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NEOMED TEMPLATE

NEOMED TEMPLATE. Ohio Opiate Project ECHO™: Expanding Access to Medication-Assisted Treatment Increasing Patient and Family Support for MAT. MENTOR ECHO: GLOBAL Learning objectives.

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NEOMED TEMPLATE

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  1. NEOMED TEMPLATE Ohio Opiate Project ECHO™: Expanding Access to Medication-Assisted Treatment Increasing Patient and Family Support for MAT

  2. MENTOR ECHO:GLOBAL Learning objectives • Evaluate patients for appropriate referral to medication-assisted treatment (MAT) using a collaborative, person-centered approach • Describe effective treatment strategies for prescribers using MAT in office-based settings • Recognize the level of care needed for complex patients in MAT programs utilizing team-based warm handoffs during transitions of care • Educate patients, families and other community/ social supports about the emotional and behavioral aspects of opioid use disorders in order to reduce stigma

  3. TODAY’S LEARNING OBJECTIVES • Recognize common patient and family objections to MAT • Discuss strategies to increase patient and family acceptance of MAT as a treatment option

  4. Questions to consider: • When was the last time a patient or family member expressed an objection to MAT? What exactly did she/he say? • What was my response (if any)? • How could I respond differently in the future?

  5. How often have you heard…? • “I went from being addicted to heroin to being addicted to MAT” • “MAT is just a crutch—not true recovery” • “I hate depending on MAT” • “I want to be weaned off MAT as soon as possible” • “If I am on MAT, I am not really sober” • “My family/sponsor/counselor says I should get off MAT”

  6. Underlying Themes & Causes • Stigma • Guilt/Shame • Misunderstanding/Misinformation about addiction

  7. Recognizing Health-Related stigma • “Health-related stigma describes a socio-cultural process in which social groups are devalued, rejected and excluded on the basis of a socially discredited health condition.” (Livingston et al. 2011) • Stigma may manifest differently on 3 levels: • Self-stigma intrapersonal • Social stigma interpersonal • Structural stigma institutional

  8. Self-Stigma • From Marianne Ali, Kitchen Manager, D.C. Central Kitchen, Washington, D.C.: “It is not the belief of others, it is the stigma within that affects me the greatest. It is the deeply rooted disdain that seems to be threaded within the fabric of my being that stagnates my progress. It reveals its ugly face when I perceive that what I have to offer is not substantial. It is the belief that I am not worthy or good enough. It is the belief that I don’t have what it takes to make it.” Source: Danya Institute, 2012

  9. Social stigma • "You finally decide to get help, and then you're punished for it—pigeonholed into a diagnosis, shamed, labeled, and discriminated against for life. The stigma can be worse than the illness.” • Participant, The Anti-Stigma Project http://www.onourownmd.org/projects/the-anti-stigma-project

  10. Structural stigma • Health-care providers • May hold negative beliefs about people with SUDs  can contribute to inequitable and poor provision of care • i.e. people with SUDs: overuse system resources • are not vested in their own health • abuse the system through drug-seeking and diversion • fail to adhere to recommended care • May refuse to offer certain services (e.g. needle exchange, MAT) or may not prescribe effective pharmacological treatments to patients suffering from other illnesses (e.g. cancer, back pain) due to stigma Source: Livingston et al, 2011

  11. Effects of stigma • Stigma deters the public from wanting to pay for treatment,  access to resources, treatment, social services • Stigma stops people from seeking help • Prevents people from acknowledging/disclosing their substance abuse problems • Fear that they will not be treated with respect or dignity within the treatment system • Stigma tragically deprives people of their dignity and interferes with their full participation in society Source: Danya Institute, 2012

  12. Helpful strategies to increase acceptance of mat • Find out more • “Tell me more about your concerns regarding MAT” • Ask if family members can be part of the appointment • Share testimonials • In My Own Words • Educate about MAT and OUD • Challenging the Myths About MAT for OUD (1 page) • MAT for Opioid Addiction: Myths and Facts (4 pages)

  13. Helpful strategies to increase acceptance of mat (CONT.) • Challenge internalized stigma • “You deserve recovery.” • “It’s OK to take medication that keeps you alive and not using/drinking.” • “We all need help with something. You don’t need to be a hero. You don’t have to prove anything to anyone.” • Call out shame • “Getting treatment is nothing to be ashamed of.” • “You are worthy of help. Your life is worthwhile.” • “I respect your efforts to get better.”

  14. “Breaking the chains of addiction” Suboxone Film wrappers on canvas, September 2018

  15. ARTIST COMMENTARY: • “What Suboxone has meant to me is that addiction had me handcuffed and Suboxone allowed me to break the chains of addiction.” • “Once the drugs stopped, I had to ‘do what they told me to do’ at 12-step meetings. I did 90 meetings in 90 days—twice. Right now I am attending Suboxone-friendly 12-step meetings. SuboxoneALONE does not keep me clean, but gives me a better chance at recovery, along with meetings and staying busy. Medication is a great tool in my arsenal. The medication is a safety net and it’s amazing.”

  16. ABOUT THE ARTIST: • He is a 31y/o man with opioid use disorder since the age of 21, who has been on buprenorphine/naloxone and continuously sober from opioids, alcohol, and other drugs for almost 5 years. In the past he sold alprazolam in order to obtain pain pills and also used cocaine and marijuana. • He also suffers from depression and anxiety, but has not been psychiatrically hospitalized in over 7 years. • He is currently working full-time as a computer programmer for a Fortune 500 Company. • He finished his associate’s degree in 2016 and is now working toward his bachelor’s degree in Computer Science. • He stopped smoking cigarettes in 2013 and works out regularly at the gym.

  17. references • The Anti-Stigma Project http://www.onourownmd.org/projects/the-anti-stigma-project • The Danya Institute. (2012) Anti-stigma toolkit: A guide to reducing addition-related stigma. http://www.attcnetwork.org/regcenters/productDocs/2/Anti-Stigma%20Toolkit.pdf • Livingston JD, Milne T, Fang M, & Amari E. (2011) The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction 107, 39–50. • http://attcnetwork.org/resources/resource.aspx?prodID=196&rcID=3&regionalcenter=3&producttype=*&keywords=*Healing the Stigma of Addiction: A Guide for Treatment Practitioners, 2nd edition • In My Own Words http://attcnetwork.org/documents/2011essaybook.Final.pdf • MAT for Opioid Addiction: Myths and Facts https://lac.org/wp-content/uploads/2016/02/Myth-Fact-for-MAT.pdf

  18. Questions to consider: • When was the last time a patient or family member expressed an objection to MAT? What exactly did she/he say? • What was my response (if any) at the time? • How could I respond differently in the future?

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