Hmm, let me see
Reverses the effects of Opioids and primarily used in the management of alcohol dependence
Sold under the brand name Narcan (among others)
Used to block the effects of opioids, especially in overdose
Last about 1/2 hour to 1 hour
What is Naltrexone
chlordiazepoxid/Librium, diazepam/valium)
Suppresses withdrawal symptoms
What are Long/intermediate-acting benzodiazepines
Methadone
naltrexone
Buprenorphine
What are medications available for the treatment of Opioid Dependency
Address non-compliance issues
Side effects
Address slow progress and medication changes
Eliciting family support
Multi disciplinary collaboration
What is the Role of the counselor
Naltrexone and Vivitrol: Naloxone (Narcan) is a short acting drug which will bring a patient out of an opiate overdose by stripping the opiate from the opiate receptor and is a life saving drug. Naltrexone, a short acting opiate/alcohol blocking agent has been used for the last 30 years.
What is the difference between Naltrexone and Naloxone
If dose is high enough keeps the person from getting much, if any, effect from the usual doses of street opioids
What is methadone
A deterrent medication that produces an unpleasant reaction when alcohol is ingested, including facial flushing, nausea, headache, vomitting, elevated blood pressure and pulse rate
Need 2+ days of abstinence prior to induction
What is Disulfiram (Antabuse)
Opioid antagonist which reverses Opioid overdoses
Effects are observed within 2 minutes of IV and IN administration
Flushes other opioids off the receptors & then prevents them from being activated for 30 - 90 minutes
Will reverse sedation and respiratory depression
Causes sudden withdrawal in the opioid dependent person
What is Naloxone (e.g. Narcan)
Level of motivation to stick with medication protocol
Capacity to stick with medication protocol due to co-occurring issues (e.g. cognitive deficits, disabling psychiatric symptoms, etc.)
Ability to access the medication: finances, insurance, geography, schedule, etc.
What are "Factors to consider in medication"
Generally speaking the it binds to a receptor and prevents it's activation
What is an Antagonist
A schedule III semi synthetic opioid which acts as a partial agonist of the mu opioid receptor and as an antagonist of kappa receptors
AKA Subutex
What is Buprenorphine
Blocks brain opiate receptors and lessens euphoria associated with alcohol use, makes alcohol use less rewarding; reduces craving
Oral Naltrexone (Revia, Depade)
Gum
Patch Lozenge
What is OTC Nicotine Addiction Medications
Side effects are painful or uncomfortable
Addiction can't be cured with medications
I won't remember to take medications
I won't remember to take medications
One addiction with substituted for another
What are "Patient (and Clinician) Concerns about Medications & Possible responses
Generally speaking it activates the receptor site in most cases
What is an agonist
Combination of Naloxone and Buprenorphine
Can help prevent cravings
Minimum effect when taken orally
Becomes pharmacologically active and can precipitate withdrawal when taken intravenously
a long acting (30 day) version of naltrexone
Used in alcohol treatment
Depot Injection
Nicotine Nasal Spray, Nicotine Inhaler, Bupropion (zyban) - Wellbutrin
Varenicline (Chantix)
What is prescription nicotine addiction medication
Some medications either not covered, or a lack of clarity as to what addiction medications are covered, under insurance formularies
a limited number of doses per month
periods of limited duration
detoxification, not maintenance
What are "Some Payer Challenges in Medication Assisted Treatment"
Only "qualifying" physicians
Board certified in Addiction Psyciatry
ASAM or AOA certified
Buprenorphine Clinical Trial Investigator
8 hours of specific raining
have other training/clinial expericen that is considered comparable
Has a DEA Identified Number
Who can Prescribe?
Is an opioid substitution therapy
suppresses opiate withdrawal symptoms for an average of 24 hours
What is methadone
Suppresses alcohol carvings by rebalancing specific brain chemicals thrown out of balance by chronic and excessive alcohol consumption
Mostly eliminated thru kidneys, not liver
Indicated for the maintenance of abstinence in patients who are dependent on alcohol
What is Acamprosate (Campral)
Toxicology testing
pill/film counts
observed administration
use of prescription drug monitoring program
Treatment agreements should also be signed and updated periodically as treatment progresses
What is "Monitoring for Compliance"
consider medications as an option
Have clinical staff knowledgeable of available addiction medications, the mechanisms of actions or those medications and the evidence based practices supporting their use
Include medical staff
What is "A treatment approach (and team) which successfully integrates MAT
Pharmacotherapy in combination with counseling, behavioral therapies and/or recovery support services
What is Medication Assisted Treatment