Presenter(s): David A. Fiellin, MD, Professor of Medicine, Investigative Medicine and Public Health, Yale University School of Medicine and John A. Renner, Jr., MD, Professor of Psychiatry, Boston University School of Medicine; Director of Addiction Psychiatry Residency Program, VA Boston Healthcare System & Boston University Medical Center
About the webinar: Since its inception, MAT with buprenorphine has been conceptualized as a long-term, if not indefinite treatment for opioid use disorders. Because of the high relapse rates associated with opioid withdrawal treatment (detox), expert opinion has rarely supported either detoxification treatment or a taper from long-term maintenance. Nonetheless, detox is sometimes the option preferred by patients and their families. Even patients who have been very successful in long-term buprenorphine treatment may define detox as their goal and attempt to taper off buprenorphine. Unfortunately there is very limited research on model protocols for taper from long-term maintenance and almost no studies meet the criteria for high quality clinical research, leaving clinicians with very limited data to guide their decision making. This webinar will review existing models for taper and detoxification, assess the quality of research evaluations of such treatments, and contrast outcomes with maintenance.
Based on our clinical experience we will also review suggested criteria for identifying patients who might be appropriate for initial detoxification treatment and also successful maintenance patients appropriate for taper. Options will be presented for patients who refuse maintenance (MAT). Models for transitioning patients into treatment with naltrexone formulations will also be considered. In addition we will review the benefits of overdose education, naloxone and management of potential co-occurring psychiatric disorders in patients undergoing taper.
View the 10/27/15 follow-up webinar recording and presentation slides here.
- Describe the natural history of opioid dependence.
- Describe the rationale for maintenance therapy.
- Describe the symptoms of opioid withdrawal.
- Describe the comparative effectiveness of opioid agonist maintenance vs. taper treatment.
- Describe the relapse, overdose and psychiatric considerations associated with buprenorphine taper.
Accreditation and Designation: American Academy of Addiction Psychiatry (AAAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
American Academy of Addiction Psychiatry (AAAP) designates this enduring material for a maximum of 1 (one) AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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