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Decreasing line graph icon REDUCE Heroin Addiction Ensure access to Medication-Assisted Treatment (MAT). Treat people addicted to heroin or prescription opioid painkillers with MAT which combines the use of medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies.

Treatment for Opioid Use Disorder Non-pharmacologic Pharmacologic Outpatient individual or group Detox methadone, buprenorphine, clonidine, “comfort meds” Intensive outpatient/partial Antagonist therapy naltrexone PO or IM Acute or Long Term Residential Agonist therapy methadone, buprenorphine Sober home/half-way house More and more, opioid dependence is being accepted as a chronic disease, much like high blood pressure or diabetes. Yet unlike these other diseases, opioid dependence carries a very powerful stigma. This stigma is rooted in the centuries-old belief that opioid dependence is a moral failure. It was only within the last 20 years that researchers began to realize opioid dependence was truly a medical condition caused by changes in the brain—changes that didn't go away, sometimes for months or even years, after patients stopped using opioids. It is for this reason that the treatment for opioid dependence should be no different than the approach that is taken to treat any other chronic medical illness. A bio-psycho-social approach should always be taken. You can predict better outcomes when pharmacologic options are combined with non-pharmacologic interventions, as relapse rates w/o medication can be as high as 95% in patients who try to “abstain on their own”. Non pharmacologic interventions have traditionally included residential treatment, iop, php, TC’s, 12 step fellowships (NA), indiv, group, family therapy and/or any combination therein. Pharmacologic interventions can take 1 of 3 routes. The FIRST one is detoxification w/supervised withdrawal using either methadone, buprenorphine,or clonidine in addition to other “comfort meds” used acutely to relieve the rhinorrhea, cramping, diarrhea, diaphoresis, piloerection and other uncomfortable sx’s that are characterisitic of opioid wd. The Second, through the use of opioid antagonists, such as naltrexone, which blocks the effects of opioids drugs and helps to prevent relapse to opioid use in highly selected populations….or THIRD, Medication assisted replacement therapy, using agonist or partial agonist medication such as methadone, buprenorphine or LAAM to normalize brain chemistry, block the euphoric effects of opioids and relieve physiological cravings and normalize body functions. These medications produce morphine like agonist effects and cross substitute for heroin. The oldest of the 3, Methadone Maint treatment, has been available for over 30 years and has been confirmed effective for opioid dependence in numerous scientific studies. ( These benefits include Reduction or cessation of iv use, Reduced risk of overdose and of acquiring or transmitting diseases such as HIV, hepatitis B or C, bacterial infections, endocarditis, soft tissue infections, thrombophlebitis, tuberculosis, and STDs, Reduced mortality, Reduced criminal activity, Improved family stability, Improved employment potential, and Improved pregnancy outcomes). Unfortunately, it is a treatment modality that can be rather disruptive to a patient’s lifestyle as they are required to visit a clinic daily for a daily dose and for some this means commuting up to several hours a day. Buprenorhine maintenance, on the other hand as we will expand on shortly, can be prescribed in an office based setting which allows patients to receive up to a month’s worth of medication at a time and more easily adapts to an adolescent’s or an individual’s lifestyle. Most importanty, although Methadone and Buprenorphine are widely used for maintenance in adult populations, Methadone Maintenance is not an option that is easily available for those under the age of 18 whereas Bup/Sub is approved for those aged 16 and above. LAAM a synthetic opioid similar in structure to methadone and approved in 1993 by the U.S. FDA for use in the treatment of opioid dependence, was removed from the European market in 2001 and from the US market in 2003 due to reports of life threatening cardiac ventricular arrhythmias. A)Pharmacotherapy involves : Antagonist maintenance treatment using naltrexone: Agonist maintenance with Methadone and LAAM. Methadone treatment provides the patient who is opioid dependent with medication, health, social and rehabilitation services that relieve withdrawal symptoms, reduce physiological cravings and allow normalization of the body's functions. Methadone treatment has been available for over 30 years and has been confirmed effective for opioid dependence in numerous scientific studies. These medications produce morphine like agonist effects and cross substitute for heroin. LAAM was removed from the market because of reports of cardiac arrhythmias. 3) Partial agonist maintenance with buprenorphine or buprenorphine plus naloxone : Approval of buprenorphine marks a historic milestone for drug abuse research and treatment. Buprenorphine crowns more than two decades of NIDA-supported research on the neurobiology of drug addiction with a medication that has the potential to increase the safety, availability, and acceptance of opioid abuse treatment in the United States. Primary care physicians can qualify by submitting a notification of intent to the substance abuse and mental health services administration, which will then provide a waiver. Qualified physicians must have active state and drug enforcement agency licenses. ASAP buprenorphine programASAP buprenorphine program

Detoxification Studies recurrently find high relapse rates after detoxification without subsequent treatment NIH consensus statement regarding treatment of opioid dependent adults indicated detoxification alone is insufficient treatment. National Institute of Health Consensus Development Conference Statement, 1997. Kosten TR, Schottenfeld R, Ziedonis D, Falcioni J. Buprenorphine versus methadone maintenance for opioid dependence. Journal of Nervous and Mental Disease 1993;181(6):358-64.; Mattick et al., Buprenorphine versus methadone maintenance therapy: a randomized double-blind trial with 405 opioid-dependent patients., Addiction, 2003 Apr;98(4):441-52.; Gowing, L., Buprenorphine for the management of opioid withdrawal., Cochrane Database Syst Rev. 2000;(3):CD002025. National Institute of Health Consensus Development Conference Statement, 1997. Kosten TR, Schottenfeld R, Ziedonis D, Falcioni J. Buprenorphine versus methadone maintenance for opioid dependence. Journal of Nervous and Mental Disease 1993;181(6):358-64.; Mattick et al., Buprenorphine versus methadone maintenance therapy: a randomized double-blind trial with 405 opioid-dependent patients., Addiction, 2003 Apr;98(4):441-52.; Gowing, L., Buprenorphine for the management of opioid withdrawal., Cochrane Database Syst Rev. 2000;(3):CD002025. Woody, GE., et al. Extended vs. Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth. JAMA 300(17) :2003-2011, 2008.

Medication Assisted Treatment Methadone Buprenorphine (Subutex) and buprenorphine and naloxone (Suboxone) Naltrexone (Vivitrol) 24 Hour Addiction Hotline 716-831-7007

Buprenorphine (Subutex) and buprenorphine and naloxone (Suboxone) Treat opioid addiction Prevent withdrawal symptoms when someone stops taking opioid drugs

U-turn icon REVERSE Heroin Overdose Expand the use of naloxone. Use naloxone, a life-saving drug that can reverse the effects of an opioid overdose when administered in time.

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All EDs counsel and provide naloxone for opioid OD patients

Moving forward

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