1. HELP. HOPE. HEALING. Understanding Medication Assisted Treatment Joan R. Shepherd, FNP The Coleman Institute

2. HELP. HOPE. HEALING. Addictive Drugs Actually Overtake the Pleasure Center Some addictive drugs release over 5 times the Dopamine that is meant to be released Monkeys in experiments with unlimited access to IV cocaine will keep using it until they die of starvation Human patients with addiction will eventually: Use their drugs instead of food Use their drugs instead of sex Use their drugs in spite of hurt to their families and loved ones Use their drugs in spite of harming themselves

3. HELP. HOPE. HEALING. Most People Can Handle Alcohol and Drugs That Release Extra Dopamine – but 10% Have Trouble Handling These Drugs They most likely have inherited a slight deficiency of the reward system Some evidence that addicts have a Dopamine D2 Receptor Deficiency: They seem to experience very strong pleasure from addictive drugs They put up with negative consequences They change their priorities Denial and rationalization keep the process going

4. HELP. HOPE. HEALING. Cravings and Relapse There are four basic causes: 1.The brain has not fully healed 2.Use of other drugs that release Dopamine 3.Triggers – memory circuits 4.Strong Emotions

5. HELP. HOPE. HEALING. PET Scan Showing PAWS

6. HELP. HOPE. HEALING. Traditional Treatment Options 1.Drug free – abstinence-based treatment 2.Methadone maintenance 3.Suboxone maintenance

7. HELP. HOPE. HEALING. Drug Free – Abstinence-Based Treatment This would be ideal if it worked… but, it doesn’t work well First, the patient needs detoxification – which is frequently unsuccessful Second, the patient needs rehabilitation – which is frequently unsuccessful because the pull back to the drugs is extremely strong

8. HELP. HOPE. HEALING. Abstinence Based Treatment (without medication assistance) has a Very Low Success Rate The first IOP where Dr. C was Medical Director had 0% success Seattle study had 3% success after only three months; other studies have less than 20% success after only six months There are a number of reasons: The brain takes about a year to heal Most people are exposed to multiple triggers every day Most people have a lot of stress in early recovery Opiate drugs are very “clean” – low side effects

9. HELP. HOPE. HEALING. Methadone Maintenance It does decrease street drug use and decrease HIV rates But, it has significant problems: People need to go to a special clinic – often daily People must continue to associate with using people Travel is very difficult Many people continue to abuse other drugs It has effects on weight, teeth, testosterone and cardiac rhythm It is harder to detoxify off methadone than other drugs Over 92% of patients who are on methadone would rather be free from having to take it

10. HELP. HOPE. HEALING. Suboxone Maintenance – Advantages Has been available since 2003 It is convenient Available in private physician’s offices Often only monthly visits Sometimes paid for by insurance It does decrease cravings and opiate use It is safer in terms of overdose potential

11. HELP. HOPE. HEALING. Suboxone Maintenance – Disadvantages It is now widely abused on the street Many patients continue to abuse other drugs Many patients skip doses or sell their Suboxone and continue to get high Extremely difficult to detoxify off even low doses

12. HELP. HOPE. HEALING. Newer Treatment- Naltrexone Antagonist Assisted Abstinence Completely blocks the brain’s opiate receptors Dramatically reduces cravings Makes relapse virtually impossible Provides time for patients to be able to make the difficult changes necessary for long term recovery Acceptance Understanding – relapse, triggers, emotions Attitude changes Ability to deal with emotions Environmental and Social change Spiritual change

13. HELP. HOPE. HEALING. Antagonist Assisted Abstinence - Contd Can be started only after detoxification is complete Oral tablets are less effective Monthly Injections available – Vivitrol Subcutaneous implants last two months

14. HELP. HOPE. HEALING. Detoxification Options Cold Turkey – very difficult In-patient Detoxification – expensive and only about 50% successful Substitution with Methadone – can only be done in a licensed clinic; success rates are very low Substitution with Suboxone – success rates are very low Ultra-Rapid Detoxification (Anesthesia) – some risks We Have Developed an Accelerated Detoxification Method

15. HELP. HOPE. HEALING. Accelerated Opiate Detoxification Treated more than 5,000 patients over the last 13 years Outpatient environment Extremely Successful - 99% complete the detoxification Usually completed in only three days Very safe Comfortable – most report it is the most comfortable detoxification they have ever experienced

16. HELP. HOPE. HEALING. Our Treatment Provides a Safe, Comfortable and Effective Solution 045678910321 Days Level of Opiates in Brain Usual Level “Cold Turkey”

17. HELP. HOPE. HEALING. 045678910321 Days Level of Opiates in Brain Usual Level Ultra Rapid Detox “Cold Turkey”

18. HELP. HOPE. HEALING. 045678910321 Days Level of Opiates in Brain Usual Level Ultra Rapid Detox Accelerated Detox “Cold Turkey”

19. HELP. HOPE. HEALING. 045678910321 Days Level of Opiates in Brain Usual Level Ultra Rapid Detox Accelerated Detox Light Sedatives “Cold Turkey”

20. HELP. HOPE. HEALING. 045678910321 Days Level of Opiates in Brain Usual Level Ultra Rapid Detox Accelerated Detox Light Sedatives “Cold Turkey”

21. HELP. HOPE. HEALING. 045678910321 Days Level of Opiates in Brain Usual Level Ultra Rapid Detox Accelerated Detox Light Sedatives “Cold Turkey” Induction onto full dose Naltrexone under light sedation

22. HELP. HOPE. HEALING. 045678910321 Days Level of Opiates in Brain Usual Level “Cold Turkey” Ultra Rapid Detox Accelerated Detox Microdose Naltrexone Light Sedatives Induction onto full dose Naltrexone under light sedation

23. HELP. HOPE. HEALING. 23 Our Facilities Provide a Nice Level of Patient Comfort…

24. HELP. HOPE. HEALING. Naltrexone Therapy Naltrexone Implants We have used implants for over 16 years, in thousands of patients Provides 2 months of reliable blockage Most patients report no cravings Can be easily replaced and therapy continued as needed Low side effects Naltrexone Monthly Injections Vivitrol has recently been approved for use Monthly injection and very reliable Can be very expensive, but is sometimes covered by insurance

25. HELP. HOPE. HEALING. Naltrexone Implants What They Are When To Use 2 month duration Recommend minimum of 12 months Minor surgical procedure Infection rate < 2% After each detox If self-detoxed / detoxed elsewhere While in treatment After period of incarceration Patient on probationary period

26. HELP. HOPE. HEALING. Naltrexone Therapy Provides a “Window of Opportunity” for Patients to Initiate Change

27. HELP. HOPE. HEALING. Our Implant Room and Nurses Station

28. HELP. HOPE. HEALING. Naltrexone can be a Physical Bridge to Long Term Recovery Full Acceptance of the illness – surrender? Understanding the illness Understanding Cravings and Relapse Ability to deal with emotions Avoiding triggers by changing people, places and things Relationship growth Career growth Spiritual growth

29. HELP. HOPE. HEALING. Rehabilitation Programs – Match Intensity to the Patient’s Need Extended Care – usually 3-12 months Recovery Residences 28 day Inpatient Rehabilitation Programs IOP – Intensive Outpatient Programs Individual Therapy

30. HELP. HOPE. HEALING. QUESTIONS?