Medication-Assisted Treatment 101: Breaking the Stigma Christie Simons, MAMFT, LPCA, LCAS-A Director of Counselor Services, Belmont Abbey College McLeod Addictive Disease Center

Medication-Assisted Treatment Introduction Common Myths?

Medication-Assisted Treatment Involves the use of medication to aid in the treatment of addiction. Types: 1. Treat acute withdrawal or initial attainment of abstinence 2. Chronic maintenance or prevention of relapse (McCance-Katz & Kosten, 2005)

Opioids: Some Basics Natural opioid receptors in the brain and throughout the body - Mu (μ), kappa (κ), and delta (δ) Endogenous (naturally produced opioids): Endorphins and Enkephalins Exogenous: Poppy, Opium, Morphine, Oxycodone, Hydrocodone, Heroin, Fentanyl, Methadone, Buprenorphine

Opioid Pharmacotherapies Overdose Treatment  - Naloxone: rapidly reverses overdose symptoms (by displacing the opioid from receptors in the brain) Treatment of Acute Withdrawal  - Clonidine: lowers severity of acute withdrawal  - Naltrexone - precipitates withdrawal, then use clonidine to treat (helps speed up detox and withdrawal)  - Buprenorphine

Opioid Pharmacotherapies Opioid Maintenance: Naltrexone: after withdrawal from opioids - blocks the effects of opioid agonists and aids in preventing relapse  LAAM: long-acting opioid (not a first line treatment due to dangers associated with cardiac complications)  Methadone  Buprenorphine

Methadone Long-acting synthetic opioid - Full agonist Half-Life of 24-48 hours (*8-12 for pain) Sits on the mu (μ) receptors in the brain  diminishes withdrawals and inhibits effects of other opioids - Recommended for pregnant women Dosing: Daily at “stable dose” – different for everyone (20 – 120mg) - Liquid Contraindications Synergistic Effects: Benzodiazepines, Alcohol, Barbiturates

Buprenorphine Long-acting synthetic opioid Partial Agonist Half-Life of 24-48 hours ‘sticky’ substance – hard to knock off receptor Ceiling effect (nearly impossible to overdose) Dosing: Daily at stable dose – (2 – 32mg) - sublingual tablets - injections Subutex vs Suboxone (Buprenorphine + Naloxone)

Opioid Treatment Program Treatment for those suffering from opiate addiction Must meet criteria for Opioid Use Disorder, Severe Accessible and cost-effective Allows for client to continue with daily life (work, parenting, etc) while avoiding withdrawal symptoms and engaging in treatment to aid in recovery Goal for most is to eventually taper off (after having developed strong recovery in other areas of life)

Opioid Treatment Program: McLeod Addictive Disease Center Largest Addiction Treatment provider in Carolinas Operating since 1969 9 OTPs (Boone, Charlotte, Statesville, Hickory, Monroe, Concord, Gastonia, Lenoir, Marion)

Opioid Treatment Program (OTP) Voluntary/walk-in: same-day service Intake assessments completed 1 – 5 days per week - Counselor, Nurse, Doctor Presents daily for at least 90 days - 1st 30 days: Induction Minimum monthly random UDS testing Minimum bi-weekly counseling sessions Weekly group Encourage participation in community-based programs, such as NA/AA/Celebrate Recovery

Questions?