug with another. It provides a safe, controlled level of medication to overcome the use of a problem opioid Research shows that when people include a medication prescribed to treat opioid use disorder as part of their recovery plan, their chances of success increase
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What are the barriers to treatment? Lack of providers in many areas Stigma Complexities of addiction (Rosenblatt 2015)
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Stigma Stigma is defined as a mark of disgrace or infamy, a stain or reproach, as on one's reputation Substance use disorders are some of the most stigmatized conditions There is often a perceived fault with substance use disorder as well as perceived control about the condition This stigma can lead to individuals being less likely to seek help or dropping out of treatment early
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Types of stigma Stigma from within Blame self, feel hopeless Stigma from recovery community Medications versus “abstinence” Stigma from clinicians Belief that treatment is ineffective Stigma from outside Choice versus disease (moral failing)
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How can we reduce stigma?
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Top MYTHS about mat
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Myth 1:MAT JUST TRADES ONE ADDICTION FOR ANOTHER MAT bridges the biological and behavioral components of addiction. Research indicates that a combination of medication and behavioral therapies can successfully treat SUDs and help sustain recovery. http://www.integration.samhsa. gov/clinical-practice/mat/mat-overview
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Myth 2:MAT IS ONLY FOR THE SHORT TERM Research shows that patients on MAT for at least 1-2 years have the greatest rates of long-term success. There is currently no evidence to support benefits from stopping MAT. http://www.integration.samhsa. gov/clinical-practice/mat/mat-overview
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Myth 3:CONDITION IS NOT SEVERE ENOUGH TO REQUIRE MAT MAT utilizes a multitude of different medication options (agonists, partial agonists and antagonists) that can be tailored to fit the unique needs of the patient. https://www.whitehouse.gov/sites/default/ files/ondcp/recovery/medication_assisted_treatment_9-21-20121. pdf
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Myth 4:MAT INCREASES THE RISK FOR OVERDOSE IN PATIENTS MAT helps to prevent overdoses from occurring. Even a single use of opioids after detoxification can result in a life-threatening or fatal overdose. Following detoxification, tolerance to the euphoria brought on by opioid use remains higher than tolerance to respiratory depression. “MAT Maintenance Treatment and Superior Outcomes” PowerPoint, Dr. Arthur Williams
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Myth 5:PROVIDING MAT WILL ONLY DISRUPT AND HINDER A PATIENT’S RECOVERY PROCESS MAT has been shown to assist patients in recovery by improving quality of life, level of functioning and the ability to handle stress. Above all, MAT helps reduce mortality while patients begin recovery.
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Myth 6:THERE ISN’T ANY PROOF THAT MAT IS BETTER THAN ABSTINENCE MAT is evidence-based and is the recommended course of treatment for opioid addiction. American Academy of Addiction Psychiatry, American Medical Association, The National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration, National Institute on Alcohol Abuse and Alcoholism, Centers for Disease Control and Prevention, and other agencies emphasize MAT as first line treatment. http://www.samhsa.gov/medication-assisted-treatment/ training-resources/support-organizations
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Medication assisted Treatment (MAT)
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Differences in how the medications work (Naltrexone)
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Goals of treatment HARM REDUCTION Reducing cravings and strengthening coping capacity Prevention or reduction of withdrawal symptoms Increasing periods of abstinence and self-efficacy Restoration of functioning disrupted by substance use
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Stages of Treatment Induction is the starting phase. Your doctor will keep a close watch to make sure you adjust to the medication safely. This can be done at home and is safe and more patient friendly. Stabilization begins when you are on the right dose and your body and brain have adjusted to the new medication Maintenance is the long-term use of medication while remaining drug free and rebuilding a life in recovery Tapering is medically managed withdrawal from a medication by gradually reduced do
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Maintenance treatment versus detox Detoxification: stopping opioids and symptomatic treatment of withdrawal Overall, high relapse rate after detox Lose tolerance and does not address underlying chronic illness Maintenance treatment: continuing regular dose of medications to treat OUD
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Assessment & Induction Overview History and physical which includes past/current use, treatment history, social supports Check MAPS history Lab tests including urine toxicology Discuss treatment options Make a plan Prior Authorization/Script to fill Instructions to return with no use for 12-24 hours prior POC testing COWS Induction 2mg and up to 8 on first day (can do this at home with instructions for patients who have used this in the past). Follow up via phone and increase to 12-16mg as needed Return in 2-3 days or 1 week and weekly until dose is stable then every 2 weeks with UDS and then move to monthly once stable
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What it’s like Mr. S is a 44 year old male with h/o HTN, depression and chronic pain presents to clinic to get help for his “problem with opioids.” Reports he was started on hydrocodone 5 yrs ago after work-related injury. First took it as prescribed, but also noticed it seemed to help with his mood and he started taking more than prescribed. Over time, he was finishing a month’s prescription in a few days and started snorting the opioids to get more potent effects. Has missed a lot of work, grown more depressed and his wife has been very concerned. He says, “I can’t do this anymore. I feel like I’m going to lose everything, but I’m afraid to stop.”
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Plan Patient would like to try buprenorphine/naloxone. Discuss treatment agreement Prescribe starting dose Observe patient after initial doses for effects Titrate dose and prescribe short term prescriptions early on in treatment and assess patient each visit including urine toxicology screen and continue to provide support to encourage ongoing sobriety. Continue patient on stabilized dose Mr.S 4 months into treatment comes to see you for followup. He is stable on dose of 12mg buprenorphine/naloxone. Urine screens are consistently negative for any other opioids. Says he is functioning much better and pain is also better controlled.
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OUD treatment effectiveness Reductions in overdose and overall death rates Reductions in opioid use and other substance use/misuse Improved HIV and Hep C outcomes Increased likelihood that a person will remain in treatment Reduced criminal justice involvement Increased likelihood of employment Recent evidence suggesting cost effective and improved quality of life Medications are the most effective treatment for OUD. Without medication treatment, patients have higher rates of substance use and overdose rates. (Norton et al 2017, Altice et al 1999, Kenworthy et al., 2017; Nosyk et al., 2015 Schwartz et al 2013, Sordo et al 2017)
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MOC is here to help Assisting MD, PA and NPs in completing the “x waiver” training Access to a Behavioral Health Consultant for referral/resource information Access to an MAT Specialist for a SAME DAY consultation Tele-health (planned for Fall 2019)
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ADDRESSING COMMON BARRIERS
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Who we serve Behavioral Health Consultants located in the following regions: Region 1 (upper peninsula) Calhoun/Kalamazoo counties Lenawee/Monroe counties Washtenaw/Livingston counties Technical Assistance and patient consultations provided to the ENTIRE state of Michigan
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X waiver requirements for prescribing MAT Who is eligible: MD Nurse Practitioner (with approved provider oversight by a waivered MD) Physician Assistant What is required: MD- 8 hour approved training course NP and PA- 24 hours of approved training (8 of which can be the MD training)
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SUD Screening tools ASAM Screening tools https://www.asam.org/education/live-online-cme/fundamentals-of-addiction-medicine/additional-resources/screening-assessment-for-substance-use-disorders/screening-assessment-tools The AUDIT (Alcohol Use Disorder Identification Test) http://auditscreen.org/ DAST-10 (Drug Abuse Screen Test) https://www.psychcongress.com/saundras-corner/scales-screeners/suds/drug-use-questionnaire-dast-10 Adolescent Screening for Drugs and Alcohol CRAFFT http://www.ceasar-boston.org/clinicians/crafft.php Opioid Risk Tool https://www.drugabuse.gov/sites/default/files/files/OpioidRiskTool.pdf Clinical Opioid Withdrawal Scale https://www.drugabuse.gov/sites/default/files/files/ClinicalOpiateWithdrawalScale.pdf
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Useful resources Providers Clinical Support System (PCSS) https://pcssnow.org/resources/resource-category/medication-assisted-treatment-clinical-resources/ Medication Assisted Treatment https://www.samhsa.gov/medication-assisted-treatment Medications for Opioid Use Disorders Treatment Improvement Protocol (TIP 63) https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Full-Document-Including-Executive-Summary-and-Parts-1-5-/Most-Popular/SMA18-5063FULLDOC?sortByValue=4
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Find us online: https://medicine.umich.edu/dept/psychiatry/programs/michigan-opioid-collaborative-moc
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Contact us Audrey Hazelbaker - Behavioral Health Consultant hazelbakera@washtenaw.org 734-292-5323 Suzanne Kapica- Project Manager suzannlk@med.umich.edu 734-615-4227 www.michiganopioidcollaborative.org