Understanding Medication Assisted Treatment

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Understanding Medication Assisted Treatment

• Nancy Price, MA
• Clinic Director
• Huntington Treatment Center

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THE EVOLVEMENT OF METHADONE MAINTENANCE TREATMENT

• (19501961) Heroin deaths increased from 7 to
  36 per 10,000 deaths
• (1964) Research project as a response to the
  postWWII heroin epidemic in NYC
• Dr. Vincent Dole Dr. Marie Nyswander

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EVIDENCEBASED FINDINGS

• Opiate addiction is a chronic, relapsing brain
  disease
• Predisposition due to genetic vulnerability and
  early environmental factors
• Has nothing to do with choices, distorted value
  systems, or being weak

• PET scans show defects in blood circulation
  abnormal cerebral activity
• Affects cognition, judgment impulse control
• Methadone stabilizes brain functioning

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MEDICATION ASSISTED TREATMENT FACTS

• Methadone is the most researched medication for
  any disease. (American Association on the
  Treatment of Opioid Dependence AATOD)
• MAT is the most effective treatment available for
  opiate addiction. (National Institute of Health
  Consensus Panel)
• MAT decreases opiate abuse by 70-80 _at_ 6 months
  and 85-90 _at_ one year. (Joseph et al., 2000)
• For every 1.00 spent on methadone treatment,
  4.00 is saved in social costs to the community.
  (National Institute of Health Consensus Panel)
• The National Drug Court Institute indicates that
  80 of patients will reduce or eliminate crime as
  they remain in MAT programs

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SOCIETAL BENEFITS

• Society sees a reduction in
• Crime/drug arrests
• Death rates
• Reduced heroin use
• Decreased risk of communicable diseases such as
  HIV, Hepatitis C STDs

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3 THERAPEUTIC BENEFITS

• 1. Reduces and eliminates narcotic cravings
• 2. Reduces eliminates physiological withdrawal
  symptoms
• 3. Blocks the euphoric effects of opiates

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WHAT IS METHADONE?

• Peak plasma levels are observed within 4 to 6
  hours of ingestion
• Has a half-life of 2448 hours
• Binds to the mu receptors in the central nervous
  system.

• Agonist
• Synthetic opioid
• Used as an analgesic and to treatment narcotic
  addiction

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SHORT LONG TERM EFFECTS OF TAKING METHADONE
In therapeutic dose ranges, Methadone does not
cause

• Damage to major organs
• Slurred speech
• Sedation or euphoria

• Changes in motor skills
• Cognitive impairment
• Congenital abnormalities in unborn children

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BEST PRACTICE GUIDELINES

• 80 120 mg/day
• Daily administration of medication
• Pharmacological therapy combined with counseling,
  peer support groups
• Recommended standard of care for pregnant
  opiatedependent women

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TREATMENT APPROACHES

• We treat addiction as a bio-psychosocial disease
  that is manageable but not curable
• We treat the biological aspects of addiction with
  medication and behavioral modification
• We treat the psychological aspects with
  individual and group counseling structured to the
  individualized needs of the patient, education,
  supportive services
• We treat the social aspects through peer support
  groups, family groups, and behavioral
  modification

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TREATMENT OPTIONS (specific to CRC Health Group
MAT programs)

• Two Medications
• Methadone
• Hydrochloride
• Suboxone
• Subutex

• Five Programs
• ShortTerm Detoxification
• LongTerm Detoxification
• Maintenance
• Maintenance to Abstinence
• Continuing Care

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OUTCOMES DATA FOR Q42007
Huntington Treatment Center
WV Treatment Programs

• 33 YO Caucasian male 85 have gainful income
• Average LOS 22 months
• Average dosage level 87 mg.
• Between 3 6 months in treatment, 90 test
  negative for illicit opiates
• After 1 year in treatment, 95 test negative for
  illicit opiates
• After 12 months in treatment, 99 of patients
  have not been arrested
• After 12 months, 97 of patients report no IV
  use

• 33 YO Caucasian male 78 have gainful income
• Average LOS 21 months
• Average dosage level 85 mg.
• Between 3 6 months in treatment, 85 test
  negative for illicit opiates
• After 1 year in treatment, 94 test negative for
  illicit opiates
• 12 months in treatment, 95 of patients have not
  been arrested
• After 12 months, 97 of patients report no IV
  use

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REFERENCES

• Joseph, H., Stancliff, S., Langrod, J. (2000).
  Methadone maintenance treatment A review of
  historical and clinical issues. The Mount Sinai
  Journal of Medicine, vol. 67, 347-364.
• Magura, Sl, Rosenblum, A. (2001). Leaving
  methadone treatment Lessons learned, lessons
  forgotten, lessons ignored. The Mount Sinai
  Journal of Medicine, Vol. 68, 62-73
• NIH Consensus Panel Report (1997). Effective
  medical treatment of opiate addiction. NIDA
• http//consensusus.nih.gov/cons/108
• CSAT National Treatment Improvement Evaluation
  Study. (NTIES). http//www.ireta.org/opiates/metha
  done.pdf
• Drug Policy Alliance (2003). About Methadone
  Second Edition. www.drugpolicy.org