1. Ten Pearls for Medication Assisted Treatment of Opiate Use Disorders
Scott Haga MPAS PA-C
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2. 1. Why Are We Doing Medication Assisted Treatment?
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3. Opioid Deaths in US

4. Deaths in Michigan

5. Cost of the Opioid Epidemic

6. Survival
DOPAMINE
WATER
FOOD

7. 2. The Stigma of Substance Use Disorders
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8. Stigma Opiate Use Disorder has an obvious stigma
Need to address this at the beginning and throughout treatment
Clinic staff
Leadership
Community
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9. 3. Need for Support in Your Organization
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10. Leadership Essential to have Senior Leadership support
Effective treatment requires creativity and a bit of a mind shift
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11. Leadership Essential to have Senior Leadership support
Understanding of “how” and “why” of MAT
Support for Team-based treatment team
Public health crisis
Medical home
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12. 4. Effective MAT is Team Based
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13. Team Based Care Team Based All staff are involved and trained
Develop Procedures
Need to be prepared for the unique challenges of treating SUD
Training
Basics of Addiction
Trauma Informed Care
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14. Team Based Care Identify a Clinical Champion
Leverage the skills and enthusiasm of team members to develop program
Identify individuals who are resistant – why?
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15. 5. Prepare Your Medical Providers
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16. Medical Issues
Prescribers need to have a buprenorphine waiver (X license)
MD/DO 8 hours
PA/NP/CNM/CRNA 24 hours
Link with a mentor who is familiar
Providers Clinical Support System
SAMHSA
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17. Forms of Buprenorphine
Buprenorphine sublingual(Subutex)
Cheap
Buprenorphine/naloxone (Suboxone, Zubsolv, etc)
Abuse deterrent
Buprenorphine implant(Probuphine)
Buprenorphine injection (Sublocade)
Improved compliance
Role for patient’s entering controlled environments
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18. 6. Financial Issues With MAT
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19. Financial Issues Reimbursement (It’s all about the money, right?)
State and payer specific
Potential challenges and work arounds
Same day billing for medical and behavioral health
CHC specific issues
Opportunities to partner with payers to demonstrate improved care
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20. 7. Behavioral Health
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21. Behavioral Health Essential component of the treatment team!
Legal requirement
Use Evidence based treatment
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22. Treatment Approaches for SUD
Medication Assisted Treatment
Cognitive Behavioral Therapy
Twelve-step approaches
Therapeutic communities
Community reinforcement/contingency management
(Jaffe et al, 2009)

23. Did I mention how important this is?
Behavioral Health
Did I mention how important this is?
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24. 8.Toxicology Testing
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25. Toxicology Testing Point of care vs. Send out Immunoassay vs GC/MS
Why “Everybody pees”
Witnessed vs. non-witnessed drops
Safeguarding integrity of urine
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26. Adulteration of urine

27. Adulteration of urine

28. Toxicology What to do with unexpected results
Opiates plus buprenorphine
Opiates, no buprenorphine
Buprenorphine, no metabolites
Other substances
Benzodiazepines
Everything else
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29. 9.Inductions
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30. Inductions Why is induction important? Home vs. office based
Previous experience with buprenorphine
Ability of patient to understand and follow induction schedule
COWS scale
Stock buprenorphine in the office?
Practical issues with induction
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31. Inductions Need to understand the unique properties of buprenorphine!
Home vs. office induction
Office induction protocol
Education of all staff about the what and why
Scheduling
Stock med vs patient bringing in own prescription
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32. 10. Philosophy of Care
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33. Treatment Philosophies
Abstainance
Harm Reduction
Complete abstainance from all drugs and other intoxicants
Powerless over addiction so treatment goal is to prevent all use
Harm reduction is a set of strategies that encourage substance users and service providers to reduce the harm done to drug users, their loved ones and communities by their licit and illicit drug use

34. Defining Recovery
What we expect
What is reality

35. Common Challenges Not showing up for behavioral health
Missed appointments/refills
After hours requests for refills
Lack of understanding of MAT
“It’s just trading one drug for another!”
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36. Discussion of Challenges You Have Faced in Your Program
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37. Contact Me
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