M.A.T. Medically Assisted Therapy Jeanne Kapenga, M.D. Medically - - PowerPoint PPT Presentation

M.A.T.

Medically Assisted Therapy Jeanne Kapenga, M.D.

Medically Assisted Therapy

 Recognized to aid in successful recovery

programs along with counseling for 90% of patients

 Allows the natural neurochemistry to return to

• pioid/drug damaged brains by preventing

cravings (and withdrawal)

 This process may take a year  Some may never fully recover

Allows focus on counseling

 Cravings are distracting, and MAT

provides medically proven improvement so pt’s can focus on their lifestyle changes

 The longer the period of abstinence, the

sooner the brain’s neurochemistry normalizes and decision-making improves

THREE MAJOR GROUPS

 METHADONE: Gold standard

• Opioid addiction

 BUPRENORPHINE: Suboxone, Subutex, etc

• Opioid addiction

 NALTREXONE: Revia, Vivitrol (injection)

• Opioid or alcohol addiction

METHADONE

 Federally regulated; distributed daily at a

clinic

 Euphoria effect; legal heroin  Long half-life means a long taper period  Inexpensive

BUPRENORPHINE

 Several formulations: with or without

naloxone (added for safety)

 Taken once or twice daily at home  Federally regulated; X-waiver  Diversion

NALTREXONE

 Not a controlled substance so not

federally regulated

 No real diversion factor (no euphoria)  Blocks cravings only  For opioid or alcohol addiction

MAT does not work alone

 Is an adjunct to counseling, group

therapy, step/community based groups and recovery coaching

 Benefits seen over time ie months to a

year as the brain neurochemistry heals

MAT and the Family

 Allows them to remain at home,

employed and functioning as a member

• f the family unit, if engaged in recovery

 Encourage family members to learn

about the disease of addiction as the pt enters recovery, for best treatment

• utcome

COMMUNITY COLLABORATION

 This crisis is the “Worst man-made

epidemic known to mankind” per CDC

 Scope and continuing escalation has

been underestimated

 First time Judicial/Law Enforcement have

made medical decisions for sentencing

SCOPE OF THE EPIDEMIC

 Prevention: Education in schools

Disrupting the supply Surgery, dental, athletic entry

 Treatment: Engaging when ready

Engaging when not ready

 “Meet them where THEY are at”

IT WILL TAKE A VILLAGE

 Schools  Law enforcement  Judicial system  Medical providers  Hospital/health care delivery systems  Community based agencies  Governmental at all levels

HEALTHCARE/HOSPITAL SYSTEM

 Multiple sectors of care involved  Emergency room: Point of contact for

• verdose or other medical need
• Assess for readiness for treatment

 Long term treatment options (months)

LAW ENFORCEMENT

 Now practicing medicine in the field with

naloxone administration and transport to the E.D. if possible

 Even if they remain at home, option for tx

JUDICIAL SYSTEM

 Incarceration is NOT the solution, but

treatment while incarcerated is

 Again, Judges are practicing medicine  National trend for mandating treatment

STATISTICS

 Important in organizing our data

collection here in MI: underreporting

 Evidence based decisions will depend

upon accurate, timely statistics (daily) to recognize mass overdose situations

 Identifying demographic factors for

determining policy in prevention

 Identifying locations of high use/resources

STATISTICS (continued)

 Evaluating resource efficacy – are the

resources placed where they are needed? Are they effective?

 Standardized Medical Examiner reporting  Developing evidence-based treatment

programs in the community

 Don’t have time now to do formal 5 year

studies – sense of urgency