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A Health Care Professional’s Toolbox to Reverse the Opioid Epidemic
AAP Substance Use Screening and Intervention Implementation Guide

Developed by the American Academy of Pediatrics (AAP) in collaboration with CDC:

View the Guide ›

Academy of Managed Care Pharmacy (AMCP)
Addiction is a disease. We should treat it like one

Ted Talk featuring Michael Boticelli, former Director of National Drug Control Policy

Watch video ›

Addiction Prediction: Errors from the Bedside Hurt Patients with Pain

The goal/purpose of this activity was to provide strategies for safe opioid use in the hospital and after patient discharge.

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Addiction, Stigma, and Discrimination: Implications for Treatment and Recovery

International studies indicate that addiction to alcohol and other drugs are among the most stigmatized conditions in society and stigma is a major barrier to seeking treatment in the United States. Studies highlight several factors that influence the degree of stigma related to different health conditions and how these may lead to discrimination and poorer health outcomes. Recent research also underscores the importance of language and terminology in inducing implicit cognitive biases which may unconsciously affect clinicians’ and policymakers’ attitudes, judgments, and behaviors toward those suffering from addiction.

View Archived Webinar ›

Address patient shame, stigma when treating opioid misuse

Assessing risk for opioid misuse, treatment of chronic pain and the role of shame in patients with opioid use disorders are just three of the topics covered in a collection of resources from a national training and mentoring project developed by physicians to promote the fundamental role of self-education and in curbing the opioid epidemic.

Read article ›

American Academy of Family Physicians (AAFP)
American Association for the Treatment of Opioid Use Disorder, Inc. (AATOD)
American Chronic Pain Association (ACPA)
American Chronic Pain Association (ACPA) Resource Guide to Chronic Pain Medication and Treatment (2013 Edition)
American Congress of Obsetetricians and Gynecologists (ACOG) Issues Guidelines on Opioid Use During Pregnancy

A free subscription to Medscape is required to complete this CME/ABIM MOC/CE
activity. Join Medscape ›

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • Evaluate recommendations for screening for opioid use during pregnancy
  • Analyze treatment options for opioid abuse during pregnancy
An Opioid Screening Instrument: Long-Term Evaluation of the Utility of the Pain Medication Questionnaire
Annals of Internal Medicine: Federal Plan for Prescriber Education on Opioids Misses Opportunities
ATTC – Anti-Stigma Toolkit: A Guide to Reducing Addiction-Related Stigma
Attention Prescribers: FDA seeks your help in curtailing the U.S. opioid epidemic
Brochure: The Facts About Naltrexone

The Subtance Abuse and Mental Health Services Administration (SAMHSA) released this brochure for physicians to give to patients being treated for opioid use disorder with Naltrexone.

Business Pulse: Opioid Overdose Epidemic | CDC Foundation
Case: Opioid Agonist Treatment Considerations in HIV-Infected and HIV/HCV-Coinfected Patients

GO TO CASE

Presenters: Jeanette M. Tetrault, MD, FACP; David A. Fiellin, MD

Case Description: Opioid use disorder is a chronic, relapsing medical disorder with available and effective treatment options. Opioid agonist treatment combined with counseling is the most effective therapy, and newer medications have revolutionized the treatment landscape for this disorder. This Cases on the Web (COW) activity reviews considerations for the initiation and maintenance of opioid agonist treatment in patients with HIV infection or HIV/hepatitis C virus (HCV) coinfection.

On completion of this activity, participants will be able to:

 Assess patients with HIV infection or HIV/HCV coinfection for the presence and severity of opioid use disorder
 Counsel patients on appropriate treatment options for opioid use disorder, focusing on opioid agonist treatments
 Describe potential drug interactions and monitoring parameters for patients receiving pharmacologic treatments for opioid use disorder, HIV infection, or HCV infection
Visit www.iasusa.org/content/opioid-agonist-treatment-considerations-hiv-infected-and-hivhcv-coinfected-patients to start learning from this new COW activity now!

CONTINUING EDUCATION CREDITS

CME Credits
The International Antiviral Society–USA (IAS–USA) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The IAS–USA designates this live activity for a maximum of 1.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This CME activity is offered from October 21, 2015, to October 21, 2016. Physicians (MDs, DOs, and international equivalents) who successfully complete the activity posttest and submit the evaluation and registration forms are eligible to receive CME credit. Other health care practitioners will receive a Certificate of Participation.

Nursing Credits
Educational Review Systems is an approved approver of continuing nursing education by the Alabama State Nursing Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Provider # 5-115. This program is approved for 1.5 hours of continuing nursing education.
Educational Review Systems is also approved for nursing continuing education by the state of California, the state of Florida and the District of Columbia.
Program expires 10/9/2017.

Pharmacy Credits
Educational Review Systems is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 1.5 hours (0.15 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the posttest. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit.
UAN # 0761-9999-15-283-H02-P
Program expires 10/9/2017.

2015 GRANT SUPPORT
This activity is part of the IAS–USA national educational effort that is funded, in part, by charitable contributions from commercial companies. Per IAS–USA policy, any effort that uses commercial grants must receive grants from several companies with competing products. Funds are pooled and distributed to activities at the sole discretion of the IAS–USA. Grantors have no input into any activity, including its content, development, or selection of topics or speakers. Generous support for this activity has been received from the following contributors:

For our HIV effort:
Platinum Supporters
Gilead Sciences, Inc
ViiV Healthcare
Gold Supporters
Bristol-Myers Squibb
Janssen Therapeutics
Merck & Co, Inc
Additional support for select activity types in this national program is provided by:
AbbVie
For our viral hepatitis effort:
Gold Supporters
AbbVie
Bristol-Myers Squibb
Gilead Sciences, Inc
Silver Supporter
Merck & Co, Inc

CDC Opioid Prescribing Guidelines

View guidelines.

Fact sheet.

Podcast: Listen to the podcast now! (iTunes account required)
No iTunes account? You can also listen to the podcast here.

Centers for Medicare & Medicaid Services (CMS) Opioid Misuse Strategy 2016
Changing the Language of Addiction

Created by Michael Boticelli, former Director of National Drug Control Policy. Offering advice to clinicians on language and addiction.

Read article ›

Checklist for prescribing opioids for chronic pain

Click the link below to see the CDC’s checklist for prescribing opioids for chronic pain: cdc_38025_DS1

Childbirth, Breastfeeding and Infant Care: Methadone and Buprenorphine

Childbirth, Breastfeeding and Infant Care: Methadone and Buprenorphine provides guidance for patients on opiate agonist treatment on what to expect during labor and delivery, postpartum, and breast feeding. It was developed by experts in the treatment of pregnant women with opioid dependence.  Please feel free to print out and share with patients. View Brochure.

 

Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain
CN Opioid Guidelines
College of Psychiatric and Neurologic Pharmcists
Common Elements in Guidelines for Prescribing Opioids for Chronic Pain

CDC document outlining common recommendations from a variety of sources, including the American Pain Society, Veterans Affairs, Canadian Guidelines on Prescribing Opioids for Treatment of Pain, and others. Access document here.

Concurrent Management of Chronic Pain and Addiction

There are identifiable behaviors and risk factors that make people vulnerable to prescription opioid abuse or addiction; understanding these factors is vital to recognizing patients at risk. In this free live webinar, experts Dr. Larry Driver and Dr. Lynn Webster will present healthcare providers with treatment strategies that meet the unique needs of patients who suffer from chronic pain and addiction. A question-&-answer period at the end of the webinar will allow participants to get expert feedback on the specific problems and questions that they face in their practice.

View Archived Webinar ›

Confronting the Stigma of Opioid Use Disorder—and Its Treatment

The Journal of the American Medical Association. Published online February 26, 2014.

Authors: Yngvild Olsen, MD, MPH1; Joshua M. Sharfstein, MD2

View Article ›

Coping With the Stigma of Addiction

Article by David Rosenbloom, PhD, gives a good background on stigma and addiction and offers 5 things people can do to fight stigma and addiction.

Read article ›

Counseling Patients on Side Effects and Driving When Starting Opioids
Decisions in Recovery: Treatment for Opioid Use Disorder
Drug Interactions of Clinical Importance with Methadone and Buprenorphine
Drug–Drug Interactions In Opioid Therapy A Focus On Buprenorphine & Methadone
Drug–drug Interactions in Opioid Therapy: A Focus on Buprenorphine & Methadone
Note:Also available as a phone app
Educating Drug Courts on Medication Assisted Treatment

The National Drug Court Institute, with funding from the Office of National Drug Control Policy of the White House,
in collaboration with the American Academy of Addiction Psychiatry, has developed an online training curriculum
designed to educate drug court professionals on medication assisted treatment for substance use disorders, with a
major focus on opioid use disorders. Nine modules were developed and are available on in the National Drug Court Research Center. 

FDA News Release: FDA Introduces New Safety Measures for Extended-release and Long-acting Opioid Medications
Harm Reduction: Compassionate Care Of Persons with Addictions

The science behind addiction is explored. Strategies for nurses to use in caring for persons with addiction are provided. Harm reduction for persons with addiction is described, and ways nurses can provide care from this perspective are explored.

Read abstract ›

HealthCare Chaplaincy Network

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A nonprofit healthcare organization that helps people faced with the distress of illness and suffering to find comfort and meaning.

Help and Healing: Resources for Depression Care and Recovery

Part of integrating primary and behavioral health care is learning how to talk about health conditions in a holistic way. Sample scripts can help guide providers and patients alike in making communication seamless – from addressing specific health topics to explaining what integrated care is and keeping team members informed. View resource.

How to Dispose of Unused Medicines
How to Prevent Opioid Overdose and Overdose-Related Death
Important Information for those who Prescribe Long-Acting Opiates

More Resources

A Risk Evaluation and Mitigation Strategy (REMS) is a strategy to manage known or potential serious risks associated with a drug product and is required by the Food and Drug Administration (FDA) to ensure that the benefits of a drug outweigh its risks. The FDA has required a REMS for extended-release and long-acting (ER/LA) opioid analgesics.

Under the conditions specified in this REMS, prescribers of ER/LA opioid analgesics are strongly encouraged to do all of the following:

  • Train (Educate Yourself)
  • Counsel Your Patients
  • Emphasize Patient and Caregiver Understanding of the Medication Guide
  • Consider Using Other Tools

More

Indicators of Buprenorphine and Methadone Use and Abuse: What Do We Know?
Institute for Research, Education & Training in Addictions
Integrating Motivational Interviewing Techniques for Brief Intervention into the Curriculum

This free webinar will examine techniques used to teach nurses Motivational Interviewing (MI) for brief intervention. Presenters will explore a variety of techniques used to teach MI for nurses and nursing students.

View Archived Webinar ›

Integration of Buprenorphine into HIV Primary Care Settings
International Prevention
Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders
Mayo Clinic
Medication-Assisted Treatment: The best therapy for opioid use disorder video

Video created by The Pew Charitable Trusts.

Medscape News: Understanding Opioids: Part 2
Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain July 2013
Motivational Interviewing (MI) for Pain Management

This webinar provides nurses who spend time trying to encourage patients to consider healthy behavior change an overview of motivational interviewing. Tools to initiate a patient-practitioner conversation around behavior change are introduced. Motivational interviewing (MI) is a clinical method for helping people to resolve ambivalence about change by helping them find their own reasons for motivation and commitment to change. A sequence of skills to begin to develop the techniques of MI are offered. Nurses participating in this session are encouraged to practice these skills to develop greater proficiency in this technique. Specific examples relevant to pain management are described.

View Archived Webinar ›

Motivational Interviewing for Clinical Practice

The webinar provides a clear presentation of Motivational Interviewing that is readily transferable to everyday clinical practice. Motivational Interviewing is a clinical style for engaging patients in treatment, enhancing motivation to reduce substance use, and supporting adherence to recommended behavioral or pharmacological treatments.

View Archived Webinar ›

Motivational Interviewing: Informative Links

1.)  Introduction to Motivational Interviewing – Bill Matulich, PhD

In this slide presentation, Dr. Matulich talks about the basic concepts of Motivational Interviewing (MI). After a brief definition, topics include: the Spirit of MI, the four basic OARS skills, and the “processes” of MI.

2.)  Motivational Interviewing: Brief Explanation

3.)  Core Clinician Skills: Introducing OARS – National Heart Foundation of Australia

  • Develop an understanding of the fundamental spirit and principles of motivational interviewing.
  • Gain up-to-date information regarding the research and evidence of motivational interviewing.
  • Develop an understanding of empathic counselling skills, central to using the technique.
  • Learn when and how to use advice and other more directive elements of motivational interviewing.
  • Observe elements of motivational interviewing, including how motivational interviewing can be used to roll with resistance, resolve ambivalence , encourage change and commitment talk, and help people carry through changes to health behaviors.

4.)  Motivational Interviewing – TheIRETAchannel 

Alan Lyme, LCSW, ICADC, ICCS, MINT, is the Clinical Supervisor for the Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant program at the Medical Center of Central Georgia. Mr. Lyme has provided trainings nationally on Motivational Interviewing, clinical supervision, and skills on working with men. He is a MINT (Motivational Interviewing Network of Trainers) recognized MI trainer, an Internationally Certified Clinical Supervisor, and an Internationally Certified Alcohol and Drug Counselor.

5.)  Motivational Interviewing: Facilitating Change Across Boundaries – Teachers College, Columbia University with William R. Miller, PhD 

6.)  Motivational Interviewing: Brief Therapy for Addictions – PsychotherapyNet with William R. Miller, PhD

MI founder William Miller talks about how Motivational Interviewing helps people resolve their ambivalence about changing addictive behaviors. Watch the full video here.

7.)  Increasing Importance in Motivational Interviewing – PsychotherapyNet with Cathy Cole, LCSW

Learn how Motivation Interviewing is applied to working with addictions in this video with Motivational Interviewing expert and trainer Cathy Cole, LCSW. Watch the full video here.

8.)  Substance Abuse (Marijuana): Motivational Interviewing OARS Skills Case Presentation

This video role-play is part of an online training for which EUs are available for re-credentialing CASACs and members of NASW. You can register for the training at the www.bestpracticetrainers.org website. In the role-play, the therapist is using Motivational Interviewing OARS skills with a client who is using marijuana.

Motivational Interviewing: Talking with Someone Struggling with Opioid Addiction
  • Health professionals are often trained in “motivational interviewing” (MI), a way of encouraging patients struggling with substance abuse to make positive changes in their lives. Family and friends of people struggling from opioid abuse can also use these simple methods of talking to their loved ones about making changes, seeking treatment, and staying on track for recovery.
  • Some of the techniques of motivational interviewing (MI) may seem surprising at first. MI can be especially difficult when discussing a topic like opioid abuse that may be emotionally charged or cause conflict. Families and friends of opioid-addicted individuals may always seek help from trained substance abuse counselors. However, these MI guidelines can be a helpful and simple start in encouraging loved ones to make a change.
  • Motivational interviewing is a way of discussing an issue that draws out an individual’s own reasons for changing, instead of relying on another person’s opinions or ideas. MI recognizes that ambivalence (having mixed feelings, or not being sure) about making a change is a common part of the recovery process. Discussing this ambivalence can help to bring out an individual’s personal reasons for making a change. MI focuses on finding and strengthening a person’s own motivation to change, in accordance with their own values, beliefs, concerns, and goals.
Principles of Motivational Interviewing
  • Collaboration vs. Confrontation. MI encourages the idea of collaboration (working together to find a solution), instead of confrontation (arguing). One person is not the “expert” and the other is not the “student.” MI’s goal is mutual understanding, — not one person or the other being proven “right.”
  • Drawing out vs. Forcing ideas about change. No matter how good another person’s ideas and reasons are, long-lasting change is more likely when a person discovers his or her own reasons for change. It is a common instinct to want to give a loved one advice and to try to “convince” them to change. However, this approach often results in more arguments than change. In MI, the interviewer’s goal is to “draw out” a person’s own motivations and skills for change, not to tell them what to do or why they should do it.
  • Autonomy vs. Authority. The true power for change rests with the person dealing with opioid abuse, not in their friends, family, or doctor. Ultimately, it is up to the individual to make changes happen. In MI, the interviewer encourages the affected individual to take the lead in brainstorming ideas about how to achieve change.
  • Roll with Resistance. This is one of the principles of MI that is hardest to follow. When discussing change, an opioid-dependent individual may often resist treatment suggestions and others’ ideas. In MI, the listener “rolls with” this resistance. The listener does not attempt to challenge or argue with the person who needs to change, since arguing often leads to the other person playing “devil’s advocate” — an ineffective situation. It is often our instinct to correct or advise a person struggling with change, and to try to solve the problem for them. However, it is often more effective to let the person come up with his or her own ideas for change. New points of view can be suggested for consideration, but shouldn’t be forced.
OARS

The basic principles of Motivational Interviewing are represented by the acronym OARS. Using each of these components help make the discussion more successful in encouraging change.

O        Open-Ended Questions: Ask questions that can’t be answered with yes or no.
A        Affirmations: Recognize and encourage a person’s strengths!
R         Reflections: Respond in a way that makes it obvious that you’ve been listening carefully. The other person can then make corrections if they did not express themselves fully. This also allows the listener to express “empathy,” the ability to see the world through another’s eyes and share in their feelings and experiences. This can make the other person feel heard and understood.

Examples of reflections: “That must be difficult.” “I hear that you’re upset.” “It sounds like…” “What I hear you saying is…” “So on the one hand it sounds like… And, yet on the other hand…”

S       Summaries: Summaries allow the listener to “recap” what has been discussed. The summary can      highlight the other person’s strengths and reasons for change.
What Does a “Motivational Interview” Look Like?

Below are some examples of questions often used in MI. Successful discussions all look different, but these examples can be a useful starting point to help your loved one begin to think about change.

  • Asking permission: Asking permission shows respect for the other person, and avoids the feeling of “lecturing.”
  • “I’ve noticed that you’ve gotten into trouble a lot lately/ been having trouble with friends/[other problems]. Is it all right if we talk about your heroin/ prescription pain pill use?”
  • Explore the persons’ reasons for change.
    • Pros: “People usually use _____ because it benefits them in some way. What are the good things about _____? What do you like about _____?”
    • Cons: “Can you tell me about the downsides? What are some aspects of using _____ that you’re not happy about? What are some things you wouldn’t miss?”
    • Look back: Ask about a time before the person’s opioid addiction. “How were things better/ different?”
    • Look forward: “What may happen if things continue as they are? What would be different if you went for treatment?”
    • Ask for examples: “In what ways?” “Tell me more.” “What does that look like?” ”When was the last time that happened?”
    • Explore Extremes: “What are the worst things that may happen if you keep using _____? What are the best things that might happen if you stop using _____?”
  • Help a person find his or her motivation for change.
    • Motivation for change comes from a person recognizing a “mismatch” between their current situation and where they want to be. A good listener can help their friend or family member to examine how their current situation and behavior conflicts with their own values and future goals.
    • Explore life goals/ values. “What sorts of things are important to you? What sort of person would you like to be?” “If things worked out in the best possible way for you, what would you be doing a year from now?” (Support positive goals and values!) “How does opioid addiction fit in with these values?”
    • Bring out discrepancies. “I hear that you have [goals, plans, values]. On the other hand, you’re telling me that heroin is causing [negatives]. “What would happen if you don’t change? What will your life be like if you stop?” “It sounds like when you stated using prescription pain meds there were many positives, but that now using them is causing you to lose friends and skip school. How would seeking treatment affect your life?”
    • Reasons for change: “What makes you think you need to change? Why do you think I/others are concerned about _____?”
  • Explore a person’s readiness for change.
    • Scales of 1-10 can be helpful. “On a scale of 1 to 10, how important is it to you to quit, where 1 is not at all important and 10 is very important?” Ask why they did not give a higher or lower answer. “Why are you at a ‘6’ and not a ‘5’? Why not a ‘7’? What would it take to move from a ‘6’ to a ‘7’?
    • Explore confidence/ fears. “How confident are you that you could cut down/ quit/ stay in treatment, if you decided to? Why?”
  • Provide Summaries
    • Summarize their choices and ambivalence (mixed feelings). “It sounds like you are concerned about heroin use because it is costing you a lot of money and causing family problems. You also said quitting will probably mean not hanging out with your best friends any more. That doesn’t sound like an easy choice.”
    • Encourage a person to fall on the positive side of their ambivalence, by siding with the negative status quo. “Perhaps using [opiate drug] is so important to you that you won’t give it up, no matter the cost.”
  • Ask about a decision.
    • “You were saying that you were trying to decide whether to continue/ cut down/ go to treatment. If you decide to change, what would you have to do to make it happen?”
    • “After talking about it, are you more clear about what you would like to do?”
  • State Goals: If the person is ready, help them set goals.
    • Good goals are SMART: Specific, Meaningful, Assessable (Measurable), Realistic, and Timed.
    • “What will be your first step? What will you do in one or two days?”
    • “Have you ever done any of these things before? What’s worked/ not worked in the past? Why?”
    • “Who will be helping/ supporting you?”
    • “On a scale of 1 to 10, what are the chances that this goal is possible for you?”
  • Provide Affirmations: MI is a Strengths-Based Approach. MI tries to emphasize the other person’s strengths instead of weaknesses. Many people have tried to change before and failed, creating many doubt and fears. Listeners can help support and highlight an individual’s strengths and skills, to encourage the belief that change is possible.
    • “It shows a lot of strength/courage/determination to…”
  • Show Empathy: If the person isn’t ready to make a decision, empathize with their difficulty.
    • How can I help you get past some of these difficulties? Is there something else that could help you make a decision?”
    • “What could you do to reduce some of these problems while you’re deciding what to do?”

[Link to MI Tri-Fold]

Sources for Motivational Interviewing
Myths and Misconceptions: Medication-Assisted Treatment for Opioid Addiction

People with opioid use disorder and their families often believe many myths and inaccuracies about MAT, overshadowing the evidence in support of MAT’s benefits.[1] Many of the negative attitudes towards MAT among patients, their doctors, and their peers may come from misunderstandings of how these treatments work. Common myths and inaccuracies about methadone treatment may prevent patients and their families from recognizing the evidence in support of methadone’s benefits.

Myth #1: MAT replaces one addiction with another.

Sometimes patients and their families or friends wonder why doctors use drugs like buprenorphine or methadone to treat opioid addiction, since these medicines are in the same family as heroin and prescription opioid pain medication. However, physician-prescribed buprenorphine and methadone are not just “substituting” one addiction for another.

Addiction treatment uses longer-acting and safer medications to help overcome more dangerous opioid addictions. Many studies have shown that maintenance treatment with long-acting opioids like methadone or buprenorphine helps keep patients healthier, reduces criminal activity, and helps prevent drug-related diseases like HIV/AIDs and Hepatitis.

Patients who strongly object to using maintenance opioids for any reason may choose a different type of MAT. For example, naltrexone is not an opioid drug, and actually works by blocking the effects of opioids in the brain for up to one month. For more information, see the Community Resources section of PCSSMAT.org.

Myth #2: MAT is a bad moral choice. It is inferior to complete, unassisted abstinence.

Some of the negative stigma of MAT comes from different ways of understanding addiction.

Addiction as a moral and spiritual problem: Some people with opioid use disorder and their communities view addiction as a moral and spiritual failing, not as a medical disease. In this view, medical treatment with methadone may seem like a “crutch,” or a weak moral choice, because patient is continuing to use an opioid on a daily basis. Complete, unassisted abstinence is the most common treatment plan in this view of addiction. MAT’s ability to make addiction recovery easier and less painful may not be seen as a benefit, but may suggest that a patient “isn’t as serious” about quitting., MAT patients do not meet many 12-step programs’ definitions of abstinence because of their use of opioidmedications, and they may be excluded from these groups.However, individuals attending 12-step groups may be criticized as having “traded one drug for another” if they reveal that they are seeking treatment with buprenorphine or methadone. This is not always the case, and many AA and NA members understand the role of MAT in recovery.

Addiction as a medical disease: Instead of understanding addiction as only a moral or spiritual failing, many medical professionals have begun to view opioid addiction as a medical disease. The disease of addiction can be caused by repeated exposure to a drug, coupled with genetic or environmental risk factors, leading to physical changes in the brain’s opioid receptors. In this view, addiction can be treated and managed with medication, much like other medical diseases. 

Myth #3: MAT is not effective because it does not immediately end drug dependence.

opioid use disorder or Addiction is not “cured” by the use of MAT. Addiction is a “chronic” (long-lasting) disease. Medical treatment for addiction can be comoared to medical treatment for other common chronic diseases like diabetes or high blood pressure. Just as diabetes is not “cured” by the use of insulin, and people with high blood pressure often continue taking medications for many years, so people with opioid addiction are not “cured” but instead well-managed by MAT.

Misconception #4: “I’ve known a few people who could stop using opioids without help from any kind of medication. MAT is only for the weak. “

Though opioid abuse may begin with a series of poor judgments, addiction involves real, physical changes in the brain. While some people are eventually able to quit using opioids on their own, the majority of patients go though many dangerous cycles of relapse and recovery. MAT can make the recovery process much safer, and has saved many lives by preventing death from overdose or dangerous behaviors associated with “street” drug use.

 

[Link to Myths and Misconceptions Trifold]

[1]Frank, D. (2011.) The trouble with morality: the effects of 12-step discourse on addicts’ decision-making. J Psychoactive Drugs 43(3), 245-256.

National Center for Complementary and Alternative Medicine (NCCAM)
National Institute on Drug Abuse (NIDA)

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  • Community Epidemiology Workgroup (CEWG) : Regional Trends in Substance Abuse
  • Mental and Health Professionals
  • ATTC and NIDA Motivational Interviewing: This conference took place on July 13, 2012 in the Baltimore-Washington Metro area. It was sponsored by the Central East Addiction Technology Transfer Center (a program of the Danya Institute), and the Mid-Atlantic Node Clinical Trials Network. It featured presentations on the Blending Products which are a collaborative effort of the The National Drug Abuse Treatment Clinical Trials Network and the National Institute of Drug Abuse/Substance Abuse and Mental Health Services Administrations Blending Initiative to disseminate treatment and training products based on results conducted by the NIDA Clinical Trials Network. See below for the recordings taken from the meeting.

Part 1: Using the ATTC/NIDA Blending Products to Affect Change
Maxine Stitzer, PhD, principal investigator of the Mid-Atlantic Node, explains the mission of the Clinical Trials Network to disseminate research-based drug abuse treatment into clinical practice. Dr. Stitzer shares with the audience how clinicians, scientists, and experienced trainers who are part of this NIDA/SAMSHA blending initiative have worked to create user-friendly treatment tools and products to facilitate evidence-based practices in front-line clinical settings.

Part 2: Using the ATTC/NIDA Blending Products to Affect Change
Christine Higgins, MA, Dissemination Specialist for the Mid-Atlantic Node of the Clinical Trials Network provides an overview of the NIDA Blending Products.

Part 3: Using the ATTC/NIDA Blending Products to Affect Change – MIA:Step
Christine Higgins, MA, Dissemination Specialist for the Mid-Atlantic Node of the Clinical Trials Network provides an introduction to MIA:Step (Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency).

Part 4: Using the ATTC/NIDA Blending Products to Affect Change
Pat Stabile, Director of HARBEL in Baltimore City speaks about the positive aspects of Clinical Trials Network studies conducted at her site. She explains how challenging it can be at times when researchers and clinicians might have different objectives and different language, but the overarching common goal to improve substance use disorder treatment makes such collaboration worth the effort.

Part 5: Using the ATTC/NIDA Blending Products to Affect Change – PAMI by Melissa Wesner

Part 6: Using the ATTC/NIDA Blending Products to Affect Change – MI:Presto
Lori Peterson, Program Director of the Lane Treatment Center presents an Overview of MI:Presto (Motivational Incentives: Positive Reinforcers to Enhance Successful Treatment Outcomes).

Part 7: Using the ATTC/NIDA Blending Products to Affect Change
Amy Pearce, LCSW-C, Clinical Director of Glenwood Life present “The Perspective from the Clinical Side.”

National Institutes of Health (NIH)

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11 Tips for Better Opioid Prescribing

Editor’s Note: As part of its effort to facilitate responsible opioid prescribing, the American Academy of Addiction Psychiatry (AAAP) hosts a listserv where clinicians can submit clinical questions and receive responses from a rotating panel of pain experts. In conjunction with the AAAP, Medscape has selected 10 of the most common questions or topics related to opioid use that have been submitted, and asked Charles E. Argoff, MD, Director of the Comprehensive Pain Management Center at Albany Medical Center, and Roger Chou, MD, Professor of Medicine and Medical Informatics & Clinical Epidemiology at Oregon Health & Science University in Portland, to provide responses. For additional resources on appropriate opioid prescribing and opioid addiction treatment, please see the AAAP’s PCSS-O and PCSS-MAT programs, which provide guidance on the safe and effective use of opioid medications and on the treatment of opioid addiction.

To access the complete article, please click here.*

*A Medscape account is required to view this article. If you do not have a Medscape account, you can create one for free.

Negative Stigma of Methadone

Negative attitudes towards the use of methadone are common among patients, their doctors, their families, and their peers, as well as in most 12-step programs.[1]Methadone treatment’s negative stigma may prevent those that would benefit from methadone from seeking treatment. “Stigma” means rejection or disgrace, which many patients feel they will suffer if they choose to seek methadone treatment. This stigma may cause friends, family, and other addicts to look down on those who choose methadone treatment, preventing them from receiving the treatment’s full benefits. [2] Patients often feel that they have to hide their use of methadone from others, and have trouble gaining social acceptance in their communities and among other addiction patients. [3]

Why is there a negative stigma associated with Methadone?

Methadone is perceived by many as “substituting” one addiction for another. Methadone treatment is only provided in special addiction clinics, separated from the rest of healthcare, which may contribute to its stigma. This separation may also serve to distance methadone from the medical model of understanding addiction as an illness rather than as a moral failing.[4]

Patients, their families, and their communities could benefit from greater acceptance of methadone treatment’s proven benefits in reducing illicit opioid use and its negative consequences. [5]

[1] Frank, D. (2011). “The trouble with morality: the effects of 12-step discourse on addicts’ decision-making.” J Psychoactive Drugs 43(3). 245-256.

[2] Frank, D. (2011).

[3] Etesam, F., Assarian, F., Hosseini, H., & Ghoreishi, F. S. (2014.) Stigma and its determinants among male drug dependents receiving methadone maintenance treatment. Arch Iran Med. Feb 17(2). 108-14.

[4] PCSS-MAT.

[5] Frank, D. (2011).

Neonatal Abstinence Syndrome Resources
The National Center on Substance Abuse and Child Welfare (NCSACW) is highlighting resources on best practices in the treatment of opioid use disorders and Neonatal Abstinence Syndrome. NCSACW is a national resource center providing information, expert consultation, training and technical assistance to child welfare, dependency court, and substance abuse treatment professionals to improve the safety, permanency, well-being, and recovery outcomes for children, parents, and families.
New England Journal of Medicine

More Resources

  • Tackling the Opioid-Overdose Epidemic: In response to the opioid overdose epidemic, medication assisted therapies are available to clinicians for patients with opioid addiction, but research has found that they are significantly underutilized. Read the New England Journal of Medicine article.
New Hampshire Medical Society Opioid Prescribing Resource
Office of National Drug Control Policy (ONDCP) Announcement to Medical Community
ONDCP: Champions Addressing the Opioid Epidemic through Hospitals

Hospitals are on the front lines of our efforts to address the national opioid crisis. ONDCP has recently engaged with a number of innovators and pioneers who are developing effective hospital-based approaches to the epidemic. These include:

  • Dr. Gail D’Onofrio, who developed and evaluated protocols for buprenorphine induction in the emergency department and linkage with primary care at Yale New Haven Hospital. Dr. D’Onofrio is currently leading a National Institute on Drug Abuse-funded clinical trial replicating the protocol in EDs in Baltimore, Cincinnati, New York City, and Seattle. More information is available here.
  • Dr. Edward Bernstein of Boston Medical Center, who recently launched the Faster Paths to Treatment program, an opioid-focused urgent care service coordination unit for people who have overdosed or have an opioid use disorder (OUD). This program is funded by the Bureau of Substance Abuse Services.
  • Dr. Traci Green of Boston University and Michelle Harter of Anchor Recovery Community Centers, who launched the AnchorED, a project through which recovery coaches from Anchor Recovery Community Centers are available 24 hours per day, 7 days per week to engage overdose survivors in all Rhode Island hospital emergency departments. ONDCP continues to track progress of this project as it expands to include the Anchor MORE (Mobile Outreach) program, which deploys peer recovery coaches from Anchor Recovery Community Centers out into the community.
ONDCP: Innovative Approaches to Recovery at Local Fire Departments

ONDCP Acting Director Richard Baum was recently briefed by the creators of two innovative fire department-led initiatives to address the opioid epidemic. Safe Station, a program developed in May 2016 by the City of Manchester, New Hampshire, welcomes people seeking help for addiction at any of the city’s 10 fire stations, where they will be given a brief medical assessment to determine if hospitalization is required and handed off to a recovery coach or case manager for direct linkage to treatment. Within its first year of operation, the program has helped over 1,600 people seeking help for opioid use disorder or another substance use disorder.

Launched in 2016, the Revere, Massachusetts, Substance Use Disorder Initiative (SUDI) fields a team consisting of a fire fighter, a recovery coach, and a harm reduction specialist who conduct door-to-door follow up visits at the homes of overdose survivors and provide them and their with families information and resources including overdose prevention and naloxone training and kits, and offer to assist individuals in accessing treatment. The initiative is housed in a central office and coordinates the city’s public health and public safety efforts in response to the opioid crisis.

ONDCP is reaching out to these and other innovative initiatives to learn from their successes so their models and best practices can be quickly replicated in communities across the country as we work to address the ongoing addiction and opioid epidemic.

Have a promising practice to share? Email your model to [email protected]

ONDCP: Responding to Opioid Use Disorder in Correctional Settings

ONDCP continues to engage with Federal partners to advance the use of medication-assisted treatment (MAT) – medications approved for the treatment of opioid use disorder (buprenorphine, methadone, or naltrexone ) – for people involved in the criminal justice system who have this disease, and it’s encouraging to see an increasing number of criminal justice systems that are beginning to implement MAT. ONDCP is championing MAT adoption in the criminal justice system in a number of ways, including by:

Opioid Prescribing: Safe Practice, Changing Lives

This CME activity from Medscape Education Neurology & Neurosurgery is intended for neurologists, primary care physicians, other physicians, nurses (including advanced practice nurses), physician assistants, pharmacists, dentists, podiatrists, optometrists and other clinicians who may be involved in the treatment of patients who are receiving opioid therapy.

The goal of this activity is to provide education on the safe use of extended-release, long-acting opioid analgesics.

Upon completion of this activity, participants will be able to:

  1. Describe appropriate patient assessment for treatment with ER/LA opioid analgesics
  2. Evaluate the risks and potential benefits of ER/LA opioid analgesics
  3. Summarize the key components of safe use of ER/LA opioid analgesics
  4. Demonstrate accurate knowledge about how to initiate and manage therapy with ER/LA opioid analgesics, including appropriate monitoring for adverse effects and possible misuse

Continue to activity.

Opioid Risk Tool

The Opioid Risk Tool (ORT) is a brief, self-report screening tool designed for use with adult patients in primary care settings to assess risk for opioid abuse among individuals prescribed opioids for treatment of chronic pain. Patients categorized as high-risk are at increased likelihood of future abusive drug-related behavior. The ORT can be administered and scored in
less than 1 minute and has been validated in both male and female patients, but not in non-pain populations. Access Opioid Risk Tool.

Also of interest is this study:

Predicting Aberrant Behaviors in Opioid-Treated Patients: Preliminary Validation of the Opioid Risk Tool

Opioid-Use Treatment

From the New England Journal of Medicine: A primer on treating opioid use disorder. Read article.

Physicians for Responsible Opioid Prescribing (PROP)
Pregnancy: Methadone and Buprenorphine

Pregnancy: Methadone and Buprenorphine provides a brief explanation on the treatment of opioid dependence during pregnancy. It is intended for patient education and was developed by experts in the treatment of pregnant women with opioid dependence. Please feel free to print out and share with patients. View Brochure .

Prescription Painkiller Overdoses: Use and Abuse of Methadone as a Painkiller
Primer on Antagonist-Based Treatment of Opioid Use Disorder in the Office Setting

This training was originally presented by Adam Bisaga, MD, during the American Academy of Addiction Psychiatry 26th Annual Meeting in 2015. View training.

Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)

Basic, evidence-based guide on addiction.

Read article ›

Publications: Complementary and Alternative Medicine

Resources

  • Jordan JB (2006) Acupuncture for the treatment of opiate addiction: a systematic review.  Journal of Substance Abuse Treatment30: 309-314
  • Khanna S and Greeson JM (2013) A narrative review of yoga and mindfulness as complementary therapies for addiction. Complementary Therapies in Medicine21: 244-252.
  • Lin J-G, Chan Y-Y and Chen Y-H (2012) Acupuncture for the treatment of opiate addiction. Evidence-Based Complementary and Alternative Medicine2012: 1-10.
  • Lu L, Zhu W, Shi J, Liu Y, Ling W, Kosten TR (2009) Traditional medicine in the treatment of drug addiction. The American Journal of Drug and Alcohol Abuse35: 1-11.
  • Meade CS, Lukas SE, McDonald LJ, et al. (2010) A randomized trial of transcutaneous electric acupoint stimulation as adjunctive treatment for opioid detoxification. Journal of Substance Abuse Treatment38: 12–21.
QT Interval Screening in Methadone Maintenance Treatment: Report of a SAMHSA Expert Panel
QTc Interval Screening in Methadone Treatment
Questions and Answers: FDA approves a Risk Evaluation and Mitigation Strategy (REMS) for Extended-Release and Long-Acting (ER/LA) Opioid Analgesics
r-Methadone Versus Racemic Methadone: What is Best for Patient Care?
Resources on Narcan Prevention Kits
Rethinking How We Talk About Addiction

Blog post by Dr. Nora Volkow, NIDA Director
People with substance use disorders and other mental health issues face greater stigma than those with other illnesses…..

Read blog post ›

Stigma in Methadone and Buprenorphine Maintenance Treatment

This module describes the history of methadone maintenance and the effectiveness and key myths of opioid agonist treatment. The module explores empathizing with patients taking methadone or buprenorphine and empowering clinicians to support patients and their significant others.

View Module ›

Substance Abuse and Mental Health Services Administration (SAMHSA)

More Resources

OPIOID USE DISORDER RESOURCES

  • Opioid Treatment Program Locator
  • Opioid Overdose Toolkit: Equips communities and local governments with material to develop policies and practices to help prevent opioid-related overdoses and deaths. Addresses issues for first responders, treatment providers, and those recovering from opioid overdose.

BUPRENORPHINE RESOURCES

NALTREXONE RESOURCES

SAMHSA Report: Clinical Advances in Non-Agonist Therapies: in an effort to continue the exploration of treatment options for people with OUD, SAMHSA/CSAT, in partnership with NIDA, held a Clinical Advances in Non-Agonist Therapies Meeting at the SAMHSA headquarters on May 11, 2016. This report is the result of that meeting.

SBIRT RESOURCES

ADDITIONAL RESOURCES

Talking with Your Adult Patients about Alcohol, Drug, and/or Mental Health Problems

AMHSA Discussion Guide for Primary Health Care Providers
This guide provides clinicians with questions to begin discussions with adult patients about mental illness, substance use disorders, or both. It includes resources for patients who need an evaluation after a positive screening.

Read guide ›

The American Society of Addiction Medicine (ASAM): Advancing Access to Addiction Medications
The ASAM Appropriate Use of Drug Testing in Clinical Addiction Medicine
The Clinical Assessment of Substance Use Disorders

Online module addresses motivational interviewing and stigma.

Read assessment ›

The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review

This study provides a systematic review of existing research that has empirically evaluated interventions designed to reduce stigma related to substance use disorders.

Read abstract ›

The Joint Commission Sentinel Event Alert: Safe Use of Opioids in Hospitals
The Joint Commission: Sentinel Event Alert
The Mental Health & Substance Use Disorder Parity Task Force – Final Report
The Opiate Epidemic – Free Access Article Collection
The Power of Language and Portrayals: What We Hear, What We See

“SAMHSA’s Center for Substance Abuse Treatment is producing a webcast series, The Power of Language and Portrayals: What We Hear, What We See, to help change the way we talk about and portray substance use in news and entertainment.” Read more.

The Role of Shame in Opioid Use Disorders

Shame plays an important role in Opioid Use Disorders (OUD) and can impede treatment if not addressed appropriately. In this module, participants will learn to recognize and treat shame in patients with OUD. Participants will learn about particular subsets of people with OUD who have specific concerns regarding shame, including people who inject heroin, and opioid-addicted pregnant women and mothers. Finally, treatment options that address shame in people with OUD will be outlined.

View Module ›


Follow-up Q and A Webinar: The Role of Shame in Opioid Use Disorders

This Q and A webinar further discussed Dr. Braun-Gabelman’s online module, “The Role of Shame in Opioid Use Disorders,” and allowed participants of the module to pose questions to Dr. Braun-Gabelman; she also presented a few cases related to this topic.

View Archived Webinar ›

TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction
TIP 53: Addressing Viral hepatitis in People with Substance Use Disorders
TIP 54 Managing Chronic Pain in Adults with or in Recovery From Substance Use Disorders
Transforming Opioid Prescribing in Primary Care (TOPCARE)

More Resources

A team of researchers at Boston Medical Center who propose a novel system change in delivery of primary care services to decrease misuse of and addiction to prescription opioids for patients with chronic pain. Includes many useful resources.
Turn the Tide Website

U.S. Surgeon General created this website as a resource for healthcare providers who prescribe opioids.

United States Office of the Surgeon General

Surgeon General launches national initiative to improve opioid prescribing, including new website. United States Office of the Surgeon General ›

VA Releases Video Tutorials on Naloxone

The VA has released a series of tutorials on Naloxone, a highly effective treatment for reversing an opioid overdose if it is administered at the time of overdose.

  • The first video demonstrates how to train people on how to use VA Auto-Injector Naloxone Kits.
  • The second video demonstrates how to train people on how to use VA Intranasal Naloxone Kits.
  • The third video demonstrates how to train people on how to use VA Intramuscular Naloxone Kits.
VA/DoD Practice Guidelines for Management of Substance Use Disorder

The guideline describes the critical decision points in the Management of Substance Use Disorder and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems. The guideline is intended to improve patient outcomes and local management of patients with substance use disorder.

Disclaimer:This Clinical Practice Guideline is intended for use only as a tool to assist a clinician/healthcare professional and should not be used to replace clinical judgment.

View guidelines.

Veterans With PTSD at Increased Risk for Receiving, Abusing Opioids, Study Finds
Webinar: Innovative Practices in Medication Assisted Treatment and Primary Care Coordination

The ONDCP hosted a webinar on MAT and Primary Care Coordination. The webinar showcased two approaches to care in which Medication Assisted Treatment is provided and care for individuals with substance use disorders is integrated with regular medical care. Watch video.

Why do our brains get addicted?

Neuroscientist Nora Volkow, director of the National Institute on Drug Abuse at the NIH, applies a lens of addiction to the obesity epidemic.

Watch video ›

Words Matter handout created by Boston Medical Center

This guide on addiction and stigma, created by Boston Medical Center, can be used as a template for your organization.

Read guide ›

Youth Opioid Addiction: a Part of Your Practice, so What Should You Know?

Plenary Session: Sunday, October 23, 2016
Pamela Gonzalez, MD, MS, FAAP

Watch video ›

Resources for Health Professionals and Pharmacists

This resource list was developed for health professionals and pharmacists.

Note: Note: Inclusion on the list does not indicate PCSS-O, AAAP, or partner organizations endorse any of the resources listed and exclusion in no way implies other resources are not available or valuable.