Transcript Slides B1
IT TAKES A VILLAGE TO BATTLE OPIATE ADDICTION: MEDICATION-ASSISTED TREATMENT (MAT) FOR OPIOID ADDICTION THROUGH A TEAMBASED PATIENT-CENTERED APPROACH ANGIE DOMINIC GEFFKEN, MD, MPH KAREN DECKER-GENDRON, RN, MSN, CNL JEANNINE OUELLETTE, LICSW, MLADC AIMEE BURKE VALERAS, PH.D., LICSW OBJECTIVES To emphasize integrated care as the essential ingredient to successful buprenorphine-aided recovery To describe how a residency-based community health center initiated a buprenorphine treatment program To illustrate, through a case example, the key elements to approaching a patient population utilizing buprenorphine treatment THE OPIATE CRISIS THE CURRENT SITUATION – NEW HAMPSHIRE It is estimated that 500 people will die from overdoses in 2016 ADDICTION IS A CHRONIC ILLNESS WHAT DOES IT FEEL LIKE TO HAVE OPIOID ADDICTION? Dole, VP, Nyswander, ME, Kreek, MJ. AIM 1966. 118; 305 MEDICATION ASSISTED THERAPY (MAT) MAT is the use of the drug, buprenorphine in combination with behavioral therapy to address the cognitive and physical aspects of addiction1,2 Opioid Buprenorphine Perfect Fit Maximum Opioid Effect Empty Receptor Receptor Sends Pain Signal to the Brain Empty Receptor No Withdrawal Pain Withdrawal Pain Imperfect Fit – Limited Euphoric Opioid Effect Courtesy of NAABT, Inc. (naabt.org) Euphoric Opioid Effect Buprenorphine Still Blocks Opioids as It Dissipates OUR JOURNEY TREATMENT MUST GO BEYOND JUST FIXING THE CHEMISTRY We need to treat the whole person… Pharmacological Treatments (Medications) Medical Services Behavioral Therapies Social Services …in their social context THE TEAM: Angie (Patient) Dominic (PCP) Karen (Nurse) Aimee (Therapist) Jeannine (Addiction Counselor) ANGIE’S STORY HEALTH CARE TEAM’S STORY ANGIE’S STORY KEY TENETS OF TEAM-BASED MAT: Communication Coordination Accountability Flexibility Advocacy LESSONS LEARNED: Relapse will happen Treatment of addiction by the primary care team reinforces the idea that this is a disease Team is helpful for constant feedback to all members SUMMARY • Integrated team-based care: essential ingredient to successful MAT recovery • Primary care: well-suited to provide MAT team-based care • Communication, coordination, accountability, flexibility and advocacy: key elements to approaching a patient population utilizing MAT FUTURE DIRECTIONS • Increase number of PCPs prescribing • Promote standard of care that encompasses providing wrap-around treatment within a multidisciplinary team • Develop a educational component for residents REFERENCES 1. Mattick RP, Breen C, Kimber J, Davoli M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev.;(2):CD002207. 2. SAMHSA. Medication Assisted Treatment. www.SAMHSA.gov/medication-assisted-treatment 3. Donaher PA, Welsh C. (2006). Managing opioid Addiction with Buprenorphine. Am Fam Physician;73:1573-8, 1580. 4. Drainoni Mari-Lynn, Farrell Caitlin, Sorensen-Alawad Amy, Palmisano Joseph N., Chaisson Christine, and Walley Alexander Y. (2014). Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment. AIDS Patient Care and STDs, 28(2): 71-81. doi:10.1089/apc.2013.0179. 5. David A. Fiellin, M.D., Michael V. Pantalon, Ph.D., Marek C. Chawarski, Ph.D., Brent A. Moore, Ph.D., Lynn E. Sullivan, M.D., Patrick G. O'Connor, M.D., M.P.H., and Richard S. Schottenfeld, M.D. (2006). Counseling plus Buprenorphine–Naloxone Maintenance Therapy for Opioid Dependence N Engl J Med; 355:365-374. DOI: 10.1056/NEJMoa055255 6. Frances L Lynch, Dennis McCarty, Jennifer Mertens, Nancy A Perrin, Carla A Green, Sujaya Parthasarathy, John F Dickerson, Bradley M Anderson and David Pating. (2014). Costs of care for persons with opioid dependence in commercial integrated health systems. Addiction Science & Clinical Practice; 9:16 DOI: 10.1186/1940-0640-9-16 7. Karen Miotto, Maureen Hillhouse, Roger Donovick, Jerry Cunningham-Rathner, Charlie Charuvastra, Matthew Torrington, Asher E. Esagoff, Walter Ling, (2012). Comparison of Buprenorphine Treatment for Opioid Dependence in Three Settings. J Addict Med, 6(1): 68–76. doi: 10.1097/ADM.0b013e318233d621 8. Darren Urada, Cheryl Teruya, Lillian Gelberg and Richard Rawson. (2014). Integration of substance use disorder services with primary care: health center surveys and qualitative interviews. Substance Abuse Treatment, Prevention, and Policy20149:15 QUESTIONS? COMMENTS?