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