What the clients hear about maintenance...
"You’ll be on
it forever"
"Why can’t you just
do it on your own?"
"Your baby is going to
be born a junky"
"If you’re on maintenance,
you’re not really in recovery"
"Be careful who you tell in NA,
and good luck getting a sponsor"
"All people on maintenance
look high"
"You’re not really clean"
"When are you getting off?"
"Methadone is liquid handcuffs"
"You have to get on disability
because you’re too doped up to get a job"
"People who don’t take maintenance medications have a stronger recovery "
"You’re taking the easy way out"
Condelli & Dunteman, 1993
• Studied treatment length and outcomes
• Hypothesized that longer duration of exposure to methadone programs are more effective than shorter ones in reducing heroin use.
• 526 patients using heroin on a weekly or daily basis from 17 community methadone treatment programs
• 85% of sample reported having difficulties in the following areas: medical or physical, mental health or emotional, family or friends, police or legal, job, work, or school, financial or money.
• 56% reported mild to debilitating depression
Results
- Short term exposure – less than 3 months; 39% continued use
- Long-term exposure – less than 6 months; 40% continued use
- Continuous exposure – more than 6 months; 17% continued use
- Patients who reported receiving high quality and easily accessible social services from the program were 3.5x more likely to retain
Gossop, Marsden, Stewart, & Treacy, 2000
•351 patients from 16 community methadone treatment programs in the UK
• Report on 2 year outcomes
• Data collected from structured interview utilizing scales for drug use, physical, and mental health symptoms
• Scales given every 3 months, dose data taken every month
Results
- Patients who remained in treatment for 2 years were twice as likely to stay abstinent than those who left the program earlier
- Higher doses were predictive of reduced use
- Marked reduction in psychological and physical health problems, and crime
- No information about social services or therapy
Fingerhood, King, Brooner, & Rastegar, 2014
• Compared Methadone and Buprenorphine demographic factors and 1 year outcomes
• 252 patients on Methadone and 252 patients on Buprenorphine
• Tracked UDS results every month for one year
• Success operationally defined as “more than 6 months with negative UDS in 1 year”
Results
- Methadone patients had a higher # of months in treatment and higher number of opioid negative months
- However, Buprenorphine patients were more likely to be employed, male, and have private insurance
- Received individual counseling and groups for more “severe” cases
- Important to look at demographic factors, each program serves different population with different needs
- The DSM 5 removed legal deviance and added cravings as the updated criteria for Substance Use Disorder
"Methadone works for me because I am held accountable by drug screens and having groups. I've met a good sober support system and have a safe place I can go to talk about my problems"
-Anonymous
"Since starting Methadone, I do not need to use illegal drugs, giving me the opportunity to save money, have less mood swings, and have consistency in my life"
-M. J.
"It has helped keep me opiate free for over a year. It has helped me not fight an uphill battle against addiction by helping remove the craving. I am a better father, son , brother and husband"
-William B
"If it wasn't for maintenance I would not have been able to take care of my sick mother for this past year, especially the last few weeks of her life"
-Danielle C
"It's nice to not have to worry anymore and just know that every day I can wake up and get through my day normally. It has taken the cravings away completely and keeps me motivated"
-Anonymous
I never feel high on Suboxone-it just prevents me from being sick and physically craving a drug that could literally kill me. It has allowed me to focus on fixing myself and all of my underlying issues"
-D.G.
"After being rejected by my first NA sponsor for being honest about being on maintenance, I got back on the horse and got a temporary sponsor in AA. I have a home group and have been drug free since December 2014"
-John A
Pregnancy and Maintenance According to SAMHSA
Here are some facts:
- "Women can conceive, have normal pregnancies and give birth to and raise healthy children while receiving methadone treatment"
v The Lindesmith Center-Drug Policy Foundation. About Methadone. 2000.
- "Methadone does not harm the developing fetus, but maternal withdrawal and detox may create significant risks of harm".
- "Methadone does not cause birth defects or other long-term health problems".
- "There is a scientific consensus recognized by US government authorities and researchers that methadone is safe and effective for the management of opioid dependence during pregnancy".
v Kaltenbach K, Silverman N, Wapner R. Methadone maintenance during pregnancy. In: Center for Substance AbuseTreatment. State Methadone Treatment Guidelines.
What do we know about Maintenance and Pregnancy?
After Care Considerations for Baby
Caregivers of infants and children exposed to substances during their fetal development, will need to be aware of developmental milestones
- motor deficits and cognitive delays
- hyperactivity, impulsivity
- attention-deficit in preschool-aged children, and in addition to school absence, school failure, and other behavioral problems in school-aged children
- growth and nutritional benchmarks to identify failure to thrive and short stature
-North Carolina Pregnancy & Opioid Exposure Project
https://www.polleverywhere.com/multiple_choice_polls/3S7D9P3MsDyxu2Y
What did we learn or confirm?
- The high risks of using out weigh the lower risks of taking maintenance medication during pregnancy
- Most times mom needs a higher dose
- Sometimes it can stay the same
- Hospitalization can be a need
- Babies may be born with a dependence for Methadone, but not addicted
What is
Neonatal Abstinence Syndrome?
There are many variables that impact if, how, and when an infant will experience withdrawal symptoms. These include:
- timing of the mother’s most recent intake of opioid
- maternal metabolism
- placental metabolism
- infant metabolism and excretion
- maternal taking of other substances, including cigarettes, cocaine, hypnotics sedatives, and/or barbiturates[1]
-North Carolina Pregnancy & Opioid Exposure Project
Initial treatment of infants showing signs of withdrawal is focused on supportive care can include:
- creating a low-stimulation environment that is dark and quiet
- swaddling the infant to inhibit self-stimulation
- providing frequent/on-demand feedings to reduce infant stress
- Providing frequent feedings helps to address the infant’s hydration level, although many infants will require intravenous fluids to maintain adequate hydration.
- encouraging skin-to-skin contact for comfort and promotion of the infant’s attachment to the mother/caregiver
- rocking or swaying the infant
Nervous System
-North Carolina Pregnancy & Opioid Exposure Project
Teaching these techniques to families and caregivers, including careful, detailed demonstrations, is an important factor in the success of the supportive care approach.
Respiratory System
GI System
"It is well established that metabolic changes during pregnancy often require an increase in the dosage of methadone to ensure optimal therapeutic results"
So what impacts the mother's dose???
-Robert Newman M.D., director of Beth Israel Medical Center’s Baron Edmond de Rothschild Chemical Dependency Institute
- Blood volume
- Renal and Gastric clearance
- COWS
- Sometimes women need a dose increase as they progress through the pregnancy.
- Sometimes women need to go inpatient to stabilize due to nausea and vomiting.
So Why Maintenance???
Let's get started with a check in!
Step 1: Take out your phone if you would like to participate
Step 2: Type 22333 in the "TO" line on your phone
Step 3: Type ALLYSONSPROU519 in the massage line and send
Step 4: Get ready to start texting!
https://www.polleverywhere.com/my/polls
What have you heard about Maintenance Medications?
Annnnd Action!
Scene One: Getting Started
Pills
Oral Films
*lac.org-Legal Action Center
DRIVING ON METHADONE OR BUPRENORHPINE (SUBOXONE): DUI?
"You’re substituting one drug for another"
What Is Buprenorphine?
- Buprenorphine belongs to a class of drugs termed opiate agonists. Like heroin and other drugs derived from morphine, buprenorphine contains chemicals that link with opioid receptors in the brain to reduce pain and produce feelings of well-being.
- Before it was approved for opioid addiction treatment, buprenorphine was prescribed for many years as a pain reliever. When it’s taken in the prescribed doses, buprenorphine replicates the actions of opioid drugs — only to a much lower degree.
Only illegal if impaired
The two laws are similar:
1. There is no DUI unless the drug makes the driver “incapable” of driving safely,” or
2. There is no DUI unless the drug impairs the driver’s ability to operate safely or the driver is under the influence of (or affected by) an “intoxicating” drug.
- Under these laws, the prosecution must show that the drug was present and actually impaired the person’s ability to drive, or the person was “intoxicated.”
- The driver’s conduct does not violate the law if the driver was taking the medication legally, and the medication did not impair driving ability or make the person “intoxicated.”
Illegal to have methadone or buprenorphine in your body
Some states have a third type of law.
In these states, it is a criminal offense merely to have any amount of the drug(s) in one’s body while driving. It does not matter that the medication is legal and does not impair functioning.
To find out which type of law your state has, you may need to ask a lawyer.
What Is Suboxone?
- Suboxone is the commercial name for buprenorphine combined with naloxone, an opioid antagonist.
- Subutex was the first version of buprenorphine to be prescribed for opioid dependence.
- Suboxone was developed in response to a need to discourage users from abusing buprenorphine by injecting or snorting the drug to get high.
- Naloxone was added to the buprenorphine to keep the user from feeling the effects of the drug if Suboxone is injected.
Scene Two: Welcome to Recovery
What Is Subutex?
- Subutex is the brand name for buprenorphine.
- Subutex is not to be confused with Suboxone.
- Both contain buprenorphine, and both are used to treat opiod dependence
- the difference is that Subutex is comprised of buprenorphine only, whereas Suboxone is a combination of buprenorphine and naloxone.
- Naloxone is what’s known as an opiod receptor antagonist—i.e, a substance intended to reverse or block the effects of opioids in the body.
Diagnostic Criteria According to DSM 5
New addition
What do we know?
Treating Opiate Use Disorder
What did we learn or confirm?
There is a difference between "addiction" and "dependence"
The National Institute of Drug Abuse
Physical reaction to lack of medication
- In some cases induces withdrawal
IN
Behavioral: Compulsion
Psychological: Obsession
Reward: Stimuli Focused
"Maintenance drugs are medications prescribed for chronic, long-term conditions and are taken on a regular, recurring basis.
Examples of chronic conditions that may require maintenance drugs are:
- high blood pressure
- high cholesterol
- substance use disorder
- depression
- diabetes
Important to note:
- Some of these are a result of unhealthy lifestyle and some are genetic. Chicken or Egg??
- Lifestyle has a significant impact on medication efficacy & ability to consistently stay well
- Medication is only 50%
OUT
hap.org
Diseases and commonly prescribed maintenance medications
Substance
Food
Gambling
Sex
Exercise
Shopping
*ben.omb.delaware.gov
* osc.ct.gov
- Methadone and Suboxone Maintenance medication is used to treat Opiate Use Disorder
- Some maintenance medications like these, cause physical dependence
- Maintenance medications must be taken daily and at the frequency indicated by a physician
- Suboxone can be a safe alternative for some people who are on Methadone
- Must be under medical supervision due to risk in instant withdrawal
https://www.polleverywhere.com/multiple_choice_polls/L67CC1ZV4dDDPnl
Maintenance Medication
and
Recovery