1. FIVE MINUTES TO MAKE A DIFFERENCE Presentation by: Mark Barnes

2. Agenda Introduction Opiates Opiate Withdrawal Methadone Methadone Maintenance Treatment Five Minutes to Make a Difference Life of a Methadone Patient Questions

3. Introduction Pharmacy manager and owner of Westboro Pharmasave Methadone certified dispensary Expanded the methadone program Support program fully

4. Opiates A narcotic substance either natural (opium/ poppy seed) or synthetic (morphine) Narcotic- any drug derived from opium with potent analgesic effects associated with both significant alterations of mood, behavior, and potential for dependence and tolerance Excellent medication for advanced pain management (cancer)

5. Opiates Cont’d Tolerance vs. dependence vs. abuse Tolerance- happens to anyone Dependence- is a long lasting disorder that leads to distress and disability - Changes in brain structure and function - Compulsive drug seeking - Abuse of narcotic Abuse- misuse of the narcotic

6. Examples of Opiates Morphine Codeine Hydromorphone Oxycodone Fentanyl Heroin Methadone

7. Opiate Withdrawal Caused after the amount of opiate is significantly decreased or abruptly discontinued after regular use The body has adapted the presence of the drug and cannot re-adapt quickly enough to its absence

8. Opiate Withdrawal Cont’d Some symptoms may include: Insomnia Muscle Aches Dilated pupils Restlessness Depression Anxiety Discomfort

9. Methadone Made in 1941 for pain control in Germany for WWII Very safe long term on organs When prescribed correctly is does not impair psychomotor performance Some side effects may include: sweating, constipation, insomnia, and weight gain

10. Methadone Cont’d Can still cause withdrawal No euphoric “rush” when stabilized Once daily dosing Stops cravings for other drugs and drug seeking behavior

11. Methadone Maintenance Treatment (MMT) Dosing Initiation- Starts at ~ 30mg - No matter what street drug Stabilization- Slowly increases every 3 days until patient is stable - Takes 2-6 weeks for most Taper- Decrease down over time - Miss 3 doses- restart needed

12. MMT Urine Screening Valuable information for practitioners Verifies patient self reporting and compliance Assess appropriateness of “carries” ‘Snapshot’ of how the patient is doing

13. MMT Carries Carries are when a patient can take home a dose of methadone to be taken unsupervised Happens once the patient is clinically stable Must have consistent negative urine tests Must be on methadone for 2 months Requires lock box Carries can be taken away

14. Five Minutes to Make a Difference Pharmacists CAN make a difference Respect, Respect, Respect Methadone patients become friends of the pharmacy Valuable insight for patients’ activities of daily living Reward great behavior

15. Life of a Methadone Patient Go to the pharmacy every day See a doctor 3 times per week Give a urine sample 2 times per week See a councilor 2 times per week Stay “clean” every minute of everyday Deal with past legal issues Once stable, can be a positive member of society

16. Questions