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

2. Medication-Assisted Treatment
Introduction
Common Myths?

3. 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)

4. 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

5. 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

6. 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

7. Methadone Long-acting synthetic opioid - Full agonist
Half-Life of 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

8. Buprenorphine Long-acting synthetic opioid Partial Agonist
Half-Life of 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)

9. 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)

10. 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)

11. 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

12. Questions?