therapeutic considerations of psychopharmacology of opiate ... · thomas durham, phd director of...

Therapeutic Considerations of

Psychopharmacology of Opiate use Disorder

Presenter: Linda Shaffer MA, Ed.S., LCAS, MAC

June 13, 2018

Thomas Durham, PhD

Director of Training

NAADAC, the Association for Addiction Professionals

www.naadac.org

tdurham@naadac.org

Produced By

NAADAC, the Association for Addiction Professionalswww.naadac.org/webinars

www.naadac.org/webinars

www.naadac.org/psychopharmacology-opioid-use-disorder-webinar

Cost to Watch:

Free

CE Hours Available:

1.5 CEs

CE Certificate for

NAADAC Members:

Free

CE Certificate for

Non-members:

$20

To obtain a CE Certificate for the time you spent watching this webinar:

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at

www.naadac.org/psychopharmacology-opioid-use-disorder-webinar

3. If applicable, submit payment for CE certificate or join NAADAC.

4. A CE certificate will be emailed to you within 21 days of submitting

the quiz.

CE Certificate

Using GoToWebinar – (Live Participants Only)

Control Panel

Asking Questions

Audio (phone preferred)

Polling Questions

Linda Shaffer MA, Ed.S., LCAS, MAC

lshaffer155@gmail.com

Webinar Presenter

Your

FOOTHILLS CONSULTING ASSOCIATES615 South Dekalb Street

SHELBY, NC 28150

PHONE: 704-480-1882 FAX: 704-480-1832

Webinar Learning Objectives

Participants will learn

how to identify

appropriate patients for

agonist therapy and will

identify alerts to

potentially inappropriate

patients for agonist

therapy.

Participants will identify

the benefits of utilizing

a patient-centered

approach to treatment

of co-occurring

disorders.

Participants will become

familiar with collaboration

avenues between therapists

and prescribing physicians.

1 32

Polling Question #1

Which of the following best describes your

professional affiliation?

a. Physician

b. Nurse

c. Counselor

d. Social worker

e. Psychologist

What are your thoughts about

medication assisted opiate treatment?

How about methadone vs buprenorphine?

Type you answers, comments, and any questions into the question box in the right hand panel on your screen and at the end of the webinar answers can be read and questions can be posed for further discussion

People with chronic pain with poor prognoses for

resolving pain = resistance to taper

People with multiple active SA diagnoses =

diversion risk

HIGH RISK PATIENTS

APPROPRIATE CANDIDATES

Have no or treatable chronic pain issues

Have history of overcoming other addictions or have no

other active addictions

Have social supports

Have current employment or good potential for employment

(diversion risk)

Failed attempts with previous agonist medications

Personal Goals/progress ☻

Personal Interventions ☻

Appointment scheduling ☻

Tapering differences ☻

Program guidelines

PATIENT CENTERED APPROACH

Consequences for missed appt

Discharge criteria

Medication counts

Office behavior

UDS results

Diversion

PROGRAM GUIDELINES

Handout – click on the handout box in the right hand panel of

your screen

Motivational Interviewing

Roll with resistance!

Cognitive Behavioral

Identify non supportive cognitive patterns.

Existential

What is your purpose in life?

Medication assisted treatment only? Thoughts on this.

Group therapy

THERAPY APPROACHES

Sign a contract or treatment agreement? violations

Drug testing frequency/lab requirements violations

Payment for services

Co-occurring dx and other controlled substances

Medication accountability

Medical Emergencies/surgeries

Transportation barriers

OUTPATIENT OFFICE-BASED CONSIDERATIONS

CO-OCCURING DISORDERS

• ConsiderationsConsiderations

National Survey on Drug use and Health (2016)

Of all adults with any mental illness:

18.5% meet criteria for SUD

Of all adults with no mental iIlness:

5.4% meet criteria for SUD

1. Previous diagnoses – are they sound?

2. ADHD/PTSD/other anxiety/bi-polar

3. Consider drug induced psychoses (bath salts/meth)

4. Alternatives to controlled substances

5. Stimulants and/or benzodiazepines (compounding

effect of bup and bzo)

6. Beware of triangulation with therapist and Dr.

Collaboration with Prescribers

• Respect each other’s skills

• Notes to chart, e mails, stickies

• Clt thoughts, clinical thoughts

• “Big picture” as therapist

• “Focus” as doctor

• Team meals, presentations etc.

COLLABORATION THOUGHTS

PA’s, NP’s and new MD prescribers = 30 patients for

one year.

move up to 100 patients after one year

waivers up to 275

*SA continuing education required.

PATIENT COUNTS

INSURANCE REQUIREMENTS

Therapy and Dr’s notes are required by both

Medicaid and 3rd party insurers to get prior

authorizations for agonist medications.

Lab results are also requested.

(in house or refer out?)

SUMMARY

Patient Selection

Accountability of patients

Address all dx including physical ailments

Utilize patient centered treatment plans

Collaborate with other professionals

Self care

Polling Question # 2

Which of the following best describes your belief

about medication-assisted treatment?

a. MAT should be a lifelong commitment in recovery

b. MAT is never appropriate in recovery

c. MAT can be a bridge to abstinence

Any new thoughts,

questions,

insights

or contributions?

Quick guide for physicians: based on TIP 40: clinical guidelines

for the use of buprenorphine in the treatment of opiod addiction.

(2005). Rockville, MD: U.S. Dept. of Health and Human

Services, Substance Abuse and Mental Health Services

Administration, Center for Substance Abuse Treatment.

Salcedo-Talboy, E. (2008). Substance abuse treatment for

persons with co-occurring disorders inservice training: based on

a Treatment Improvement Protocol, TIP 42 (pp. 1-7). Rockville,

MD: U.S. Dept. of Health and Human Services, Substance

Abuse and Mental Health Services Administration, Center for

Substance Abuse Treatment.

Your treatment with suboxone film [Pamphlet]. (n.d.).

BIBLIOGRAPHY

Linda Shaffer MA, Ed.S., LCAS, MAC

lshaffer155@gmail.com

Thank You!

Your

FOOTHILLS CONSULTING ASSOCIATES615 South Dekalb Street

SHELBY, NC 28150

PHONE: 704-480-1882 FAX: 704-480-1832

www.naadac.org/psychopharmacology-opioid-use-disorder-webinar

Cost to Watch:

Free

CE Hours Available:

1.5 CEs

CE Certificate for

NAADAC Members:

Free

CE Certificate for

Non-members:

$20

To obtain a CE Certificate for the time you spent watching this webinar:

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at

www.naadac.org/psychopharmacology-opioid-use-disorder-webinar

3. If applicable, submit payment for CE certificate or join NAADAC.

4. A CE certificate will be emailed to you within 21 days of submitting

the quiz.

CE Certificate

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