Module 5 Participant Copy of PowerPoint

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Slide 1: Title Slide

BONUS Module: Opioid Use Disorder (OUD) Treatment and Recovery Information

Slide 2:  Meet the Developers

The following Montana State University faculty and staff helped create the content of this toolkit:

Michelle U. Grocke-Dewey, Ph.D. Principal Investigator, Assistant Professor, Health & Human Development, MSU Extension FCS Health & Wellness Specialist

Alison Brennan, Ph.D. Principal Investigator, Assistant Professor, Health & Human Development, MSU Extension FCS Mental Health Specialist

Barbara Allen, M.S. Program Director, MSU Extension Associate Specialist

Jennifer Munter, Program Manager, MSU Extension

Barbara Watson, Program Coordinator, MSU Extension

Lori Mayr, FCS Administrative Assistant, MSU Extension

Slide 3:  Learning Objectives

At the conclusion of this bonus module, participants will:

Better understand what Opioid Use Disorder (OUD) is

Learn about the origins of Medication-Assisted Treatment (MAT) for OUD

Be more familiar with the different OUD treatment options

Understand the difference between Opioid Treatment Programs (OTP) vs Office-Based Opioid Treatment (OBOT).

Slide 4: Components of Evidence-Based Care For Opioid Use Disorder (OUD)

Evidence-based care for OUD involves several components:

• Personalized diagnosis and treatment plan tailored to the individual and family
• Long-term management – Addiction is a chronic condition with the potential for both recovery and recurrence. Long-term outpatient care is important.
• Access to FDA-approved medications (MAT)
• Effective behavioral interventions delivered by trained professionals
• Coordinated care for OUD and other conditions
• Recovery support services, such as mutual aid groups, peer support specialists, and community services

Slide 5: Cycle of OUD

Cravings>>Opioid Use>>Withdrawal>>>Cravings>>>Opioid Use>>>Withdrawal......

Slide 6: What is MAT?

Medication-Assisted Treatment uses both medication and therapy in a combined approach to treat Opioid Use Disorder, sustain recovery, and prevent overdose. 

The three components of MAT:

1. Stabilization in opioid withdrawal management.
2. Medication maintenance using one of three FDA-approved medications (methadone, buprenorphine, and naltrexone)
3. Counseling and behavioral therapies.

4-minute video on MAT

Slide 7 & 8: The History of Medication-Assisted Treatment

1956:

Dr. Marie E. Nyswander (author of The Drug Addict as a Patient)

• Abstinence without medication was causing relapse.
• Maintenance using opioid medications could be used to help with functioning.

1958:

The American Bar Association and the American Medical Association (AMA) issued a report.

• Recommended that an outpatient facility prescribing opioids to treat addiction be established on a controlled experimental basis.

1962: 

Dr. Vincent P. Dole (specialist in metabolism at Rockefeller University) Received a grant to investigate the feasibility of opioid maintenance using opioid-based drugs.

1964:

Dr. Nyswander joined Dr. Dole's research staff along with others. Findings included:

• Short and fast acting opioids had sedating effects.
• The short half-life caused opioid tolerance.

1970:

Dr. Jerome Jaffe made methadone maintenance a major public health initiative to treat OUD.

1980:

NIDA completed testing of naltrexone

• FDA approved in 1984. 
• Most useful for highly motivated patients who have undergone detoxification.

1995:

Naltrexone also received FDA approval as a preventive treatment for alcohol use disorder.

1997: 

National Institutes of Health (NIH) consensus panel called for expansion of methadone

2000:

The DATA Act of 2000 was passed, allowing qualifying/waivered office-based practitioners to dispense FDA approved medications for OUD.

2002:

Buprenorphine became FDA approved. It was the first drug approved for treatment of OUD in physicians' offices.

2003:

Interim rule change made buprenorphine available for use in Opioid Treatment Programs certified by  SAMHSA.

2021:

1,836 Opioid Treatment Program Facilities in the U.S. (4 in Montana).

51,974 buprenorphine waivered practitioners in the U.S. (50 in Montana).

Slide 9: MAT Treatment Options for Opioid Use Disorder (OUD)

Slide 10: Common Names of Opioid Pain Medications Used to Treat OUD

Slide 11: Non-Opioid Prescription Medication Used to Treat OUD

Slide 12: Methadone

• Long-acting opioid agonist.
• Helps to maintain abstinence by reducing opioid cravings and withdrawal symptoms.
• Unlike other opioids, methadone acts much more slowly in the body = reduces euphoric highs and lows while diminishing withdrawal symptoms.
• Only made available through federally-regulated OTPs
  • Not all MAT clinics are OTP clinics and therefore cannot prescribe methadone.

Slide 13: Burprenorphine

• Partial agonist = binds to opioid receptors but activates them less strongly than a full agonist (like methadone).
  • This suppresses and reduces cravings, lessens withdrawal, and blocks the euphoric effects of opioids.
  • When taken as prescribed, it lowers the potential for misuse.
• First medication used to treat OUD that can be prescribed/dispensed in physician offices.
  • This significantly increases access to treatment options.
• Buprenorphine in Office-Based Opioid Treatment (OBOT) facilities:
  • Must complete specialized training called a Drug Addiction Treatment Act (DATA) or Buprenorphine Waiver Certification if physicians want to serve more than 30 patients.
  • IF, under 30 patients, no waiver training is required, however they do have to file a Notice of Intent (NOI) to obtain their waiver training if eventually they choose to increase to 100 patients after their first year and 275 after year two.  
  • EXCEPTION:  “Three-day Rule” allows practitioners to administer but not prescribe for a 72-hour period.  Patients must come back daily to receive their dose.  

Slide 14: Buprenorphine Waiver 

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides buprenorphine waiver certifications allowing physicians, not practicing in a SAMHSA-certified opioid treatment program (OTP), to prescribe buprenorphine to OUD patients. SAMHSA-waivered practitioners, who are certified in prescribing buprenorphine, can be found on the SAMHSA website.  

https://www.samhsa.gov/medication-assisted-treatment/practitioner-program-data/treatment-practitioner-locator

Buprenorphine is also administered at SAMHSA certified opioid treatment programs (OTPs).  A list of certified and accredited programs can be obtained by visiting the SMAHSHA website.

Slide 15: Burprenorphine with Naloxone

• Buprenorphine can be combined with naloxone to prevent opioid overdoses.
• Naloxone interferes with (inhibits) the physiological response in the body.
• These medications are called SUBOXONE®, ZUBSOLV®, BUNAVAIL®

For an alphabetical list of SUBOXONE® treatment programs and doctors who prescribe SUBOXONE® in Montana please visit:

https://www.opiateaddictionresource.com/treatment/suboxone_treatment_directory/mt_suboxone/

https://dpt2.samhsa.gov/treatment/directory.aspx

Slide 16: Naltrexone

• Like naloxone, naltrexone is an opioid antagonist. 
• Blocks the euphoric and sedative effects of opioids. 
• Reduces cravings for opioids.
• Prevents opioids from producing rewarding effects (euphoria).
• Prescribed outside of an Opioid Treatment Program (OTP)

Slide 17: Video

MAT: A Doctors Perspective (5-minute video)

Slide 18: MAT Drugs and Side Effects

Slide 19: Can These Side Effects Cause Impairments in Everyday Life (i.e., work, home)

• Side effects will vary depending on the medication, dosage, and duration of treatment.
• Workers with safety-sensitive jobs (bus driver, heavy machine operators, dispatchers, etc.) may be subject to restrictions or limits on the job.
• Case-by-case determinations by qualified occupational healthcare providers may be necessary.
• Medication side effects often diminish over time and should therefore be periodically assessed.

Slide 20: Length of MAT Treatment

• Varies depending on medication
• Duration can span from months to years
• Long-term treatment has proven to be more effective in preventing relapse
• Tapering depends on several factors:

- Compliance, tolerance, adverse effects, and progress toward abstinence

- The tapering process can take several months

• Abrupt or premature removal can increase the risk of relapse and/or an overdose

Slide 21: Outcomes of MAT

The MAT approach has been shown to:

• Improve patient survival by reducing overdose occurrences
• Increase retention in treatment
• Decrease illicit opioid use and other criminal activity
• Increase patients’ ability to gain and maintain employment
• Improve birth outcomes among pregnant women who have substance use disorders

Slide 22: Types of Intervention Approaches

Integrated Health Care

Early Intervention Delivery Method

Recovery-Oriented Systems of Care Recovery Approach

Family Support

Peer-Based Recovery Support

Slide 23: MAT: Intergrated Health Care Approach

Integrated Health Care: A team of primary care and behavioral health clinicians, working together with patients and families, using a systematic approach to provide patient-centered care for a defined population.

MAT as an integrated approach:

• Mental health and substance use disorders (SUDs)
• Health behaviors, and how they contribute to:
• chronic medical illness,
• life stressors and crises,
• stress-related physical symptoms, and
• ineffective patterns of health care utilization.

Slide 24:  Early Intervention Delivery Method

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an approach to the delivery of early intervention and treatment to people with substance use disorders and those at risk of developing these disorders.

S— quick assessment of the severity of substance use and identifies  appropriate level of treatment.

BI—focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.

RT—provides those identified as needing more extensive treatment with access to specialty care.

2017 study, 11 programs serving over 1 million people found an 80% reduction in self-reported illicit substance use, including opioid use, following intervention (Connolly & Baaklini, 2021).

Slide 25: Recovery-Oriented Systems of Care (ROSC) Approach

• ROSC: a coordinated network of community-based services and support:
  • person-centered
  • builds on the strengths and resiliencies of individuals, families, and communities
• The establishment of ROSC is a relatively new concept in the substance use disorder field.

Slide 26:  Recovery Oriented Activity Examples 

Slide 27: ROSC Combined With Family Support

Family Support Programs are an important part of ROSC

• Promote hope
• Active agents of change in their lives, not passive recipients of services
• Rejoin and rebuild life in the community

Slide 28: Peer-Based Recovery Support

Peer Suppor Activities:

• Advocating for people in recovery
• Sharing resources and building skills
• Building community and relationships
• Leading recovery groups
• Mentoring and setting goals

Peer Support Roles

• Providing services and/or training
• Supervising other peer workers
• Developing resources
• Administering programs or agencies
• Educating the public and policymakers

Slide 29: Opioid Use Disorder Treatment Providers In Montana

Click on this link for local providers:

https://dpt2.samhsa.gov/treatment

Slide 30: Treatment Provider Information on Substance Use Disorders (SUDs)

The Montana DPHHS has a very intuitive SUDs treatment provider location website with an interactive map. The webpage is titled: Substance Use Disorder Providers by Level of Care Available at: 

https://dphhs.mt.gov/amdd/SubstanceAbuse/TreatmentProviderInformation

Slide 31: Conclusion

Please visit our website:

http://health.msuextension.org/opioid_misuse.html

• Access to all five modules and PowerPoints
• Access to the Native American Toolkit
• Access to informational and recovery story videos
• Print/download educational resources
• Order a medication disposal pouch (while supplies last)

If you have any questions, please email our program director   Barbara Allen  [email protected]

Montana Department of Public Health and Human Services website:

https://dphhs.mt.gov/opioid/

Slide 32 & 33:  References

Beth Connolly, & & Vanessa Baaklini. (2021, January 21). Primary Care Providers Can Help Steer People to Opioid Addiction Treatment. The Pew Charitable Trusts. https://www.pewtrusts.org/en/research-and-analysis/articles/2021/01/25/primary-care-providers-can-help-steer-people-to-opioid-addiction-treatment.

Centers for Disease Control and Prevention. (2019, May 22). Medication-Assisted Treatment for Opioid Use Disorder (2019-133). Centers for Disease Control and Prevention. https://www.cdc.gov/niosh/docs/wp-solutions/2019-133/default.html.

Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 43.) Chapter 2. History of Medication-Assisted Treatment for Opioid Addiction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64157/

Dunbar, E., Brennan, A., & Grocke, M. 2020. Stigma Free Addictions Terminology for Montanans. MontGuide. MT202013HR. Montana State University Extension.

Medication-Assisted Treatment (MAT). SAMHSA. (n.d.). https://www.samhsa.gov/medication-assisted-treatment.

[Partnership to End Addiction]. (2013, June 17) Medication-Assisted Treatment Overview: Naltrexone, Methadone & Suboxone l The Partnership [Video]. YouTube. https://www.youtube.com/watch?v=tMusvDyoIRI

[Psych Hub]. (2019, April 16) Medication Assisted Treatment [Video]. YouTube. https://www.youtube.com/watch?v=iWnrUCWY6AM

Screening, Brief Intervention, and Referral to Treatment (SBIRT). SAMHSA. (n.d.). https://www.samhsa.gov/sbirt.

Substance Abuse and Mental Health Services Administration. (2011, February 23). Recovery-Oriented Systems of Care (ROSC) Resource Guide.

What Is Integrated Behavioral Health Care (IBHC)? The Academy. (n.d.). https://integrationacademy.ahrq.gov/products/behavioral-health-measures-atlas/what-is-ibhc.

Zwick, J., Appleseth, H. & Arndt, S. Stigma: how it affects the substance use disorder patient. Subst Abuse Treat Prev Policy 15, 50 (2020).  https://doi.org/10.1186/s13011-020-00288-0