1. NCBH MAT Learning Community
January 11th 2016 : Arthur robin Williams MD

2. Cases
Adolescents
Benzodiazepines
Vivitrol induction
Rural areas
Intoxicated patients

3. Adolescents Do MAT choices differ for adolescents and young adults?
Who should receive which MAT modality?
How best involve parents/family?

4. Adolescents
Met with client and his mother for assessment (lives with mother)
17 year old male, completed the 11th Grade, currently working in landscaping
On probation for robbery, referred by PO
heroin twice a week (IN) since he was 16 (max sober 6mo period)
Also tried alcohol, pot, molly, LSD, and cocaine.
No medical problems, no medications
Recent inpatient with discharge for ongoing drug use
Client agreed to our outpt program and will go to residential if keeps using

5. Adolescents
Mother is hesitant to sign the release for staff to talk to PO
Pt states last heroin use a week ago but Utox positive
Initially client attended IOP daily x 3 weeks with negative UDS
Then his attendance became sporadic, he was home “with the flu” often
Parents took to ER for detox and he entered Residential program
He lasted about two weeks before he was kicked out for using and 2mo later re-admitted to residential
What criteria to consider for MAT for adolescents in outpatient?
What staff/provider mix needed for an Outpatient MAT program?

6. Chronic pain
Patients with OUD who want to continue taking opioids for pain?
How to coordinate with prescribers?
What if becomes a distraction in groups
What if client is falling asleep and slurring words

7. Benzodiazepines
Clients taking these become disorientated and disruptive (i.e. groups)
Continuing benzodiazepines is often counterproductive?
How to work with prescribers?
How to address the underlying problems (ie panic/anxiety symptoms)
How best taper off?

8. Vivitrol induction
Who is the best fit for Vivitrol injections (XR-NTX)?
Residential needed for stabilization?
ASAM placement criteria
How to track outcomes?

9. Rural areas How to best reach rural areas?
How to coordinate care remotely?
Role of telemedicine
How best share PCSS-MAT/PCSS-O and mentor training?

10. Intoxicated patients Patients who arrive drunk or high
When is it safe to provide treatment?
When is residential needed?
How to arrange outpatient detox for active users?