medical treatment of opoid use disorder (oud)
TRANSCRIPT
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Medical Treatment of Opoid Use
Disorder (OUD)Mike Bushey, MD, PhD
Assistant Professor of PsychiatryIndiana University School of Medicine
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PART 1: DEFINING & DIAGNOSING ADDICTION
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ADDICTION leads to PERMANENT BRAIN CHANGES that ALTER BEHAVIOR
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Behavior Can Be DRIVEN
4
THIRST DRINKHUNGER EATEXHAUSTION SLEEP
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Hun
ger
Time
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Hun
ger
Time
Choice to Eat
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Hun
ger
Time
Choice to Eat
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Hun
ger
Time
Choice to Eat
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Behavior Can Be LEARNED
BEHAVIOR CONSEQUENCE
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BEHAVIOR PUNISHMENT-
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+BEHAVIOR REWARD
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USE OPIOID CONSEQUENCE
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USE OPIOID NAUSEA-
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USE OPIOID EUPHORIA
+
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USE OPIOIDS
Feel BetterWithdrawal(Craving)
Mood
Euphoria
Time
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Behavior Can Be DRIVEN
16
THIRST DRINKHUNGER EATEXHAUSTION SLEEP
CRAVING USE OPIOIDS
INNATE
DISEASE
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DSM-V Criteria for Opioid Use Disorder (OUD)1. Larger amounts or over a longer period than intended.2. Unsuccessful efforts to cut down or control opioid use.3. Great deal of time is spent to obtain, use or recover from opioids.4. Cravings for opioids.5. Failure to fulfill roles at work, school, or home.6. Social or interpersonal problems caused by opioids.7. Activities are given up or reduced because of opioid use.8. Physically hazardous opioid use9. Continued opioid use despite physical or psychological consequences10. Tolerance.*11. Withdrawal.*
For Diagnosis of OUD:Mild: 2-3 presentModerate: 4-5 presentSevere: 6 or more present
* Don’t count toward OUD diagnosis if patient is prescribed opioids
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DSM-V Criteria for Opioid Use Disorder (OUD)
1. Larger amounts or over a longer period than intended.2. Unsuccessful efforts to cut down or control opioid use.3. Great deal of time is spent to obtain, use or recover from opioids.4. Cravings for opioids.5. Failure to fulfill roles at work, school, or home.6. Social or interpersonal problems caused by opioids.7. Activities are given up or reduced because of opioid use.8. Physically hazardous opioid use9. Continued opioid use despite physical or psychological consequences10. Tolerance.*11. Withdrawal.*
Impaired Control Over Use
Social ConsequencesHealth Consequences
Physiologic Dependence
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PART 2: TREATING ADDICTION
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TREATMENT GOAL:DECREASE the ODDSthe ADDICTED BRAIN will CHOOSE the ADDICTED BEHAVIOR.
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Addiction Treatment
NIDA. Principles of Drug Addiction Treatment. 2012. McLellan et al., JAMA, 284:1689-1695, 2000 .
Hypertension Treatment Addiction Treatment
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Treatment Modalities for SUDs
Pharmacotherapy• Alcohol use disorder
naltrexone, acamprosate, disulfiram, topiramate
• Opioid use disorder methadone, buprenorphine, naltrexone
• Tobacco use disorder varenicline, bupropion, NRT
• Cocaine use disorder• Topiramate, naltrexone
• Methamphetamine use disorder• Bupropion/naltrexone
Psychosocial/behavioral• Modalities Cognitive Behavioral Therapy (CBT) Motivational Enhancement Therapy (MET)
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Treatment Modalities for SUDs
Pharmacotherapy• Alcohol use disorder
naltrexone, acamprosate, disulfiram, topiramate
• Opioid use disorder methadone, buprenorphine, naltrexone
• Tobacco use disorder varenicline, bupropion, NRT
• Cocaine use disorder• Topiramate, naltrexone
• Methamphetamine use disorder• Bupropion/naltrexone
Psychosocial/behavioral• Modalities Cognitive Behavioral Therapy (CBT) Motivational Enhancement Therapy (MET)
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Readiness for Change
Precontemplation
Contemplation
Action
Maintenance Preparation
Relapse
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Medication for Opioid Use Disorder (MOUD)
• Improves patient survival• Increases retention in treatment• Decreases illicit opioid use• Decreases criminal activity• Increase patients’ ability to gain and maintain employment• Improves birth outcomes among pregnant women• Lowers a person’s risk of contracting HIV or hepatitis C
Substance Abuse & Mental Health Services Agency, 2020
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Opioid
OpioidReceptor
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Opioid
OpioidReceptor
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FULL AGONIST (Methadone)
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FULL AGONIST (Methadone)
PARTIAL AGONIST(Buprenorphine)
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ANTAGONIST(Naltrexone)
FULL AGONIST (Methadone)
PARTIAL AGONIST(Buprenorphine)
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Opi
oid
Effe
ct
Dose
PARTIAL AGONIST(Buprenorphine)
FULL AGONIST (Methadone)
ANTAGONIST(Naltrexone)
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MOUDisVeryEffective in Treatment Retention
Kakko, et al. The Lancet 361, no. 9358 (2003): 662-68.
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MOUD Benefits Are Consistent Across Studies
Haight, et al. The Lancet 393, no. 10173 (2019): 778-90.
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MOUD Also CanIncrease Abstinence
Haight, et al. The Lancet 393, no. 10173 (2019): 778-90.