Counseling Points - September 2007 - (Page 17)

CP Counseling Points Office-based Medication-assisted Treatment of Opioid Dependence • Significant growth in the population of individuals with addictions to opioids presents a continuing clinical problem. • Current methadone treatment clinics can only meet the needs of <25% of these individuals, leaving more than 75% untreated. • Legislation from the Drug Addiction Treatment Act (DATA) of 2000 was enacted to provide the opportunity for office-based treatment. Two subsequent updates to the legislation expanded the maximum number of patients a group practice can treat, and increased the limit from 30 to 100 patients that an individual physician who is certified for 1 year can treat. • A number of recognizable signs and symptoms during a physical examination can point to a potential or existing opioid dependency. • Specific tools, including the CAGE alcohol abuse instrument adapted to include drugs (CAGE-AID), Drug Abuse Screening Test (DAST), and the Mentally Ill Drug & Alcohol Screening (MIDAS) questionnaires, can help to further assess patients who may be at risk for developing an opioid dependency • The presence of three or more criteria from the DSM-IV-TR within the past 12 months is considered diagnostic of a drug dependence disorder warranting treatment. • Thorough patient counseling is important to identifying the appropriate treatment approach, based on the patient’s resources and the availability of programs in the community. ™ • Outpatient, office-based buprenorphine treatment provides a much-needed option for treatment to patients presenting with opioid addiction. • Successful buprenorphine treatment depends upon a strong counseling relationship between the addicted individual and the addiction nurse, who prepares the patient for treatment and monitors progress. • Buprenorphine has a 95% rate of occupancy of opioid receptors (which is dose dependent), preventing other opioids from attaching. • For induction with buprenorphine to begin, the individual should have discontinued using all opioids long enough to have entered a mild to moderate withdrawal (signified by a Clinical Opiate Withdrawal Scale [COWS] score of ≥12), in order to prevent precipitated withdrawal from the therapy. • Once the patient is stabilized, long-term addiction counseling should begin. • Maintenance therapy with buprenorphine may last for 3 months to several years, with counseling provided for as long as needed to keep the individual drug-free. • Two websites, SAMHSA.gov and NAABT.org, provide excellent resources for buprenorphine treatment and continued recovery from addiction. SEPTEMBER 2007 17 http://SAMHSA.gov

Table of Contents Feed for the Digital Edition of Counseling Points - September 2007

Welcome Office-Based Medication-Assisted Treatment of Opioid Dependence Summary Continuing Education Posttest Postest Answer and Program Evaluation Form

Counseling Points - September 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.