2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use. 3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects. 4. Craving, or a strong desire or urge to use opioids. 5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids. Treatment of OUD and SUD Treatment options for OUD are improving as better understanding of this disease process increases. Buprenorphine, methadone and naltrexone are the most popular medications used in the treatment of OUR. 56 Historically, pharmacological treatment for opioid use disorder was referred to as Medications for Addiction Treatment (MAT). Medications for Opioid Use Disorder (MOUD) has since replaced this terminology and is considered a more appropriate description of this treatment. MOUD involves a combination of medications that target the physical dependence on opioids and includes psychosocial interventions such as counseling and skills development to improve treatment outcomes. Linking people with OUD to successful treatment can occur in many settings. Outpatient care programs, hospital departments (including emergency departments), harm reduction and syringe services programs, and criminal justice settings all present opportunities for linkage to care. Access to medications used to treat OUD have been closely regulated in the past. Due to the extraordinary increase in the number of patients requiring treatment, efforts have been made to expand and promote the use of these medications by various providers. The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. This agency regulates the safe use of these medications for the treatment of OUD. (https://www.samhsa.gov/) SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities and promotes MOUD treatment. SAMHSA also facilitates and guides practitioners in treatment and regulates access to specific medications. The Providers Clinical Support System (PCSS) (https://pcssnow.org/) is a national training and clinical mentoring project developed in
7. Important social, occupational, or recreational activities are given up or reduced because of opioid use. 8. Recurrent opioid use in situations in which it is physically hazardous. 9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. response to the prescription opioid misuse epidemic and the availability of pharmacotherapies to treat opioid use disorder. PCSS trains health professionals to provide effective, evidence-based, medication- assisted treatments to patients with opioid use disorder in primary care, psychiatric care, substance use disorder treatment, and pain management settings. Research shows that medications and therapy together may be more successful than either treatment method alone. 57 Health care professionals often miss opportunities to engage patients about OUD. Few providers consider how to address OUD within their practice, and still fewer offer MOUD. Unfortunately, many people seeking treatment for OUD cannot access MOUD resources. Significant disparities in access to MOUD persist, and many Americans live in areas where MOUD programs are not available. Social workers, medical professionals and family can all assist patients 10.Exhibits tolerance. 11.Exhibits withdrawal. with finding resources related to the treatment of OUD. Peer support workers, if available, increase the likelihood of engagement with a warm handoff and treatment plan for OUD. Peer support workers are specially trained individuals that can interact with patients suffering from OUD. These workers are individuals that have successfully recovered from SUD in the past. Peer support workers engage in a wide range of activities, including advocacy, linkage to resources, sharing of experience, community and relationship building, group facilitation, skill building, mentoring, goal setting, and more. 58 Linking those living with OUD to effective treatments will reduce substance use in communities, lower rates of infectious disease, and prevent early death from overdose of opioids and other drugs. 59 Additional resources related to MOUD can be found on the CDC website at https://www.cdc.gov/drugoverdose/ featured-topics/linkage-to-care.html.
MOUD - MEDICATIONS FOR OPIOID USE DISORDER
Methadone Methadone is one of the most common medicines to treat OUD. It is an opioid agonist and can only be prescribed and dispensed in licensed methadone clinics. Methadone therapy for OUD typically requires frequent visits in conjunction with an established opioid treatment program and may be inconvenient or feel stigmatizing for some patients. Methadone was
first developed and used as a pain reliever in 1947. Methadone maintenance has been evaluated since its development in 1964 as a medical response to the post-World War II heroin epidemic in New York City. 60 Prior to the release of buprenorphine, methadone was the gold standard for treatment of opiate addiction. Methadone is a full opioid agonist and retains most
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Book Code: CT24CME
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