Transcript File - ncaddwestchester.org

Medication Assisted Treatment
Michael Ryan, LCSW, CASAC
What is Methadone Maintenance?
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.
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.
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
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.
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.”
When opioids attach to the mu receptors, dopamine is
released, causing pleasurable feelings to be produced.
As opioids leave the receptors, pleasurable
feelings fade and withdrawal symptoms
(and possibly cravings) begin.
Opioids continue leaving the mu receptors until a
person is in a mild-to-moderate state of withdrawal .
Methadone then attaches to the empty opioid
receptors, suppressing withdrawal symptoms and
reducing cravings.
Methadone attaches firmly to the receptors. At
adequate maintenance, methadone fills most
receptors and blocks other opioids from attaching.
How Much?
ENOUGH!
My dose isn’t “holding” me...
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Environment
Stressors
Alcohol
Other drugs/medications
Vitamins
Urinary pH
Methadone Blood Levels
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
Smart Statistic
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%
Methadone Myths
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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
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
• 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.
• 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.
• 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.
• 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.
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.
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).
• 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).
• 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.
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.