The range of providers of psychosocial supports includes social workers, nurses, pharmacists, counselors, peer recovery specialists, outreach workers, physicians, and advanced practice professionals. They are currently providing psychosocial supports of varying models and intensities to patients receiving MAT for OUD.
Full Answer
What is medication-assisted treatment for Oud?
Jul 02, 2019 · Medication-assisted treatment (MAT) is a "whole-patient" approach to the treatment of OUD that combines the use of medications and psychosocial supports, such as counseling. Studies have demonstrated that MAT can effectively treat OUD by decreasing opioid use and opioid-related overdose deaths. The U.S. Department of Health and Human Services (HHS), …
Should patients with Oud have access to mental health services?
Jul 07, 2019 · The range of providers of psychosocial supports includes social workers, nurses, pharmacists, counselors, peer recovery specialists, outreach workers, physicians, and …
Is group therapy a useful modality for delivering psychosocial supports during Oud treatment?
Jan 01, 2009 · The Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence review the use of medicines such as methadone, buprenorphine, naltrexone …
What is patient-centered care for Oud?
Medication-assisted treatment (MAT) is considered the best treatment option for OUD as part of a comprehensive treatment plan. MAT for OUD is defined as the use of one of three …
What is the role of a nurse care manager?
Within this model, a nurse care manager plays a key role in providing support to patients and physicians. The nurse care manager engages patients early in treatment, supervises medication induction, monitors stabilization, and provides frequent education and supports as needed.
What are the challenges of OUD?
Meanwhile, others have faced substantial life challenges ( e.g., trauma, incarceration) and/or have challenging co-occurring conditions, such as psychiatric comorbidities.
What is one on one counseling?
One-on-one counseling is a prevalent type of psychosocial intervention throughout the literature. For example, in one study, manual-based opioid dependence counseling included psychoeducation on addiction and recovery, lifestyle change, and relapse-prevention in 45-minute to 60-minute sessions. [ 41] .
What is psychosocial support?
Psychosocial supports include formal or informal counseling by the prescribing physician or other professionals, individual and group therapies, structured or evidence-based psychotherapies, participation in structured peer counseling, and efforts to identify and address the social determinants of health.
What is MAT in medical terms?
Medication-assisted treatment (MAT) is defined as the "use of medications, in combination with counseling and behavioral therapies, to provide a "whole-patient" approach to the treatment of substance use disorders." [ 1] .
Does naloxone block buprenorphine?
The inclusion of naloxone protects against intravenous misuse of buprenorphine because, as an antagonist, naloxone covers the opioid receptors and blocks the effects of other opioids. Taken as intended, the naloxone in the combination product is not well absorbed and has no clinical effect.
Why are opioids misused?
The most commonly-reported reason that opioids were misused was to relieve physical pain (62.3 %). The misused prescription opioids were obtained: From a friend or relative (53.0 %) Through prescription(s) or stealing from a healthcare provider (37.5 %), typically through one doctor.
What is tolerance in DSM 5?
Tolerance is defined as either: 1) a need for markedly increased amounts of opioids to achieve intoxication or desired effect, or 2) a markedly diminished effect with continued use of the same amount of an opioid. Withdrawal. You can refer specifically to DSM-5 Criteria A and B for opioid withdrawal syndrome:
What are the symptoms of OUD?
Three (or more) of the following, developing within minutes to several days after Criterion A: dysphoric mood; nausea or vomiting; muscle aches; lacrimation or rhinorrhea; pupillary dilation, piloerection, or sweating; diarrhea; yawning; fever; or insomnia. Diagnosing OUD.
What drugs are tested in urine?
Test urine for opioids, alcohol (ethyl glucuronide), and other drugs, such as benzodiazepines1. Conduct a complete blood count (especially if any signs of bacterial infection such as endocarditis) Assess for hepatitis B/C and HIV for those who inject intravenously.
What is an OTP for methadone?
Opioid treatment program (OTP) for methadone therapy. Methadone can only be dispensed through an OTP that is accredited by a SAMHSA-approved accrediting body and certified by SAMHSA. Factors Influencing Selection of MAT. Multiple factors may influence the selection of a specific type of MAT.
What is 12-step facilitation therapy?
Twelve-Step Facilitation Therapy: manualized therapy focusing on optimizing a patient’s capacity to participate optimally in 12-step mutual help programs. Developed for alcohol use disorder, not drug use disorders, it focuses on moving through steps 1-3 and each individual session ends with assignment of recovery tasks oriented toward active 12-step participation. This structured approach is quite different than the usual encouragement and discussion of 12-step adjuncts that is delivered in clinical treatment settings, but may be closer to what is delivered in “drug-free” community recovery programs.
What is behavioral health services?
Behavioral health services means any non-pharmacological intervention carried out in a therapeutic context at an individual, family, or group level. Interventions may include structured, professionally administered interventions (e.g., cognitive behavior therapy or insight oriented psychotherapy) delivered in person, interventions delivered remotely via telemedicine shown in clinical trials to facilitate medication-assisted treatment (MAT) outcomes, or non-professional interventions.
What is OUD in medical terms?
Opioid use disorder (OUD) is defined by the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) 1 as the maladaptive use of opioids, prescribed or illicit, resulting in two or more criteria that reflect impaired health or function over a 12-month period.
What is the treatment for OUD?
The Food and Drug Administration (FDA) has approved three medications for preventing opioid relapse and for stabilization/maintenance treatment of OUD: buprenorphine, naltrexone, and methadone.
What are the three medications that are approved for preventing relapse?
The Food and Drug Administration (FDA) has approved three medications for preventing opioid relapse and for stabilization/maintenance treatment of OUD: buprenorphine, naltrexone , and methadone. All three are ligands that bind to central mu-opioid receptors as the molecular target for their therapeutic activity, yet they differ significantly in their respective intrinsic activities at the mu-opioid receptor, their pharmacokinetic and pharmacodynamic properties (with effects on efficacy and toxicity), and the mechanisms by which they confer relapse-prevention protection to treated individuals ( Table 1 ).
What are the risk factors for opioid overdose?
They include misuse of heroin and opioid analgesics, misuse of diverted buprenorphine and methadone, increases in opioid prescribing, having four or more prescribers or pharmacies filling opioid prescriptions, being prescribed doses equivalent to more than 100 mg morphine, opioid ingestion coupled with alcohol or the use of other sedatives/hypnotics (with synergistic effects on respiratory depression), receipt of public subsidy income providing access to drug purchase and binge drug use, suboptimal methadone-induction practices in relation to both pain management and addiction, opioid-analgesic switching, previous overdose history, loss of opioid tolerance among OUD due either to extended abstinence during incarceration or to treatment-related abstinence, and older age, with smoking status and co-occurring medical conditions likely contributing to fatalities. 2,63–71 Given that MAT reduces illicit opioid use, educates about OUD and accidental-overdose prevention, and may provide (where available) intranasal naloxone rescue kits to family and friends for use at the scene of an opioid overdose, 68,72 it is expected that MAT would be an important factor in preventing accidental opioid-overdose deaths occurring in those with OUD while they remain in active treatment. While data to date suggest that that is indeed the case for buprenorphine, methadone, and naltrexone ER, 19,63 more data are required to judge the safety of MAT following treatment dropout and planned medication discontinuation, particularly for antagonist therapies for which the preclinical 20 and clinical 28,31,73 evidence indicates increased risk for respiratory depression upon opioid agonist reexposure.
What is MAT therapy?
MAT is recommended for adults presenting for clinical treatment of OUD with physiological dependence: it significantly augments treatment retention, reduces illicit opioid use, reduces the burden of opioid craving, and, in the case of agonist therapies, provides effective relief of the opioid withdrawal syndrome.
What is MAT treatment?
Thus, MAT is a stabilizing addition to relapse-prevention counseling and mutual help groups (such as Narcotics Anonymous) in that it increases the effectiveness of those interventions. Longer-term, abstinence-based residential treatment without MAT shows limited effectiveness, especially among recently detoxified heroin users, 97,98 and loss of tolerance during this period of abstention poses an increased risk of fatal overdose if one relapses to opioid use upon discharge to home. Youth is a predictor of early dropout from psychosocial treatment of OUD, 99 whereas medication adherence and early opioid abstinence predict greater retention and treatment success among youth treated with buprenorphine/naloxone. 100 A 2005 Cochrane review noted that the available evidence was insufficient to support psychosocial treatment alone as effective for OUD. 101 The evidence remains insufficient, even to predict which individuals, if any, are likely to do well without MAT.
Is buprenorphine safe for adolescents?
The buprenorphine/naloxone combination is FDA approved for adolescents aged 16 and older and has demonstrated safety and efficacy for youth with OUD. 26 As such, it is currently the treatment of choice. Nevertheless, concern about adolescent nonadherence and the misuse and diversion of buprenorphine/naloxone has generated some support for empirical treatment with naltrexone ER. Caution is advised, however, because evidence is lacking as to the safety and efficacy of naltrexone ER in this population. In the United States, methadone maintenance is not available for the treatment of adolescents.
