Medication Assisted Treatment Programs A review of Medication-Assisted Treatment Programs in Regards to Opioid Addiction Emily Kallay GRC MSW Program General Guidelines for Creating an Effective Poster Posters need to be read by attendees from a distance of 3 feet or more, so lettering on illustrations should be large and legible. The title should be in very large type, 84 pt. or larger. Do NOT use all capitals for titles and headings. It makes them hard to read. Text on panels should be between 18 and 24 pt. to be legible. Use double or 1.5 spacing between lines of text. Keep each panel relatively short and to the point. More than 25 lines won't get read, but 15 to 18 usually will. Framing the text by putting a box around it will also help readers to focus. Choose a simple font such as Times, Helvetica or Prestige Elite and stick with it. Avoid overuse of outlining and shadowing, it can be distracting. To make something stand out, use a larger font size, bold or underline instead. Whenever possible, use graphs, charts, tables, figures, pictures or lists instead of text to get your points across. Make sure your presentation flows in a logical sequence. It should have an introduction, body and conclusion, just like any other presentation. Posters don’t need to be "arty". Simplicity, ease of reading, etc., are more important than artistic flair. In a room full of posters, consider the visual impact your presentation needs to make in order to attract readers. Use colors behind panels to increase contrast and impact, but avoid fluorescent colors which will make things hard to read when someone gets closer. Consider bringing extra copies of your data and conclusions. Abstract Data Results This paper reviews medication assisted treatment options to treat opioid addiction. This project is designed to further examine options for Medication assited treatment programs. Naltrexone, Methadone , and Buprenorphine play a key role in the success of remaining abstinent from opiates. The goal is to determine who is most appropriate. Current Scope of Opioid Abuse Over the past several years the rate of opioid pain relievers prescribed in the United States has soared. Consumption of hydrocodone and oxycodone have more than doubled, and overdose deaths related to opioids have quadrupled (Kolodny et al., 2015). The rise of prescription opioid use has been associated with the increase of emergency room visits for medication seeking patients. The spike in overdoses related to opioid addiction is striking. Approximately 2.1 million individuals in the U.S are dependent on prescription opioid pain killers, and 467,000 are dependent on heroin (Andraka-Christou, 2016, p. 310). Christou (2016) states that treatment exists for opioid dependence, but it is underutilized. In 2013, 22.7 million Americans were dependent on illicit drugs, but only 3 million Americans received treatment for drug dependence (Andraka-Christou, 2016, p. 311). A course of Opioid Addiction No matter which opioid drug one is using, long-term use could lead to dependency and withdrawal. Although withdrawal from opiates is not life-threatening, it is often so uncomfortable that people use to avoid withdrawal symptoms ("Opioids - Opiates: Addiction, Withdrawal, Crisis, Recovery Facts," 2018). Some withdrawal symptoms may include, "low energy, irritability, anxiety, agitation, insomnia runny nose, teary eyes hot and cold sweats, goosebumps yawning muscle aches and pains abdominal cramping, nausea, vomiting, diarrhea" (Opioids - Opiates: Addiction, Withdrawal, Crisis, Recovery Facts," 2018). There are different stages of opioid withdrawal. Growth and Statistics According to the National Institute of Drug abuse and the National Center For Health Statistics at the Center for Disease Control and Prevention, there were over 64,000 opioid overdose deaths in 2016 (National Institute on Drug Abuse, 2017).Dunn et al. (2016) reviewed the opioid use in rural areas versus urban areas. Evidence pointed out that rural areas are more likely to abuse prescription opioids painkillers, but unlike urban settings, rural areas are less likely to have treatment facilities in the area (Dunn et al., 2016, p. 2). According to the Journal of Substance Abuse Treatment, 90.4% of buprenorphine doctors prescribe in a metropolitan area, where as 1.3% reside in a rural area (Dunn et al., 2016). In rural areas, medication-assisted treatment programs have long waiting lists. The training and use of naltrexone are less likely in rural areas versus urban areas, which could account for the increase overdose rates in these regions (Dunn et al., 2016, p. 2). Medication Assisted Treatment Programs Medication-assisted treatment (MAT) programs help relieve physical withdrawal symptoms, along with cravings for opioid use ("Medication and Counseling Treatment Substance Abuse and Mental Health Services Administration (SAMHSA -)," 2015). Along with treating the physical withdrawal symptoms, cognitive and behavioral therapies are used ("Medication and Counseling Treatment | SAMHSA - Substance Abuse and Mental Health Services Administration," 2015). The prescribed medication helps to stabilize the brain chemistry and block the euphoric feeling when using these substances ("Medication and Counseling Treatment | SAMHSA - Substance Abuse and Mental Health Services Administration," 2015). All medications used by MAT programs must be approved by the Food and Drug Administration (FDA), and treatment is tailored to meet the needs of each patient ("Medication and Counseling Treatment | SAMHSA - Substance Abuse and Mental Health Services Administration," 2015). Medications also can help reduce cravings and alter or eliminate the effects of illicit substances, which deters continued use. Further research needs to be conducted for an assessment for the clinician to properly assess each patient appropriately before prescribing medication to ensure the best possible outcome. Harm Reduction The goal of harm reduction programs is to reduce high-risk behaviors, reduce and eliminate the use of illicit drug use, eliminate criminal activity, and prevent the spread of infectious diseases ("Medication and Counseling Treatment | SAMHSA - Substance Abuse and Mental Health Services Administration," 2015). Runyan, Hewitt, Martin, and Mullin (2017), report that abstinence is not a realistic goal. Most patients who enter treatment will continue to use illicit substances. A harm reduction approach means shifting the focus off of abstinence to meet the patients where they are, in regards to motivation to change (Runyan, Hewitt, Martin, & Mullin, 2017) Naltrexone (ReVia or Vivitrol) This drug can have serious side effects with certain antipsychotic medications and has not been approved for a person younger than 18 years old. Pregnant women cannot use naltrexone because the impact on the fetus is unknown (Substance Use Best Practice Tool Guide EVIDENCE-BASED TREATMENTS, 2016).Individuals who are most suitable for this drug may be of the professional world. Naltrexone should also be used as an option for those who are in residential treatment, and those who are less likely to relapse("Naltrexone and Heroin | Naltrexone Treatment for Opiate Addiction," n.d.). Naltrexone should not be used for those who are at a high risk of relapse, hepitits C, history of depression, and pregnancy. Future screening could assess for risk of relapse, medical, and mental health history, and time in treatment. Methadone Methadone is appropriate for those who live in urban areas and are ok with daily attendance. Methadone is a commitment and can be succcessful for someone who needs structure, and a daily routine. Methadone would be appropriate for those who have exhausted all medication options and continued to relapse (Breslin & Malone, 2006).. Methadone can be used for pregnant women who are continuing to use. Educating the women on the risks of Neonatal syndrome is essential (Holbrook, 2015). Future screening should assess for: age, pain, treatment history, pregnancy, medical and mental health history, and were the person lives (transportation), and evaluation of risk factors. Buprenorphine: Individuals who would potentially benefit from this treatment option may include: those who take sobriety seriously and do not need as much monitoring, participants who do not need as much structure, those who have completed treatment and can obtain this from doctors office, those who work and or have children. Future screening should assess for: time in treatment, past treatment history, severity of opioid use, legal history, medical and mental health history, and age. Procedure Keywords: Opioid, Medication-assisted treatment programs, methadone, buprenorphine, and naltrexone. The peer-reviewed articles were researched from sources such as PsychARTICLES, Medline, and EBSCO SocINDEX. Strategies used to search these articles were conducted using the following: Buprenorphine, Naltrexone, and Methadone. Qualitative, Quantitative and Meta-analysis research was reviewed to determine the effectiveness of each medication. Medication Assisted Treatment Programs Harm reduction Abstinence Discussion Limitations of this study were there was very little research on naltrexone. Further research needs to be conducted on the effectiveness. Also, there is no research on how to assess and screen for the appropriateness of each medication. Further research needs to be done on this. Limitations Strengths of this study were the research provided for methadone and buprenorphine. Methadone and buprenorphine have been around for a while and are highly recognized as the treatment for opioid use disorders. This information can help provide a better understanding of the importance of MAT programs in outpatient settings. Strengths References Andraka-Christou, B. T. (2016). America needs the treat act: Expanding access to effective medication for treating addiction. SSRN Electronic Journal. doi:10.2139/ssrn.2779675 National Institute on Drug Abuse. (2017, September 15). Overdose death rates. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates Breslin, K. T., & Malone, S. (2006). Maintaining the viability and safety of the methadone maintenance treatment program. Journal of Psychoactive Drugs, 38(2), 157-160. doi:10.1080/02791072.2006.10399840 Opium. (2016, April 6). What are the stages of opiate withdrawal? Retrieved from http://www.opium.org/what-are-the-stages-of-opiate-withdrawal.html Runyan, C. N., Hewitt, A. L., Martin, S. A., & Mullin, D. (2017). Confronting the new epidemic: Integrated care for opioid use disorders. Families, Systems, & Health, 35(2), 248-250. doi:10.1037/fsh0000279 Department of Mental Health and Substance Abuse Services. (2016). Evidence based treatments. Substance use best practice tool guide, 75-123. Dunn, K. E., Barrett, F. S., Yepez-Laubach, C., Meyer, A. C., Hruska, B. J., Petrush, K., … Bigelow, G. E. (2016). Opioid overdose experience, risk behaviors, and knowledge in drug users from a rural versus an urban setting. Journal of Substance Abuse Treatment, 71, 1-7. doi:10.1016/j.jsat.2016.08.006 Substance Abuse and Mental Health Services Administration. (2016, 31). Bupernorphine. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine Substance Abuse and Mental Health Services Administration. (2015, 28). Medication and counseling treatment. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment Holbrook, A. M. (2015). Methadone versus buprenorphine for the treatment of opioid abuse in pregnancy: Science and stigma. The American Journal of Drug and Alcohol Abuse, 41(5), 371-373. doi:10.3109/00952990.2015.1059625 Substance Abuse and Mental Health Services Administration. (2016, 12). Naltrexone Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone   Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36(1), 559-574. doi:10.1146/annurev-publhealth-031914-122957