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Medication Assisted Treatment Michael Ryan, LCSW, CASAC

Medication Assisted Treatment Michael Ryan, LCSW, CASAC. What is Methadone Maintenance?. History of Methadone Maintenance. 1962:

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Medication Assisted Treatment Michael Ryan, LCSW, CASAC

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  1. Medication Assisted TreatmentMichael Ryan, LCSW, CASAC

  2. What is Methadone Maintenance?

  3. History of Methadone Maintenance 1962: Dr. Vincent Dole while doing research at “Rockerfeller University on the disease of “Obesity” was prompted to read a book written by “Dr. Marie Nyswander titled “The Drug Addict” Dr. Dole saw how some people would have uncontrollable cravings for food the same as a drug addict would have for drugs.

  4. History of Methadone Maintenance 1963: Dole and Nyswander collaborated their research. Performed (15) month case study on the lives of (6) long time Heroin users. They found that daily methadone use totally eliminated withdrawal symptoms, volunteers regained interest in work,family, school, and healthy recreation.

  5. History of Methadone Maintenance 1965: By 1965, Dole and Nyswander had completed studies on (22) heroin addicts, all outcomes were successful 1967: Their work was highly recognized by the American Medical Association

  6. Two Views of Opioid Dependence View 1 Opioid addiction is an incurable disease. Treatment requires long term medical maintenance. View 2 Opioid addiction is caused by weak will, moral failing, other psychodynamic factors, or is predetermined.

  7. Treatment Goal “The goal of opioid treatment is to relieve withdrawal symptoms, reduce craving and permit normal functioning so that, in combination with rehabilitation services, patients can develop productive lifestyles.”

  8. When opioids attach to the mu receptors, dopamine is released, causing  pleasurable feelings to be produced.

  9. As opioids leave the receptors, pleasurable feelings fade and withdrawal symptoms (and possibly cravings) begin.

  10. Opioids continue leaving the mu receptors until a person is in a mild-to-moderate state of  withdrawal .

  11. Methadone then attaches to the empty opioid receptors, suppressing withdrawal symptoms and reducing cravings. 

  12. Methadone attaches firmly to the receptors.  At adequate  maintenance, methadone fills most receptors and blocks other opioids from attaching. 

  13. How Much? ENOUGH!

  14. My dose isn’t “holding” me... Environment Stressors Alcohol Other drugs/medications Vitamins Urinary pH Methadone Blood Levels

  15. BENEFITS OF METHADONE TREATMENT Marked decrease in illicit opiate use. In addition there is also a significant and consistent reduction in the use of other illicit drugs, including cocaine, and in the abuse of alcohol Marked reduction of criminal activity Marked decrease in emergency room visits Increase rate of gainful employment Marked decrease rate of transmission of HIV, Hepatitis (A, B, C, etc.) and other infectious diseases

  16. The National Institute on Drug Abuse (NIDA) Treatment Outcome Study: Heroin Use Decreased by 70% Criminal Activity Decreased by 57% Full-time Employment Increased by 24% Smart Statistic

  17. MethadoneMyths Methadone gets into your bones Methadone rots your teeth Methadone makes you fat Methadone is harder to kick Methadone disrupts your sex life Low doses of methadone are better than high doses The shorter the methadone maintenance treatment the better Pregnant addicts should not take methadone because it hurts their unborn baby Methadone damages the liver Methadone maintenance patients don’t need pain medication

  18. Other Forms of MAT Buprenorphine (Suboxone) Drugs that activate opioid receptors are termed opioid agonist. Heroin and methadone are opioid agonist. Opioids that bind to opioid receptors but block, rather than activating them, are termed opioid antagonist such as naltrexone and naloxone. l

  19. Opioid partial agonist are drugs that activate receptors, but not to the same degree as full agonist. • Buprenorphine is an opioid partial agonist. It is the partial agonist properties of buprenorphine that make it safe and an effective option for treatment of opioid addiction.

  20. Buprenorphine has sufficient agonist properties such that when it is administered to individuals who are not opioid dependent but are familiar with the effects of opioids, they experience subjectively positive opioid effects. These subjective effects aid in maintaining compliance with buprenorphine dosing in patients who are opioid dependent.

  21. Buprenorphine occupies opioid receptors with great affinity and thus blocks opioid full agonist from exerting their effects. • Buprenorphine dissociates from opioid receptors at a slow rate. This enables daily or less frequent dosing of buprenorphine, as infrequently as three times per week in some studies.

  22. Buprenorphine is abusable, consistent with its agonist action at opioid receptors. Its abuse potential, however, is lower in comparison with that of opioid full agonist.

  23. Pregnant Women • The scant evidence available does not show any casual adverse effects on pregnancy or neonatal outcomes from buprenorphine treatment, but this evidence is from case series, not controlled studies. • Methadone is currently the standard of care in the United States for the treatment of opioid addiction in pregnant women.

  24. Medication-Assisted Treatment for Alcohol Use Disorders (AUD) • Researchers continue to evaluate the efficacy of numerous compounds to treat AUD’s. To date, FDA has approved four medications for treatment of AUD’s: • 1. Acamprosate (Campral) • 2. Disulfiram (Antabuse) • 3. Oral naltrexone (ReVia, Depade) • 4. Extended-release injectable naltrexone (Vivtrol).

  25. When implemented according to recommended guidelines, medication-assisted treatment combined with brief intervention or more intensive levels of nonpharmacologic treatment can do the following: • 1. Reduce post acute withdrawal symptoms that can lead to a return to drinking (acamprosate’s hypothesized mechanisms of action). • 2. Lessen craving and urges to drink or use drugs (naltrexone).

  26. 3. Decrease impulsive or situational use of alcohol (disulfiram). • In addition, maintaining a therapeutic alliance with a healthcare practitioner can achieve the following: • 1. Improve patients’ attitudes toward change. • 2. Enhance motivation. • 3. Facilitate treatment adherence, including participation in specialty substance abuse care and support groups.

  27. Case Management • Case Management is a set of social service “functions” that helps a client access the resources they need to recover from a AOD abuse problem. • Because AOD abuse affects so many areas of the affected persons life, a comprehensive continuum of services promotes recovery and enables AOD abuse client to fully integrate into society as a healthy, AOD free individual. • Case Management is needed because in most jurisdictions, services are fragmented and / or inadequate to meet the needs of AOD abusing populations.

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