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OMAT (Opioid Medication Assisted Treatment Options for Opioid Substance Use Disorders Crossroads’ Turning Points, Inc

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OMAT (Opioid Medication Assisted Treatment Options for Opioid Substance Use Disorders Crossroads’ Turning Points, Inc OMAT (Opioid Medication Assisted Treatment Options for Opioid Substance Use Disorders Crossroads’ Turning Points, Inc. Opioid = Pain Killer • Pain-killing agents that originate from the poppy flower and its product opium. www.endthepain.org/learning/Glossary.html • Originally, a term denoting synthetic narcotics resembling opiates, but increasingly used to refer to both opiates and synthetic narcotics. www.prostate-cancer.org/resource/glosso.html • Medications made from, artificially developed from, or containing opium, a potent pain-killing substance that is derived from poppy pods. www.ichelp.com/AboutIC/FAQs/Terminology/tabid/288/Default.asp x • The opioids include natural opioids (eg morphine), semisynthetics (eg heroin), and synthetics with morphine-like action (eg codeine, hydromorphone, methadone, oxycodone, fentanyl). www.cdag.cochrane.org/en/glossary.html List of Opioids • Heroin • Morphine • Codeine • Fentanyl • Hydrocodone (Vicodin) • Hydromorphone (Dilaudid) (more potent than Morphine) • Oxycodone (Percodan; Percocet) • Oxycontin • Methadone • Naltrexone (Vivitrol) • Buprenorphine • Others Conditions for which Opioids are prescribed: • Medical procedures • Dental procedures • Automobile and other accidents • Sports injuries • Acute pain • Chronic pain • Opioid substance use disorder Co-occurring Disorders (Substance Use and Mental Health disorders) • Anxiety Disorders • Depressive Disorders • Post-traumatic Stress Disorders • Schizophrenia • Eating, sleeping, adjustment, impulse-control, personality Disorders • Others Treatment Options Abstinence-Based Medication-Assisted • Abstinence from all • Use of medication to substances is the goal in the enhance or assist treatment recovery plan in order to gain and • Traditional maintain recovery • Acceptance at 12-step • Modern meetings • Can be used in association with 12-step meetings Medical examples of Medication- Assisted Treatment • Diabetes: Insulin with change of diet and exercise • Heart disease: Heart/blood pressure medications with change of diet and exercise • Cancer: Chemotherapy and other medications with change in diet, exercise, etc. Mental Health examples of Medication-Assisted Treatment • Depression: Antidepressant medications with group/individual talk sessions • Anxiety: Anti-anxiety medications with group/individual talk sessions • PTSD: Antidepressant/Anti-anxiety medications with group/individual talk sessions • Schizophrenia: Antipsychotic mediations with group/individual talk sessions Substance Use Disorder examples of Medication-Assisted Treatment • Monitored/Dispensed Antabuse with a Cognitive Behavioral Treatment Program • Monitored/Dispensed Vivitrol/Naltrexone with a Cognitive Behavioral Treatment Program • Monitored/Dispensed Methadone with a Cognitive Behavioral Treatment Program OMAT Program Placement Criteria • ASAM (American Society of Addiction Medicine) placement criteria for OMAT (Opioid Medication Assisted Treatment) Dimension 1 (Intoxication and/or Withdrawal Potential): The patient is physiologically dependent on opiates and requires OMAT to prevent withdrawal. Dimension 2 (Biomedical Conditions and Complications): None or manageable with outpatient medical monitoring. OMAT Placement Criteria (ASAM Continued) Dimension 3 (Emotional, Behavioral, or Cognitive Conditions and Complications): None or manageable in an outpatient structured environment. Dimension 4 (Readiness to Change): The patient is ready to change the negative effects of opioid use, but is not ready for total abstinence. Dimension 5 (Relapse, Continued Use or Continued Problem Potential): The patient is at high risk of relapse or continued use without OMT and structured therapy to promote treatment progress. Dimension 6 (Recovery Environment): The patient’s recovery environment is supportive and/or the patient has skills to cope. Crossroads’ Turning Points, Inc. OMAT Clinic/Program • Comprehensive Clinical evaluations: Addiction Severity Index, Socrates, Mini Mental Status, Mental Health Screen • Medical evaluations/tests (blood work, EKG/ECG (electrocardiogram)) • Monitored/Dispensed Methadone medication • Cognitive Behavioral Treatment; Group, Individual, and Family Sessions; evidence-based curricula • Financial Obligation Plans; sliding fee scale, Medicaid • Urinalyses and Breathalyzers • Individualized Treatment Plans • Individualized Transition Plans • Licensing and Accreditation Admission Process • Triage (First contact with Crossroads) • Clinical Staffing (Meet with the OMAT Team) • Clinical evaluation ( CAC: Certified Addictions Counselor) • Medical evaluation (MD: Medical Doctor) • First dose/Induction (on Doctor’s orders; RN/LPN: Registered Nurse/Licensed Practical Nurse) Continued treatment • Dosing Stabilization: First 30 to 90 days (daily dosing in the clinic) • Dosing Stabilization Continued: 3 to 6 months (may begin to earn take-home doses) • Detox: 6 to 12 months; slow, humane (may continue to earn take-home doses) • Group, individual, and family sessions throughout treatment • Medical coordination with Primary Care Physicians throughout treatment • Some patients will remain in the OMAT Program for life Take-home doses: Earning Independence from the Clinic • Daily dosing; patient comes to the clinic every day for their dose • Phase I; patient can earn one take-home dose weekly • Phase II; patient can earn two take-home doses weekly (non-consecutive) • Phase III; patient can earn three take-home doses weekly (two consecutive; one separate) • Phase IV; patient can earn four take-home doses weekly (two consecutive; then two more consecutive) • Phase V; patient can earn 13 take-home doses Rules for take-home doses • Lock box container for transport • Secured storage at home • Limited access to the doses by family members • Who will return the doses to the OMAT clinic in the event of the patient’s death/absence? • Diversion prevention: Call-back procedures • No replacement doses Discharging/Detoxing from the OMAT Program • Administrative Discharge/Detox • Planned/Scheduled • Blind planned/scheduled (patients become afraid of lower and lower doses) • Some patients will remain for life without ever discharging or detoxing Benefits of OMAT Programs • Allows patients to improve their family/social lives; raise their own children • Allows patients to hold down employment/careers; be self-sufficient • Allows patients to be psychologically and medically stable; healthy • Decreases illicit use of substances (opioids and others); decrease crime • Improving quality of life for individuals leads to an improvement in the quality of life in the community; safer streets Questions?.
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