Empire State of Care
True or False: Detox is a form of treatment for substance use disorders.
False
True or False: Rehab only refers to inpatient programs
False: Rehab is most commonly used to describe inpatient programs, but it actually includes both inpatient and outpatient non-crisis services.
True or false: opioid detox services are not always medically necessary.
True. Medical necessity means that a medical team has determined that a person’s condition must be treated in an inpatient setting and cannot be treated on an outpatient basis. Opioid withdrawal can range from being unpleasant to being excruciatingly painful, but it is generally not life-threatening on its own. Importantly, one issue is that someone who receives opioid detox services and then returns to using opioids after detox can be at a higher risk of overdose.
True or False: There are no FDA-approved medications for stimulant use disorder
True, but although there are no medications approved to treat stimulant use disorder, some medications can be prescribed off-label to treat stimulant withdrawal.
True or false: methadone is considered safe for long-term use.
True. Methadone is approved by the FDA as a safe MOUD to use long-term. It is a myth that using methadone long-term can impede bodily functions and deteriorate organs.
True or False: Opioid Treatment Programs (OTPs) provide both methadone and buprenorphine treatment.
True
List three reasons why someone might choose methadone treatment for OUD
Typically the least expensive of the three MOUD options
Offers a more structured treatment setting, often requiring daily visits to an OTP and taking medication under staff supervision.
Someone does not need to be in withdrawal to start methadone treatment
Pregnant people can take methadone for OUD
Name at least three signs or symptoms of alcohol use disorder (AUD).
A strong, irresistible urge to drink
Drinking more for a longer period of time than planned
Multiple attempts to cut down or stop drinking
Blackouts (memory loss)
Needing to drink greater amounts of alcohol to feel its effects
Spending a lot of time either drinking or feeling hungover after drinking
Repeatedly experiencing physical harm while drinking or after drinking
Withdrawal symptoms when the effects of alcohol wear off, including nausea, sweating, tremors, anxiety, restlessness, hallucinations, and seizures
Continuing to use alcohol even when it is interfering with other aspects of life, including health, family, friends, work, or school.
Where can someone receive extended-release injectable naltrexone for OUD?
Any licensed health care provider can prescribe naltrexone, and no special training is necessary. Note: naltrexone is not the gold standard! Methadone and bupe are.
Name at least four symptoms of opioid withdrawal.
Muscle cramps
Nausea and vomiting
Anxiety
Watery discharge from the eyes and nose
Diarrhea
Insomnia
Hot and cold flashes
Sweating
List three reasons why someone might choose buprenorphine treatment for OUD.
Can be prescribed by health care providers in various settings: any health care provider who is licensed to prescribe medications (doctors, nurse practitioners, physician assistants, etc.) in Syringe Service Programs, NYS-licensed substance use treatment programs, and emergency departments.
With a prescription, buprenorphine can be obtained at a pharmacy and taken at home, just like any other medication.
Bupe can be prescribed via telemedicine.
What services does a Mobile Medical Unit (MMU) provide?
Services offered in MMUs include medical screenings, buprenorphine and methadone treatment for opioid use disorder, peer support, telehealth capability, and referrals and linkages to other health care services. MMUs expand OTP services to areas where people may congregate, like residential treatment programs, nursing homes, homeless shelters, prisons, and jails. MMUs help reduce stigma and deliver services to people who may find it challenging to access treatment within an OTP.
What is the difference between inpatient and outpatient rehabilitation services?
Inpatient programs are 24/7 medically supervised programs that are often based in hospitals or other acute care settings. These programs provide intensive management of symptoms related to drug use.
Outpatient rehab services are designed for people who have ongoing substance use issues, lack sufficient support systems, need help with basic skills, or have other health care needs. These programs offer educational resources and social services and teach skills to help access community resources. A team with different kinds of experts, including a Medical Director, oversees these services, and the staff-to-client ratio is higher compared to other outpatient services.
Where can someone receive buprenorphine (bupe) for OUD?
Any licensed health care provider can prescribe buprenorphine, and no special training is necessary.
What is detox?
In general, detox refers to the medical supervision and monitoring of someone who is experiencing substance use withdrawal symptoms. Detox services can also include medical and psychiatric assessments. The clinical term for detox is "medically supervised withdrawal." Typically, someone in detox will receive medication for easing withdrawal symptoms and cravings. The medication dosage is slowly decreased, with the goal of stopping the medication by the time the person is discharged from detox services. Detox is often mistakenly referred to as treatment when in fact it is not. It is a service that helps support people while they are experiencing withdrawal symptoms.
Why might you want to refer an outreach participant to a SHOW Van?
SHOW vans (run by NYC Health+Hospitals) primarily serve people who are unstably housed and who are experiencing substance use, mental health, or medical problems.
SHOW vans can provide immediate wound care
SHOW vans can connect people to long-term care, social services, and treatment. They can also provide direct linkages and escorts to clinics, appointments, or emergency care.
Why is extended-release injectable naltrexone (Vivitrol) not considered a first-line treatment for Opioid Use Disorder (OUD)? List at least one reason.
Vivitrol increases the risk of opioid overdose between injections or when the medication has worn off, as it reduces opioid tolerance.
Starting Vivitrol requires the patient to abstain from opioids for seven to ten days before beginning the medication to avoid severe withdrawal symptoms. The need for opioid abstinence can create a barrier to treatment.
It should not be used during pregnancy.
Vivitrol may not be covered by all insurance plans and can be expensive.
What does receiving methadone treatment for OUD look like?
Methadone is a highly regulated substance. Typically, people need to visit their OTP daily in person to take their methadone medication under staff supervision. In some cases, as someone continues in treatment, they may be allowed to take medication home. Mobile Medication Units can also prescribe and dispense methadone.
Discuss at least one reason why methadone and buprenorphine are considered the gold standards for Medications for Opioid Use Disorder (MOUD).
They are the safest and most effective treatments for opioid use disorder. Methadone and buprenorphine improve social wellbeing and functioning, and they are the only OUD medications demonstrated to reduce the risk of fatal overdose.
Decrease overdose and all-cause mortality
Reduce or stop opioid use
Reduce behaviors linked to HIV transmission
List one to two factors that might impact someone’s decision to participate in a medically supervised outpatient services vs. outpatient rehabilitation (rehab) services.
Medically supervised outpatient services provide clinical services for people who need short-term substance use services, whereas outpatient rehabilitation services are designed for people who have more chronic needs. Additionally, the staff to client ratio at outpatient rehabilitation services is higher compared to other outpatient services.
A participant tells you they might be interested in treatment for OUD, and asks you to tell them more about it. What could you answer?
Three medications exist; methadone and buprenorphine are the gold standards, also extended-release injectable naltrexone
Can get methadone and bupe from OTPs
Can also get bupe from other health care providers, like primary care providers
As an outreach worker, can't help you decide which treatment option would be good for you, but can certainly connect you with a provider that can; are they interested in a referral?
What is a “Substance Use Disorder” and how is it different from “substance use”?
Substance use disorder is a mental health diagnosis that refers to a problematic pattern of using a substance that results in impairment or noticeable distress in daily life. “Substance use” is a broad term used to describe any instance of using substances, including alcohol, drugs, or medications, for any purpose. Not everyone who uses drugs has a substance use disorder.
Medications for opioid use disorder are just one of the strategies in the menu of harm reduction strategies. Name at least three others.
Safer Supply
Syringe Service Programs
Fentanyl and Xylazine Test Strips
Overdose Prevention Centers
Drug-Checking Services
A participant who uses stimulants is interested in treatment. What can you share with them about treatment for stimulant use disorder?
Contingency Management is a treatment that helps people stop using stimulants by rewarding positive behaviors. For example, someone might get a gift card or voucher when they attend a counseling session or meet a recovery goal. This approach can also be used along with other types of therapy or support programs.
Why are detox services often medically necessary for alcohol, benzodiazepine, and xylazine?
For alcohol and benzodiazepines, withdrawal symptoms can range from mild to severe, and have the potential to cause seizures, hallucinations, and even be life-threatening. Because of this, it is important for withdrawal from these drugs to be managed in collaboration with a health care provider. For xylazine, signs and symptoms can be the same or overlap with withdrawal symptoms from other drugs. People experiencing xylazine withdrawal might develop very high blood pressure and might notice feeling anxious, irritable, and restless.
If a participant would like to proceed with alcohol or benzodiazepine detox services, it is best to help them select a detox program that utilizes a harm reduction approach and provides strong transition planning.