Transcript How OTPs Can Improve Outcomes and Lower Costs in the

Improved outcomes and lower costs.
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Drugs of abuse produce their effects by altering
brain chemistry and structure.
Neurotransmitters and associated receptors
responsible for everyday functions are altered by
the consumption of drugs.
When the drug being abused is an opiate, these
changes can be very long lasting.
Heroin (opiate) addiction is a disease – a
“metabolic disease” – of the brain with
resultant behaviors of “drug hunger” and
drug self-administration, despite negative
consequences to self and others. Heroin
addiction is not simply a criminal behavior or
due alone to antisocial personality or some
other personality disorder.
(Dole, Nyswander and Kreek, 1966, 2006)
After decades of research and clinical
experience and after hundreds of peer
reviewed studies in scholarly journals the
evidence is clear that the best clinical
outcomes for the chronic long-term opiate
addict are achieved when addiction medicines
are used as part of a comprehensive approach
to treatment. This is particularly true if the
measure of success is long term abstinence
from illicit opiates.
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When a provider (or treatment
modality) claims to have a high degree
of success in treating chronic, longterm, opiate addiction how can I
decide if I should believe them?
What not to believe:
• Anecdote
• Testimonials & Rallies
• Almost anything which begins ….”I can tell you from
my personal experience…”.
• So-called “data” which is self-generated and which
has not been subject to academic and/or peer
review, and which has not been published in
respected scientific journals.
Real proof consists of:
• Peer-reviewed outcome studies published in scholarly journals.
• Repeated outcome studies by a wide-range of scientists over
time which point to a continued and repeated result. Not “One
and done”.
• Medication Assisted Treatment for opiate addiction meets this
standard!
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The National Institutes on Health in 1997 concluded
that Methadone “…combined with attention to
medical, psychiatric, and socioeconomic issues, as
well as drug counseling, has the highest probability
of being effective…” in the treatment of opiate
addiction.
Two Recent Studies in Support of
Medication Assisted Treatment
• Assessing the Evidence: Medication Assisted
Treatment with Methadone
• Assessing the Evidence: Medication Assisted
Treatment with Buprenorphine
To Find All Three Studies Go To:
www.compa-ny.org
Once on the website go to the “News” section and find
each study under the heading “Research in Support of
Medication Assisted Treatment”.
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Number of patients currently in treatment:
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212,000 (USA)
>500,000 (worldwide)
Methadone is a medication: used in the
detoxification & maintenance treatment of opioid
addiction in conjunction with the appropriate social
and medical services
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Efficacy in “good” treatment programs using
adequate doses (80 to 150mg/d):
Voluntary retention in treatment (1+ year) = 50 –
80%
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Continuing use of illicit heroin = 5 – 20%
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OTP Oversight & Regulation
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SAMHSA
DEA
OASAS
NYS DOH
LGUs
What Services Can You
Expect an OTP to
Provide?
Assessment & Intake
• Determine if patient is appropriate for OTP
treatment (possible referral)
• Intake Physical
• Individual Treatment Plan (based on patient
goals, not “cookie-cutter”
Medication:
• Methadone*
• Suboxone (a.k.a. Buprenorphine)**
• Vivitrol**
• Also – An important distinction between dispensing
and prescribing.
* Provided by all OTPs
** Provided by some OTPs
Counseling:
• Individual (brief & longer)
• Group
• As called for by individual treatment plan
Harm Reduction Interventions:
• HIV
• HEP C
• STDs
Services Provided by Some OTPs:
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Primary Care
Alternative to Inpatient Detox
Directly Observed Therapy
Social Service & Criminal Justice Supports
Typical Benefits of OTP Treatment:
• Retention in treatment
• Reduction or elimination of illicit opiate use
• Reduction or elimination of problematic secondary substance
use
• Reduction in rates of contracting both HIV and Hepatitis C
• Reduction in rates of transmitting HIV, STDs, and Hepatitis C to
others
• Reduction in the rates of criminal behavior
• Reduction in the rate of incarceration and re-incarceration
• Reduction in overdose deaths
• Reduction in both number and duration of hospital inpatient
stays
Benefits of OTP Treatment (continued):
• Improvement in overall health (especially in pregnant
women)
• Improved engagement in primary care
• Improvement in housing
• Improvement in employment / productive engagement
Even More Benefits
• Lowest cost per successful outcome
• Can most often be done in an outpatient
setting
• Least disruptive to normal patient life –
family & work responsibilities
With the amazing success rate of medication
assisted treatment why isn’t it being used
more widely?
Why does there continue to be resistance to
this treatment?
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Overcome “Data Resistance”
(hiding from evidence).
Urgent need for good science to
triumph over…
– SPAM –
Stigma, Prejudice, And
“MythUnderstandings.”
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Methadone was invented by the Nazis as a form of
“chemical handcuffs”. As proof people say an early
name for the drug “Dolophine” was a tribute to
Adolf Hitler.
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Methadone was invented in 1937 by the German
pharmaceutical company IG Farben prior to World
War II as a pain killer.
Beyond initial laboratory testing it was never used
in Nazi Germany.
At the end of the war Eli Lilly obtained all the IG
Farben facilities and patents and named the drug
Dolophine as a combination of the Latin word dolor
(pain) and the French word fin (end).
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Patients on Methadone are getting high from the
drug and it’s just substituting one drug for another.
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When a patient is properly stabilized on Methadone
there is no “high”.
The drug is slow acting and it takes more than24
hours for the drug to be fully metabolized.
Virtually all drugs which produce a “high” are fast
acting and achieve high levels in the blood stream
quickly.
Methadone is not just replacing one drug for
another since Methadone treats an imbalance which
has been created in the brain from the extended
use of short acting drugs like heroin.
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Methadone patients are sedated, behave like
“zombies” and are said to be “on the nod”. Thus
they are incapable of productive engagement like
work or school, and they should not be allowed to
drive a car.
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Once a patient is stabilized on Methadone there is
no sedation or cognitive imparement.
There is no reason a Methadone patient should not
be allowed to drive a car.
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Methadone is harder to kick that heroin.
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Once the brain has been altered by long term opiate
addiction it is very difficult for many patients to
achieve a “drug free” state without the use of
addiction medicines.
Transitioning from Methadone to a “drug free” state
is no more problematic than transitioning from
illicit opiate addiction to a drug free state.
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Methadone rots your bones, and produces a
number of other negative Physical health
consequences.
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Just the opposite is true. The drug itself does no
harm when taken correctly.
The patient in Methadone treatment pays more
attention to their physical health and well being
since they are no longer preoccupied by drug
seeking behavior.
The result is a dramatic improvement in overall
health.
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Methadone is unsafe. This is proven by the fact
that there has been a dramatic increase in
Methadone related deaths and Methadone
overdoses.
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Methadone (like all opiates) can suppress respiration.
Until an opiate tolerance is established a sufficient dose of
Methadone can cause serious illness and death.
A GAO (General Accounting Office) report on Methadone
deaths had two major finding:
◦ Because of a lack of standardization in how deaths are
reported, a death may be called “Methadone related” if
there was any Methadone in the post-mortem toxicology
report. This does not prove Methadone was the cause of
death.
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The vast majority of true Methadone overdose
deaths involved patients who were prescribed
Methadone for home use for pain management.
 Patients were not properly informed of the dangers of the
medication, or failed to use the drug as prescribed or to store
it safely.
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In very few cases was death linked to the use of
Methadone for the purposes of opiate addiction
management.
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Methadone is a “crutch” for people too weak to go
drug free.
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The physical changes in brain chemistry have
nothing to do with strength of will.
Once addiction has occurred and the brain
chemistry and physiology has been altered the
brain will constantly seek an opiate drug to address
this craving.
Addiction medication (Methadone, Buprenorphine,
& Vivitrol) resolves this physical craving and
dramatically reduces the likelihood of relapse to
illicit opiate use.
Using Addiction Medicines is
Against our Philosophy
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Etymology of
“Philosophy”
Philo - loving
Sophia - wisdom
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How is it possible to love
wisdom and reject science?
Where can I find an OASAS licensed OTP
near me?
Go to the OASAS Website:
www.oasas.ny.gov/providerdirectory
• Click on “Treatment Providers”, then
• Under “Provider Type” scroll down to “Methadone
Treatment” *
* Of course it should say “Opioid Treatment Programs”!
For more information about Opioid Treatment
& Opioid Treatment Programs, contact:
Allegra Schorr
President
COMPA (Committee of Methadone Program
Administrators of New York State Inc.)
911 Central Avenue, #322
Albany, NY 12206
[email protected]