Ten Pearls for Medication Assisted Treatment of Opiate Use Disorders Scott Haga MPAS PA-C Footer Text 2/17/2019

1. Why Are We Doing Medication Assisted Treatment? Footer Text 2/17/2019

Opioid Deaths in US

Deaths in Michigan

Cost of the Opioid Epidemic

Survival DOPAMINE WATER FOOD

2. The Stigma of Substance Use Disorders Footer Text 2/17/2019

Stigma Opiate Use Disorder has an obvious stigma Need to address this at the beginning and throughout treatment Clinic staff Leadership Community Footer Text 2/17/2019

3. Need for Support in Your Organization Footer Text 2/17/2019

Leadership Essential to have Senior Leadership support Effective treatment requires creativity and a bit of a mind shift Footer Text 2/17/2019

Leadership Essential to have Senior Leadership support Understanding of “how” and “why” of MAT Support for Team-based treatment team Public health crisis Medical home Footer Text 2/17/2019

4. Effective MAT is Team Based Footer Text 2/17/2019

Team Based Care Team Based All staff are involved and trained Develop Procedures Need to be prepared for the unique challenges of treating SUD Training Basics of Addiction Trauma Informed Care Footer Text 2/17/2019

Team Based Care Identify a Clinical Champion Leverage the skills and enthusiasm of team members to develop program Identify individuals who are resistant – why? Footer Text 2/17/2019

5. Prepare Your Medical Providers Footer Text 2/17/2019

Medical Issues Prescribers need to have a buprenorphine waiver (X license) MD/DO 8 hours PA/NP/CNM/CRNA 24 hours WWW.ASAM.ORG Link with a mentor who is familiar Providers Clinical Support System SAMHSA Footer Text 2/17/2019

Forms of Buprenorphine Buprenorphine sublingual(Subutex) Cheap Buprenorphine/naloxone (Suboxone, Zubsolv, etc) Abuse deterrent Buprenorphine implant(Probuphine) Buprenorphine injection (Sublocade) Improved compliance Role for patient’s entering controlled environments Footer Text 2/17/2019

6. Financial Issues With MAT Footer Text 2/17/2019

Financial Issues Reimbursement (It’s all about the money, right?) State and payer specific Potential challenges and work arounds Same day billing for medical and behavioral health CHC specific issues Opportunities to partner with payers to demonstrate improved care Footer Text 2/17/2019

7. Behavioral Health Footer Text 2/17/2019

Behavioral Health Essential component of the treatment team! Legal requirement Use Evidence based treatment Footer Text 2/17/2019

Treatment Approaches for SUD Medication Assisted Treatment Cognitive Behavioral Therapy Twelve-step approaches Therapeutic communities Community reinforcement/contingency management (Jaffe et al, 2009)

Did I mention how important this is? Behavioral Health Did I mention how important this is? Footer Text 2/17/2019

8.Toxicology Testing Footer Text 2/17/2019

Toxicology Testing Point of care vs. Send out Immunoassay vs GC/MS Why “Everybody pees” Witnessed vs. non-witnessed drops Safeguarding integrity of urine Footer Text 2/17/2019

Adulteration of urine

Adulteration of urine

Toxicology What to do with unexpected results Opiates plus buprenorphine Opiates, no buprenorphine Buprenorphine, no metabolites Other substances Benzodiazepines Everything else Footer Text 2/17/2019

9.Inductions Footer Text 2/17/2019

Inductions Why is induction important? Home vs. office based Previous experience with buprenorphine Ability of patient to understand and follow induction schedule COWS scale Stock buprenorphine in the office? Practical issues with induction Footer Text 2/17/2019

Inductions Need to understand the unique properties of buprenorphine! Home vs. office induction Office induction protocol Education of all staff about the what and why Scheduling Stock med vs patient bringing in own prescription Footer Text 2/17/2019

10. Philosophy of Care Footer Text 2/17/2019

Treatment Philosophies Abstainance Harm Reduction Complete abstainance from all drugs and other intoxicants Powerless over addiction so treatment goal is to prevent all use Harm reduction is a set of strategies that encourage substance users and service providers to reduce the harm done to drug users, their loved ones and communities by their licit and illicit drug use

Defining Recovery What we expect What is reality

Common Challenges Not showing up for behavioral health Missed appointments/refills After hours requests for refills Lack of understanding of MAT “It’s just trading one drug for another!” Footer Text 2/17/2019

Discussion of Challenges You Have Faced in Your Program Footer Text 2/17/2019

Contact Me Scott@scotthaga.com Footer Text 2/17/2019