Transcript Heroin = T40.0,.1

Medication Assisted
Therapy (MAT) in the US
and Worldwide
hams.cc/methadone.pptx
Kenneth Anderson
HAMS
Opioid Substitution Therapy (OST) Worldwide
Yes No
Four countries have no data: Western Sahara,
South Sudan, North Korea, and Greenland
• Three countries have opioid assisted detox but
no maintenance, Bahrain, Cyprus, and Oman
• In the past decade a substantial number of
countries have initiated OST, including
Afghanistan (2009 pilot program), Cambodia
(2010), Kenya (2014), Kosovo (2012), Morocco
(2010), and many more.
Opioid Use Worldwide
• Heroin is the primary opioid of abuse in most
of the world
• High rates of non medical use of oxycodone,
hydrocodone, etc. are found primarily in the
US
• Most non medical prescription opioid use
outside the US involves methadone,
buprenorphine, fentanyl, codeine, darvon,
demerol or morphine
Treatment admissions by primary
opioid type US 2013
Treatment admissions by opioid type
in Europe (including Turkey) 2014
Percentage of treatment entrants reporting an
opioid other than heroin as primary drug
•In Estonia 86% of
admissions are due to
fentanyl
•In Finland 86% of
admissions are due to
buprenorphine
•In the Czech Republic 30%
are due to buprenorphine
7% are due to methadone,
48% are due to heroin and
16% to other opioids
Australia closed opioid treatment
episodes by opioid type
Opioids injected in India as reported by
clients at 22 needle exchange programs
Prevalence of heroin and non-medical prescription
opioid (NMPO) use in US and Switzerland 2014
Heroin accounts for 95% of Swiss
opioid seizures (stable since 1990)
Swiss court cases since 1990 involving illicit opioids by type
2014 Swiss opioid treatment admissions by
primary drug for all treatment types
MAT in USA, Switzerland, and Australia
compared
• Treatment of opioid addiction has been a
resounding success in Switzerland and also
majorly successful in Australia
• Treatment of opioid addiction has been an
abysmal failure in the USA
• Here’s some reasons why
Lifetime prevalence of heroin use among young
people in Switzerland and US 1992-2012
US rate in 2014 was 1.5
Drug Misuse-Related Deaths in USA
and Switzerland 1995-2013
Accidental opioid overdose deaths age
15-54 USA Australia 1999-2014
ICD-10 codes F11, F19, X42, X44, T40.0-4, .6
All overdose deaths in USA and Australia due to
heroin and Prescription Opioids age 15-54
Heroin = T40.0,.1; PO = T40.2-4, .6
Switzerland
MAT
Medication Assisted Treatment
HAT
•Heroin Assisted Treatment
•Under direct Federal control
•Uses heroin to treat heroin
dependence
•Only available in specialty
clinics
SAT
•Substitution Assisted Treatment
•Under control of cantons
(states)
•Uses methadone, SROM (slow
release oral morphine),
buprenorphine, and
levomethadone (off label)
•Available from GPs or clinics
Swiss admissions for opioid treatment 2014
Type
Number of clients
Percentage of facilities reporting
outpatient
312
37%
inpatient
150 (main problem)
70%
HAT
130
100%
MMT
934
12 of 26 cantons
40% of clients (168) in inpatient drug treatment (for any drug) reported
also being in substitution therapy
Inpatients reporting opioids as a problem
Heroin
221
Methadone
50
Buprenorphine
6
Fentanyl
3
Other opioids
11
60% of Swiss SAT is provided by MDs,
typically primary care physicians
Clients may pick up
their daily dose at
the doctor’s office
or the drug store
Percentage of clients per dosing point
Australia 2015
Types of MAT in Switzerland 2014
•17,008 people in
SAT in 2014
•About 1400 people
(1649 cases) in HAT
in 2014
Types of MAT in Australia
Urine Testing
Switzerland
Patients should be asked
about their parallel
consumption of other
substances. Provided
there is no threat of
sanctions, their replies are
generally reliable.
Systematic urine testing
does not yield any further
benefit in such cases.
USA
42 CFR § 8.12(f) (6). OTPs
must provide adequate
testing or analysis for drugs
of abuse, including at least
eight random drug abuse
tests per year... For patients
receiving long-term
detoxification treatment,
the program shall perform
initial and monthly random
tests on each patient.
Take-Homes
Switzerland
• Abstinence not required for
take homes
• “Stable patients can be
provided with take-away
doses with the specific aim
of strengthening the
relationship of trust and
improving the success of
treatment (less parallel
consumption, higher
retention rate)”
USA
• 42 CFR § 8.12 (h) (4) (i)
Unsupervised or “takehome’’ use. (2) (i) Absence
of recent abuse of drugs
(opioid or nonnarcotic),
including alcohol
USA
• Only 27% of clients admitted to treatment for opioid
dependence in the USA receive MAT
• 17 states do not cover methadone under Medicaid and
many private insurances also refuse to pay.
• Many Americans who cannot afford it must pay for
methadone out of pocket and it’s often more than
their rent
• Methadone reduces death rates 75% compared to
active use but abstinence based 28 day treatment
increases death rates 3,000% over active use
•In Switzerland
methadone is
FREE!
Conclusion
• The US needs to follow the lead of Switzerland
and Australia
• We need to allow GPs to prescribe and dispense
methadone
• We need to make pharmacies into dosing points
• We need to make all OST free
• We need to stop treating OST patients like
criminals and monsters
• hams.cc/methadone.pptx