HomeMy WebLinkAbout2016-08-08 16-290 Council Documents (21) Medication and Counseling Treatment I SAMHSA Page 1 of 8
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Counseling Treatment
Medication- Medication and Counseling
Assisted Treatment
Treatment
Certification of Medication-assisted treatment(MAT) is the use of medications with
Opioid Treatment counseling and behavioral therapies to treat substance use disorders
Programs and prevent opioid overdose.
Buprenorphine
Waiver Medication-Assisted Treatment(MAT) is the use of medications, in
Management combination with counseling and behavioral therapies, to provide a
"whole-patient"approach to the treatment of substance use disorders.
Oversight of Research shows that a combination of medication and therapy can
Accrediting successfully treat these disorders, and for some people struggling with
Bodies addiction, MAT can help sustain recovery. Learn about many of the
substance use disorders that MAT is designed to address.
Medication and
Counseling MAT is primarily used for the treatment of addiction to opioids such as
Treatment heroin and prescription pain relievers that contain opiates. The
prescribed medication operates to normalize brain chemistry, block the
euphoric effects of alcohol and opioids, relieve physiological cravings,
Buprenorphine and normalize body functions without the negative effects of the
Methadone abused drug. Medications used in MAT are approved by the Food and
Drug Administration (FDA), and MAT programs are clinically driven and
Naltrexone tailored to meet each patient's needs. Combining medications used in
MAT with anxiety treatment medications can be fatal. Types of anxiety
Naloxone treatment medications include derivatives of Benzodiazepine, such as
Opioid Xanax or valium.
Overdose
Common Opioid Treatment Programs (OTPs)
Comorbidities Opioid treatment programs (OTPs) provide MAT for individuals
Insurance and diagnosed with an opioid use disorder. OTPs also provide a range of
Payments services to reduce, eliminate, or prevent the use of illicit drugs,
potential criminal activity, and/or the spread of infectious disease. OTPs
• focus on improving the quality of life of those receiving treatment.
Training Materials
and Resources
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OTPs must be accredited by a SAMHSA-approved accrediting body and
Physician and certified by SAMHSA. The Division of Pharmacologic Therapies (DPT), .
Program Data part of the SAMHSA Center for Substance Abuse Treatment (CSAT),
oversees accreditation standards and certification processes for OTPs.
Legislation, Learn more about the certification of OTPs and SAMHSA's oversight of
Regulations & OTP Accreditation Bodies.
Guidelines
Federal law requires patients who receive treatment in an OTP to
About DPT receive medical, counseling, vocational, educational,and other
assessment and treatment services, in addition to prescribed
medication. The law allows MAT professionals to provide treatment and
Buprenorphine services in a range of settings, including hospitals, correctional facilities,
Pharmacy offices, and remote clinics. Learn more about the legislation,
Lookup regulations, and guidelines that govern OTPs.
MAT-PDOA As of 2015, OTPs were located in every U.S. state except North Dakota
and Wyoming. The District of Columbia and the territories of Puerto
Rico and the Virgin Islands also had OTPs in operation.
Counseling and Behavioral Therapies
Under federal law, MAT patients must receive counseling, which could
include different forms of behavioral therapy. These services are
required along with medical, vocational, educational, and other
assessment and treatment services. Learn more about these
treatments for substance use disorders.
MAT Effectiveness •
In 2013, an estimated 1.8 million people had an opioid use disorder
related to prescription pain relievers, and about 517,000 had an opioid
use disorder related to heroin use. MAT has proved to be clinically
effective and to significantly reduce the need for inpatient detoxification
services for these individuals. MAT provides a more comprehensive,
individually tailored program of medication and behavioral therapy.
MAT also includes support services that address the needs of most
patients.
The ultimate goal of MAT is full recovery, including the ability to live a
self-directed life. This treatment approach has been shown to:
• Improve patient survival
• Increase retention in treatment
• Decrease illicit opiate use and other criminal activity among people
with substance use disorders
• Increase patients'ability to gain and maintain employment
• Improve birth outcomes among women who have substance use
disorders and are pregnant
Research also shows that these medications and therapies can •
contribute to lowering a person's risk of contracting HIV or hepatitis C
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by reducing the potential for relapse. Learn more about substance
•
misuse and how it relates to HIV,AIDS, and Viral Hepatitis. Learn more
about common comorbidities that occur with substance use disorders.
Unfortunately, MAT is greatly underused. For instance, according to
SAMHSA's Treatment Episode Data Set(TEDS) 2002-2010, the
proportion of heroin admissions with treatment plans that included
receiving medication-assisted opioid therapy fell from 35% in 2002 to
28% in 2010. The slow adoption of these evidence-based treatment
options for alcohol and opioid dependence is partly due to
misconceptions about substituting one drug for another. Discrimination
against MAT patients is also a factor, despite state and federal laws
clearly prohibiting it. Other factors include lack of training for physicians
and negative opinions toward MAT in communities and among health
care professionals.
MAT and Patient Rights
SAMHSA's Partners for Recovery Initiative produced a brochure
designed to assist MAT patients and to educate and inform others. This
Medication-Assisted Treatment Know Your Rights Brochure—2009
presents and explains the federal laws that prohibit discrimination
against individuals with disabilities and how they protect people
receiving MAT for opioid addiction.
Under the Confidentiality Regulation, 42 Code of Federal Regulations
• (CFR) 2, personally identifiable health information relating to substance
use and alcohol treatment must be handled with a higher degree of
confidentiality than other medical information.
Medications Used in MAT
FDA has approved several different medications to treat opioid
addiction and alcohol dependence.
A common misconception associated with MAT is that it substitutes one
drug for another. Instead, these medications relieve the withdrawal
symptoms and psychological cravings that cause chemical imbalances
in the body. MAT programs provide a safe and controlled level of
medication to overcome the use of an abused opioid. And research has
shown that when provided at the proper dose, medications used in
MAT have no adverse effects on a person's intelligence, mental
capability, physical functioning, or employability.
Medications used in MAT for opioid treatment can only be dispensed
through a SAMHSA-certified OTP. Some of the medications used in MAT
are controlled substances due to their potential for misuse. Drugs,
substances, and certain chemicals used to make drugs are classified by
the Drug Enforcement Administration (DEA) into five distinct categories,
or schedules, depending upon a drug's acceptable medical use and
potential for misuse. Learn more about DEA drug schedules.
II/
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Opioid Dependency Medications •
Methadone, buprenorphine, and naltrexone are used to treat opioid
dependence and addiction to short-acting opioids such as heroin,
morphine, and codeine, as well as semi-synthetic opioids like
oxycodone and hydrocodone. People may safely take medications used
in MAT for months, years, several years, or even a lifetime. Plans to
stop a medication must always be discussed with a doctor.
Methadone
Methadone tricks the brain into thinking it's still getting the abused
drug. In fact, the person is not getting high from it and feels normal, so
withdrawal doesn't occur. Learn more about methadone.
Pregnant or breastfeeding women must inform their treatment provider
before taking methadone. It is the only drug used in MAT approved for
women who are pregnant or breastfeeding. Learn more about pregnant
or breastfeedinq women and methadone.
Buprenorphine
Like methadone, buprenorphine suppresses and reduces cravings for
the abused drug. It can come in a pill form or sublingual tablet that is
placed under the tongue. Learn more about buprenorphine.
Naltrexone •
Naltrexone works differently than methadone and buprenorphine in the
treatment of opioid dependency. If a person using naltrexone relapses
and uses the abused drug, naltrexone blocks the euphoric and sedative
effects of the abused drug and prevents feelings of euphoria. Learn
more about naltrexone.
Opioid Overdose Prevention Medication
FDA approved naloxone, an injectable drug used to prevent an opioid
overdose. According to the World Health Organization (WHO), naloxone
is one of a number of medications considered essential to a functioning
health care system.
Alcohol Use Disorder Medications
Disulfiram, acamprosate, and naltrexone are the most common drugs
used to treat alcohol use disorder. None of these drugs provide a cure
for the disorder, but they are most effective in people who participate
in a MAT program. Learn more about the impact of alcohol misuse.
Disulfiram
Disulfiram is a medication that treats chronic alcoholism. It is most
effective in people who have already gone through detoxification or are •
in the initial stage of abstinence. This drug is offered in a tablet form
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and is taken once a day. Disulfiram should never be taken while
•
intoxicated and it should not be taken for at least 12 hours after
drinking alcohol. Unpleasant side effects (nausea, headache, vomiting,
chest pains, difficulty breathing) can occur as soon as ten minutes after
drinking even a small amount of alcohol and can last for an hour or
more.
Acamprosate
Acamprosate is a medication for people in recovery who have already
stopped drinking alcohol and want to avoid drinking. It works to
prevent people from drinking alcohol, but it does not prevent
withdrawal symptoms after people drink alcohol. It has not been shown
to work in people who continue drinking alcohol, consume illicit drugs,
and/or engage in prescription drug misuse and abuse. The use of
acamprosate typically begins on the fifth day of abstinence, reaching
full effectiveness in five to eight days. It is offered in tablet form and
taken three times a day, preferably at the same time every day. The
medication's side effects may include diarrhea, upset stomach, appetite
loss, anxiety, dizziness, and difficulty sleeping.
Naltrexone
When used as a treatment for alcohol dependency, naltrexone blocks
the euphoric effects and feelings of intoxication. This allows people
with alcohol addiction to reduce their drinking behaviors enough to
• remain motivated to stay in treatment, avoid relapses, and take
medications. Learn more about how naltrexone is used to treat alcohol
dependency.
Access Medication for the Treatment of Alcohol Use Disorder: A Brief
Guide—2015 to learn more about MAT for alcohol use disorder.
MAT Medications and Child Safety
It's important to remember that if medications are allowed to be kept
at home, they must be locked in a safe place away from children.
Methadone in its liquid form is colored and is sometimes mistaken for a
soft drink. Children who take medications used in MAT may overdose
and die.
Find Treatment
• Opioid Treatment Program Directory
• SAMHSA's Behavioral Health Treatment Services Locator
• SAMHSA's Buprenorphine Treatment Physician Locator
Additional Resources
• Access information about SAMHSA's federal partners, associations, and
other support organizations that offer MAT-related resources for
consumers and substance use treatment professionals.
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Last Updated: 09/28/2015 •
PHYSICIAN LOCATOR
PIOID TREATMENT
ROC3RAMDIRECTORY
F a
PHARMACY LOOKUP •
New Federal Regulations Increase Limit Rule to
275 Patients
Physicians who have prescribed buprenorphine to 100 patients for
at least one year can now increase their patient limits to 275
under new federal regulations. Review the final rule in the Federal
Register.
The form to request the higher limit is not yet available. To receive
the form and guidance information, contact the SAMHSA Center
for Substance Abuse Treatment(CSAT) at
info@ buprenorphine.samhsa.gov. Please include your contact
information, your data waiver number and patient limit, and a
statement affirming your 100 patient certification for at least one
year.
For more information, send an email or call 866-BUP-CSAT(866-
287-2728).
•
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•
Publications
» 2014 Buprenorphine Summit: Report of Proceedings (PDF 13
MB)
» Medication-Assisted Treatment for Opioid Addiction: Facts for
Families and Friends—2009
» Federal Guidelines for Opioid Treatment Programs—2015
» Medication-Assisted Treatment of Alcohol Use Disorder—
2015
»TIP 40: Clinical Guidelines for the Use of Buprenorphine—
2004
Related SAMHSA Resources
» Behavioral Health Treatments and Services
» Medical Records Privacy and Confidentiality
• » Mental and Substance Use Disorders
» Prescription Drug Misuse and Abuse
Contact Us
For information on buprenorphine treatment, contact the SAMHSA
Center for Substance Abuse Treatment(CSAT) at 866-BUP-CSAT
(866-287-2728) or info@buprenorphine.samhsa.gov.
For information about other medication-assisted treatment(MAT)
or the certification of opioid treatment programs (OTPs), contact
the SAMHSA Division of Pharmacologic Therapies at 240-276-2700
or otp-extranet@opioid.samhsa.gov.
Contact SAMHSA's regional OTP Compliance Officers to determine
if an OTP is qualified to provide treatment for substance use
disorders.
•
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