1. Medically assisted treatment
MAT Update
Medically assisted treatment

2. Why do we care?
The U.S. Department of Health and Human Services has identified opioid use disorder as a national crisis, and in August 2017 a national emergency was declared. Drug overdose is the leading cause of accidental injury among U.S. adults, and rates of opioid-related overdoses increased 200% between and Estimates suggest that drug overdose has emerged as the leading cause of death for Americans younger than 50 years.

3. Drugs of choice
Opioids
Meth
Alcohol
Cocaine
Others

4. Sources
Provider's Clinical Support System for Opioid Therapies (
American Society of Addiction Medicine ( and practice/practice-resources)
California Society of Addiction Medicine (

5. Models of Buprenorphine-Based MAT for Opioid Use Disorder
Some of the current models for addressing the problem.
Emergency department initiation of OBOT - Buprenorphine is initiated in the emergency department, then patients are linked with an OBOT provider
Hub-and-spoke model - Centralized hub provides initial management; when stabilized, patients are transferred to primary care “spokes” in the community; spoke sites have some psychosocial support, which may include social workers and counseling

6. More models
Inpatient initiation of MAT - Patients identified as having opioid use disorder in the hospital setting are seen by a multidisciplinary addiction consult service; buprenorphine is initiated in the hospital, then patients are linked with primary care clinics for ongoing treatment; psychosocial services are provided on-site in primary care settings
OBOT integrated model in which behavioral health, primary care services, and MAT are provided in same setting; six core psychosocial services are required, and some telehealth services are offered

7. Patient assessment
Meeting patients where they are
Physically
Recovery

8. Opioid agonist

9. Mu (μ) receptors stimulated by opioids causing the full range of opioid effects.
Adapted from slides at vivitrol.com

10. Addiction vs dependence
Increased tolerance
Withdrawal
Addiction
Craving
Loss of control
Impairment & distress in important life areas

11. Heroin, codeine, morphine – 2-4 hours Methadone – 24 hours
Half life
Heroin, codeine, morphine – 2-4 hours
Methadone – 24 hours
Buprenorphine – hours

12. Types of medications Agonist
Morphine-like effect (e.g., heroin, methadone)
Partial Agonist
Maximum effect is less than a full agonist (e.g., buprenorphine)
Antagonist
No effect in absence of an opiate or opiate dependence (e.g., naloxone)

13. Buprenorphine DATA 2000 greatly increases access
Less severe dependency allows for easier transitions between recovery with and without medication
Partial agonist is safer with less overdose potential
Lower abuse potential
People live a normal life free from craving and withdrawal
SAVES LIVES

14. Limitations of Buprenorphine
Not a full agonist and does not retain people in treatment as well as full agonist
Has diversion potential and may be misused
Medication is expensive and access is limited
Stigma in the recovery community

15. Advantages of vivitrol
Safe to use, no abuse potential
Blocks the effects of opioids
Reduces danger of accidental overdose
No physical dependence
Little or no stigma in the recovery community

16. Recovery - maybe Detox Inpatient Intensive outpatient Medical access
Psych access