management of substance use disorder module p: addiction-focused pharmacotherapy
DESCRIPTION
Initiate or continue opioid agonist therapy Available since 1960’s BUT confined to Opioid Treatment Programs, under federal and state controls. Most effective medication in treating addiction, when used in well-run treatment program. Available since 1960’s BUT confined to Opioid Treatment Programs, under federal and state controls. Most effective medication in treating addiction, when used in well-run treatment program.TRANSCRIPT
Management of Substance Use Disorder
Module P: Addiction-Focused Pharmacotherapy
Patient withsubstance use disorder (SUD)
(A)
Is the patient opioid
dependent? (B)
Is Opioid agonist therapy (OAT)
appropriate for andacceptable to the
patient?(C)
Initiate or continue opioid agonist
therapy(D)
Initiate or continue opioid agonist therapy
• Available since 1960’s BUT confined to Opioid Treatment Programs, under federal and state controls.
• Most effective medication in treating addiction, when used in well-run treatment program.
Indications for OAT
• Opioid dependence > 1 year• 2 or more unsuccessful opioid
detoxification episodes within a 12-month period
• Relapse to opioid dependence within 2 years from OAT discharge
Is the Patient OpioidDependent?
(B)
Is naltrexone therapyAppropriate for and
Acceptable to the patient?(E)
Arrange for detoxification if
IndicatedSee Module S
Assure patient is detoxified
andOpioid free
before continuing
(F)
Initiate naltrexone for opioid
Dependence with patient Education
and monitoring (G)
• Naltrexone has no positive psychoactive effects. Some highly motivated patients can be successful using naltrexone therapy.
• Subpopulations with better prognosis for response include:– Patients highly motivated for
abstinence – Patients in the criminal justice
system, with monitored administration– Health care workers with
employment-related monitoring
Indications for Naltrexone
• Ability to achieve at least 7-10 days of abstinence to rule out the need for detoxification
Is the patient alcoholDependent?
(H)
Is Pharmacotherapy for Alcohol Dependence
Indicated?(I)
Initiate pharmacotherapy forAlcohol dependence with patient
Education monitoring(J)
Indications for Naltrexone in the Treatment of Alcohol Dependence
• Ability to achieve at least 3-5 days of abstinence to rule out the need for detoxification
• Drinking within the past 30 days and/or reports of craving
• Most effective when the patient is engaged in addiction-focused counseling
Indications for Disulfiram in the Treatment of Alcohol Dependence
• Alcohol dependence with:– Abstinence >24 hours– Combined cocaine and alcohol– Failure of or contraindication to
naltrexone– Previous response to disulfiram
Volpicelli et al. Arch Gen Psychiatry. 1992;49:876-880
Naltrexone in the Treatment of Alcohol
Dependence
No. of Weeks Receiving Medication10 2 3 4 5 6 7 8 9 10 11 12
0.00.20.40.60.81.0
Naltrexone HCl (N=35)Placebo (N=35)