Treatment/Deterrence

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"One thing you can't hide—is when you're crippled inside." - John Lennon

Medication-Assisted Treatment (MAT) for Opioid Use Disorders:

  • The most effective form of treatment for opioid use disorders
  • Includes the use of medication (buprenorphine, and buprenorphine and naloxone combination [Subutex®, Suboxone®]) along with counseling and other support
  • Combined with behavioral therapy, effective MAT programs for opioid addiction can decrease overdose deaths, be cost-effective, reduce transmissions of HIV and hepatitis C related to IV drug use, and reduce associated criminal activity
  • Current limitations:
    • The Drug Addiction Treatment Act of 2000 (DATA 2000) was intended to address that problem and improve access for patients with substance abuse disorder outside of the usual treatment facilities, like the traditional methadone clinic.
    • When originally passed, DATA 2000 allowed qualified physicians to apply for a waiver to prescribe Schedule III, IV, and V narcotic drugs for maintenance treatment or detoxification treatment in the private-office setting.
    • Unfortunately, primary care physicians have been slow to apply for the waiver and can only accept a limited number of patients.
    • Reasons for not participating in MAT include:
      • Inadequate reimbursement by insurance plans
      • The service is beyond the scope of practice of office-based physicians
      • Addicted patients are considered undesirable for their clinic settings

Prescription Drug Monitoring Programs (PDMPs)

  • State-run electronic databases that can provide a prescriber or pharmacist information regarding a patient’s prescription history.
  • Identifies patients who are potentially knowingly or unknowingly misusing medications.
  • Forty-six states and Washington, D.C. can legally share PDMP data across state borders. Many states allow out-of-state health care professionals to query their databases directly.
  • Limitations:
    • Inability to distinguish whether providers are working together in the same practice, thereby creating false image of drug seeking behavior
    • Incompatable database systems

Deterrent strategies

  • Prescription Drug Take-Back Programs: combine media and other educational efforts to promote safe use, storage, and disposal of potentially dangerous drugs, and include opportunities for the public to return “expired, unused, and unwanted prescription drugs” to collection centers.
  • Suicide Prevention: chronic pain and depression, as well as other emotional disorders, often go hand in hand, and all of these conditions may increase the likelihood that a person has available prescription drugs that could be used for suicide.
  • Voluntary strategies:
    • Clinician’s assessment in a history and physical exam that includes psychosocial factors, family history, and risk of abuse
    • Clinician’s regular monitoring of the progress of patients on opioids and assessment for aberrant behavior that may indicate abuse
    • Random urine drug screening and pill counts for patients at risk
    • Opioid “contracts” or “treatment agreements” between health care providers and patients, under which medication use by high-risk patients is closely monitored

References:

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