Medication Assisted Treatment: An Introduction
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Transcript of Medication Assisted Treatment: An Introduction
Medication Assisted Treatment:An Introduction
Deborah A. Orr, Ph.D., RNRemington CollegeSchool of Nursing
Why is it difficult to stop taking some drugs?
What causes the cigarette (non) smoker to relapse?
How does the unsuccessful treatment client feel after relapse?
• How does relapse impact the likelihood of attempting to stop drugs again?
Goal of Medication Assisted Treatment (MAT)
“MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is most successful. Medication assisted treatment (MAT) is clinically driven with a focus on individualized patient care.”
http://www.dpt.samhsa.gov/
Collaborative Treatment Approach
client/family
Medical care counseling
Community self-help groups
Addiction is a Brain Disease
• Receptor changes
• Neurotransmitter changes
Addiction and the Brain
1. Drug attaches to receptors in brain -> PLEASURE
2. Repeated drug use -> TOLERANCE 3. Absence of drug after prolonged use: ->
WITHDRAWAL
What drugs? Cigarettes, alcohol, benzodiazepines, opioids
Other drugs target neurotransmitters
Examples: cocaine, crack cocaine, amphetamines, methamphetamine
Stimulants alter brain function by blocking reuptake of dopamine, so effects of dopamine are intensified.
Can’t you just taper the drugs on your own?
Withdrawal
• What is the relationship between discomfort from physical withdrawal symptoms
and the ability to successfully tolerate
detoxification?The ability to retain, process, and apply
information? To benefit from counseling?
Substance: Nicotine
Withdrawal symptoms:• Irritability• Restlessness• Sleep disturbance• Decreased concentration• Increased appetite• Nicotine cravings• Depression• Anxiety
Treatment• Nicotine replacement
medication (patch, gum, etc.)
• BUPROPION (Zyban): reduces cravings and may help with depression
Alcohol
• Chronic, heavy alcohol consumptions depresses the neurotransmitters GABA and glutamate
• Withdrawal creates a rebound of these neurotransmitters brain hyperexcitability
• Withdrawal symptoms: anxiety, irritability, agitation, tremors, seizures, and DTs
• Alcohol withdrawal can be fatal.
Alcohol Treatment
Detoxification: medically supervised• Main problems: seizures, hypertension, DTs• Replacement therapy with a chemically similar
medication (phenobarbital, valium, librium or ativan) + treatment of withdrawal symptoms
Maintenance: antabuse, vivitrol (naltrexone)
Benzodiazepines
• valium, librium, ativan, xanax• Withdrawal can be fatal• Withdrawal symptoms depend on amount,
frequency, duration, and half-life of the specific drug
Benzodiazepine Withdrawal Symptoms
• Severe sleep disturbance• Irritability• Anxiety• Hand tremor• Sweating• Difficulty in concentration, confusion and cognitive
difficulty, memory problems• Dry retching and nausea, weight loss• Palpitations, headache• Hallucinations, seizures, psychosis, and possible suicide
Benzodiazepine Detoxification Medications
• Medically managed detoxification• Usually a benzodiazepine taper + treatment of
withdrawal symptoms• Anti-seizure medications sometimes used
when there is a history of seizures
Opioids
• Examples: heroin, morphine, dilaudid, methadone, oxycontin, demerol
• Withdrawal Symptoms: sweating, gooseflesh, yawning, chills, runny nose, tearing, nausea, vomiting, diarrhea, and muscle and joint aches
Medically-Assisted Withdrawal from Opioids
• Relieves withdrawal symptoms while patients adjust to a drug-free state
• Can occur in an inpatient or outpatient setting• Typically occurs under the care of a physician
or medical provider• Serves as a precursor to behavioral treatment,
because it is designed to treat acute withdrawal symptoms
SOURCE: Principles of Drug Addiction Treatment: A Research-Based Guide, NIDA, 2000.
Replacement Medication: Methadone
• Must be dispensed from a licensed opioid treatment center (methadone program).
• Pros + Cons• Only approved treatment for pregnant opioid
dependent women (prevent fetal withdrawal)
Suboxone (buprenorphine/naloxone)
• Must be prescribed by MD• May be inpatient or office based• May be for detoxification or
maintenance• Administer the drug sublingually
for a sustained period at a dosage sufficient to prevent opioid withdrawal, block the effect of illicit opiate use, and decrease opioid craving
• Better social functioning• Less risk for illegal behaviors• Less HIV risk behavior• Better able to participate in substance
abuse treatment (the brain works better!)
Benefits of Opioid Replacement Medications for Opioid Addiction
SOURCE: Principles of Drug Addiction Treatment: A Research-Based Guide, NIDA, 2000.
Treatment Regimen
• Concomitant behavioral counseling (relapse prevention, managing triggers, increased coping skills, etc.)
• Detox versus prolonged detox versus maintenance
• Vivitrol (naltrexone) once opioid-free to minimize cravings
Contraindications to Opioid replacement therapy
• Benzodiazepine use, in particular• Alcohol dependence• Serious untreated de-stabilizing psychiatric
disorders• Inability to safely store or take medication• Repeated non-adherence to prescribed dosing
regimen
Stimulants
• cocaine, crack cocaine, amphetamines, methamphetamine
• Chronic use depletes the “reward” neurotransmitter, dopamine
Stimulant Withdrawal Symptoms
• Fatigue, but insomnia• Restlessness, irritability• Loss of motivation• Depression• Difficulty concentrating• Sinus problems, headache• Cravings
Stimulants and Other Drugs
• Withdrawal danger: often used with alcohol or benzodiazepines (which need medically supervised withdrawal)
• No replacement medication available for stimulant detoxification
• treatment of withdrawal symptoms• Monitor for depression and treat as needed
Medical Stabilization Begins Treatment
• MAT makes the person less physically uncomfortable
• Cognitive impairment caused by withdrawal is minimized, so counseling can start sooner and be more effective
• Counselors, client, and medical provider plan treatment course
• Counselors support medication adherence behavior by actively exploring barriers.
Counseling
• Initial counseling addresses highest risk situations for safety, and relapse
• Ongoing counseling addresses triggers, as well as the residue of addiction in the client’s current life.
• Counseling addresses psychological issues.• Counselors alert medical providers to
problems discovered in counseling. TEAM.
Resources
http://store.samhsa.gov/list/series?name=TIP-Series-Treatment-Improvement-Protocols-TIPS
• TIP 45: Detoxification and Substance Abuse Treatment
• TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs
• TIP 42: Substance Abuse Treatment for Persons With Co-Occurring Disorders