Management of Benzodiazepines in Management of Benzodiazepines in - - PowerPoint PPT Presentation

Management of Benzodiazepines in Management of Benzodiazepines in Medication-Assisted Treatment: P j O i d N S Project Overview and Next Steps

Management of Benzodiazepines in g p Medication-Assisted Treatment

Objectives: Objectives:

• Overview of the development and next steps of

the project

• Description of the RAND/UCLA Appropriateness

Method, which will be used to develop clinical guidelines for the management of g g benzodiazepines in MAT

• Ways in which we need you to be involved.

Th d f id d t d d The need for guidance and standards

Use of benzodiazepines in

Treating the Addiction and Promoting Recovery

• Use of benzodiazepines in

MAT is a complicated and multi- faceted issue without clear clinical guidance

Addressing y

clinical guidance

• Published literature, treatment

protocols and guidelines d i i d

Collateral Mental Illnesses

demonstrate variation and inconsistency in clinical practice.

• There is a need to establish a

e e s a eed to estab s a set of principles for the appropriate use of benzodiazepines in MAT benzodiazepines in MAT

l f h j

Out of discussions

Development of the Project

Out of discussions between providers and Roland Lamb at the Philadelphia Department Philadelphia Department

• f Behavioral Health

Intellectual disABILITY Services, Office of Addiction Services came the suggestion of the model for developing best practices

RAND/UCLA Appropriateness Study done by CCBH and IRETA in Western PA…

D l t f th j t

I iti ll Mi h l Fl h t d l t

Development of the project

Initially Michael Flaherty and later Peter Luongo of IRETA

• Developed and submitted a proposal to

p p p DBHIDS to develop clinical guidelines

• Dr. James Schuster of CCBH
• Shared experience with Buprenorphine project

Shared experience with Buprenorphine project

• Expressed interest in partnering in the

development of guidelines for Benzodiazepines

Ki k Off C f Kick Off Conference

C f Pl i Conference Planning

• Kick-Off Conference was planned for ~150

p stakeholders in Philadelphia, Pennsylvania and the larger region. E t l b f Phil d l hi d b d

• Expert panel members from Philadelphia and beyond

were selected to speak at the conference and participate in the guideline development process. g

• Logistical support for the conference provided by

SAMHSA

C f A d Hi hli ht Conference Agenda Highlights

Rates of Benzodiazepine Use in Medication‐Assisted Treatment in Pennsylvania and Nationally

Epidemiology, Morbidity and Mortality for Benzodiazepine Use – Jane C. Maxwell, PhD Rates of Benzodiazepine Use in MAT from CCBH counties – James Schuster, MD, MBA Rates of Benzodiazepine Use in MAT from CBH counties – Matthew O. Hurford, MD

Settings and Coordination of Care

l l f h d d d h l h Clinical Management of the Benzodiazepine‐dependent Patient – Laura F. McNicholas, MD, PhD Benzodiazepine Prescribing in Primary Care Settings: Issue for Concern? ‐ Louis E. Baxter, Sr., MD, FASAM Psychiatry and Co‐Occurring Disorders – Peter A. DeMaria, Jr., MD, FASAM, DFAPA Benzodiazepines and Buprenorphine in the OBOT Setting – Laura A. Murray, DO Benzodiazepines and the Pregnant Patient: Special Challenges – Karol Kaltenbach, PhD Panel discussion with audience participation Panel discussion with audience participation

Drug Interactions

Pharmacology (Drug‐Drug Interactions) – Antoine Douaihy, MD Treatment of Anxiety in the Methadone Maintained Patient – Abigail Kay, MD, ABPN, ABAM

Risk Management and Patient Education

Risk Management – Trusandra Taylor, MD, FASAM, MPH Patient Safety and Education – Jan Kusserow, RN, BSN, CCM

Development of Clinical Guidelines

Guidelines for Treating OMT Patients with Benzodiazepines: Can We Get Some Help Here? – Peter R. Cohen, MD

C f i S ! Conference is a Success! So… what’s next?

R di G id li t th Fi ld Recommending Guidelines to the Field

• RAND/UCLA Appropriateness Method was

/ pp p developed in the 1980s to assist in identifying

• veruse/underuse of medical procedures.

Thi th d tili d b IRETA/CCBH/RAND t

• This method was utilized by IRETA/CCBH/RAND to

develop a set of buprenorphine practice guidelines.

• Report available at:

Report available at: http://www.ccbh.com/providers/phealthchoices/articl es/current/buprenorphine.php

RAND/UCLA Appropriateness Method RAND/UCLA Appropriateness Method RAM used for:

P d th t d f tl

• Procedures that are used frequently
• Procedures that are associated with a

substantial amount of morbidity and/or substantial amount of morbidity and/or mortality

• Procedures that consume significant

g resources

• Procedures with wide variations among

hi i t f geographic areas in rates of use

• Procedures whose use is controversial

RAND/UCLA A i t M th d RAND/UCLA Appropriateness Method

Steps in the process

Literature Rating Clinical Review g Process Guidelines

RAND/UCLA A i t M th d RAND/UCLA Appropriateness Method

Steps in the process

Literature Rating Clinical Literature Review

• We need your input!

Rating Process Clinical Guidelines

• We need your input!
• Development of

background paper

• Development of

proposed clinical guidelines

RAND/UCLA A i t M th d RAND/UCLA Appropriateness Method

Steps in the process

Literature R i Rating P Clinical G id li Review Process

• Expert panel rates

proposed clinical

Guidelines

proposed clinical guidelines, using background paper to guide ratings

• Round 1 Ratings
• Round 1 Ratings
• Expert Panel Meeting
• Round 2 Ratings

RAND/UCLA A i t M th d RAND/UCLA Appropriateness Method

Steps in the process

Lit t R ti Cli i l Literature Review Rating Process Clinical Guidelines

• Development of draft

clinical guidelines

• Draft clinical guidelines

to be posted for public to be posted for public comment at DBHIDS

W d i t! We need your input!

• Submitting resources during literature review

Submitting resources during literature review

• Clinical experience and/or research literature on any

aspect of management of benzodiazepines in medication-assisted treatment

• Submit resources via email to: dawn@ireta.org

Deadline for submission of resources: April 30 2012

• Deadline for submission of resources: April 30, 2012

Public comment on draft clinical guidelines

• Public comment on draft clinical guidelines,

during September 2012.

Project Timetable Project Timetable

PROJECT MILESTONE TARGET DATE

Kick-Off Conference Held February 2012 Kick-Off Conference Held February 2012

Follow Up Webinar Held April 2012 Provider Input Solicited April 2012

Lit Review and Background Paper Completed May 2012 Preliminary Guidelines Drafted May 2012 First Round of Ratings Completed June 2012 Expert Panel Meeting Held July 2012 Second Round of Ratings Completed August 2012 Second Round of Ratings Completed August 2012 Final Report Provided to Philadelphia August 2012

Public Comment Solicited September 2012 Public Comment Solicited September 2012

Q i ? d f i ?

Dawn Lindsay, Ph.D.

Questions? Need More Information?

Feel free to contact us.

Director of Evaluation Services Institute for Research Education and Training in Addictions 425 6th Avenue, Suite 1710 Pittsburgh, PA 15219 412.258.8571 412.391.2528 (fax) ( ) dawn@ireta.org