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?.