1 / 20

MEDICATION ASSISTED ADDICTION TREATMENT: “APPROPRIATE USE” DAS Quarterly Provider Meeting

MEDICATION ASSISTED ADDICTION TREATMENT: “APPROPRIATE USE” DAS Quarterly Provider Meeting. Louis E. Baxter, Sr., M.D., FASAM Medical Director-DAS President Elect American Society Addiction Medicine. GOALS & OBJECTIVES. Review comprehensive evaluation components DSM-IV-TR diagnosing

morey
Download Presentation

MEDICATION ASSISTED ADDICTION TREATMENT: “APPROPRIATE USE” DAS Quarterly Provider Meeting

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MEDICATION ASSISTED ADDICTION TREATMENT: “APPROPRIATE USE”DAS Quarterly Provider Meeting Louis E. Baxter, Sr., M.D., FASAM Medical Director-DAS President Elect American Society Addiction Medicine

  2. GOALS & OBJECTIVES • Review comprehensive evaluation components • DSM-IV-TR diagnosing • Review full treatment planning • Patient Placement – ASAM PPC-2 • Treatment of Co-occurring Disorders • Medication Assisted Therapy for detoxification, maintenance, and pain management

  3. ADDITIONAL RESOURCES • CSAT TIP # 43 Buprenorphine Therapy • CSAT TIP # 45 Detoxification and Substance Abuse Treatment *** • National Quality Forum – “Evidence Based Treatment Practices for Substance Use Disorders” • ASAM’s Monograph – “Achieving Treatment Success in Alcohol Dependence”

  4. COMPREHENSIVE EVALUATION COMPONENTS • “Chief Complaint” …why are you here? • Alcohol Use History … Screening Tool (CAGE) • Drug Use History … Rx, Illicit, and OTC • Previous Treatment History … include Clergy • Previous Psych History … admissions and OP • Legal History • Past Medical / Surgical History / Medications • Family History … Psychiatric and Substance Use • Marital History • Psychosocial History … Employment / Clubs/ Hobbies

  5. DIAGNOSES • DSM-IV-TR Criteria for Substance Use Disorders • Use disorder; Abuse; Dependence (Addiction) • DSM-IV-TR Criteria for Psychiatric Disorders • Depression; Bipolar; Anxiety • Laboratory Data Documentation of Medical Disorders • Chronic pain; Seizure; Migraines; HIV/AIDS; Liver disease • National Quality Forum Guidelines (2005) • Evidence-based Best Practices for SUD

  6. FULL TREATMENT PLANNING • Assessment – Diagnosis • Detoxification – Medical Maintenance • Rehabilitation – Counseling • After / Continuing Care – Twelve Step Program • Co-occurring Illness Care • Pain Management Care • General Medical Care

  7. APPROPRIATE LEVEL OF CARE • ASAM Patient Placement Criteria-2 • Only peer reviewed beta tested tool for patient placement • Level 0.5 … Brief Intervention (3-6 sessions) • Level I … Traditional Outpatient (Individual) • Level II … Intensive Outpatient (group therapy) three to five 90 minute sessions weekly • Level III … Residential (Medically supervised) • Level IV … Hospital based (Medically managed)

  8. TREATMENT WORKS • Full Treatment Experience (Detoxification; Rehabilitation; Maintenance) • General Population recovers @ 77% @ 1yr • Detoxification & Rehab Only @ 33% @ 1yr • Detoxification Alone @ < 10% @ 1 yr

  9. TREATMENT OUTCOME COMPARISONS • Alcoholism … 50-70% abstinent • Opioid Dependence … 50-80% abstinent • Cocaine Dependence … 50-60% abstinent • Nicotine Dependence … 20-40% abstinent • Diabetes (relapse) … 30-50% stable • Hypertension (poor control) … 50-60% • Asthma (multiple ER visits) … 60-80% (Gaber, Davidson, 1992; McLellan 2002)

  10. MEDICATION ASSISTED THERAPIES • Medications for detoxification • Medications for maintenance • Medications for psychiatric illnesses • Medical management of pain

  11. MEDICATIONS FOR DETOXIFICATION • Librium … Alcohol and Benzodiazepine detoxification • Benzodiazepine & Phenobarbital … Benzodiazepine detoxification • Suboxone (Subutex) & Methadone …Opiate detoxification • Clonidine & Naltrexone … Opiate detoxification • Bromocryptine & Amantadine … Stimulant detoxification • Wellbutrin … Cannabis detoxification

  12. MEDICATIONS FOR MAINTENENCE • Buprenorphine ….Opiate dependence • Methadone … Opiate dependence • Acamprosate … Alcohol dependence • Naltrexone …Alcohol and Opiate dependence • Vivitrol .......... Alcohol dependence • Disulfram … Alcohol dependence • Nicotine Replacement …Nicotine dependence

  13. STATUS OF ALCOHOL TREAMENT • More Treatment Options than ever before • New medications and psychosocial approaches • Guidelines for use of medications in “actively using”alcohol patients and“patients in recovery” • Treatment in outpatient and primary care settings ASAM Levels I and II • Medications help promote and sustain recovery • Problem … Less than 1/5 of facilities are using new pharmacotherapy (barriers?) • Need to engage physicians to move forward in pace with the new developments in alcohol treatment

  14. MEDICATIONS FOR ALCOHOL DEPENDENCE FDA APPROVED • Disulfiram…aversion therapy • Oral Naltrexone … reduction in craving • Injectable Naltrexone … compliance • Acamprosate … reduction in cravings and prolonged withdrawal syndromes

  15. DISADVANTAGES OF MEDICATION THERAPY • “Use in lieu of” full treatment experience • Burdensome regimes and side-effects may undermine commitment to recovery • Poor medication selection … must meet patient needs • Premature discontinuation of medications (need to match with patient’s recovery status)

  16. ADJUNCTIVE MEDICATIONS • SSRIs ………… Affective Depressant Disorders • Buspar ……… Anxiety Disorders • Benzodiazepines (Oxazepam, Librium, Klonopin) … in special psychiatric cases (GAD, Panic Disorder, Agoraphobia) • Phenothiazines ... Affective Disorders (Schizophrenia) • Lithium ……… Major Depression • Trazadone … Insomnia • Other Medications for Medical Problems under medical supervision

  17. MEDICATIONS FOR PAIN MANAGEMENT • NSAIDs … at maximum dosages ATC • Methadone … in combination with NSAIDs • Buprenorphine in combination with NSAIDs • Neuroleptics … in combination with other meds • SSRIs … have been shown to be useful • Clonidine … for neuropathic pain • Clonazepam … for lancinating pain • Baclofen …for central nervous system pain • LONG Acting Narcotics …. medical supervision

  18. SPECIFIC PROTOCOLS • PREGNANT OPIOID DEPENDENT PATIENTS SHOULD NOT BE DETOXIFIED • The treatment of choice is METHADONE MAINTENANCE • BUPRENORPHINE … 2,4,6,8 OR 16 MG FOR Detox and Maintenance (postpartum)

  19. TREATMENT ISSUES • Mobile Medication Van … multiple communities • Needle Exchange Program • Mobile Methadone and Buprenorphine • New Drug Protocols … Peer Review-Control Group Studies

  20. SUMMARY … THE BEGINNING • Addiction treatment is growing up • Pharmacotherapy has arrived • Pharmacotherapy is not in lieu of traditional therapy • Pharmacotherapy is an integral part of a“full treatment experience” • Pharmacotherapy is not for everyone • The need for pharmacotherapy should not lead to exclusion from treatment programs

More Related