MEDICATION ASSISTED THERAPY AND THE ROLE OF THE … · MEDICATION-ASSISTED TREATMENT (MAT) The use of medications in combination with counseling and behavioral therapies, to provide

MEDICATION ASSISTED THERAPY AND THE ROLE OF THE

PHARMACIST

George E. Downs, PharmD

University of the Sciences

Philadelphia College of Pharmacy

October 19, 2018

OBJECTIVES

• Summarize the value of MAT for the OUD patient.

• Select the best option of MAT for a patient using case management.

• Discuss the sigma, professional and legal barriers in pharmacy practice that impede the appropriate implementation of MAT.

• Design an ideal delivery system of MAT for OUD patients in your community.

• Design a communication network with MAT providers, civic leaders, law enforcement and judicial leaders to improve care for OUD patients

DISCLOSURES

• The speaker has not received any commercial or financial support for this program.

• The speaker will not discuss off-label or investigational use of medications.

PROBLEM AND POPULATION

❧ Growing population in the US with dependence and substance use disorders (SUD) to opioid drugs ❧ 2012: Greater than 2 million people aged 12 years and older in the US met the

diagnostic criteria for opioid abuse or dependence ❧ Treatment

❧ Opioid agonist medication assisted treatment (OA-MAT) ❧ Methadone

❧ Buprenorphine

❧ Naltrexone* ❧ Abstinence based treatment

APPROACHES FOR PHARMACOTHERAPIES

❧ Antagonist approach o occupy but do not activate receptors, hence antagonize agonist

effects (e.g., naltrexone). o Premise: block euphoric and reinforcing effects of opioids

❧ Agonist substitution approach o directly activate opioid receptors (e.g., morphine, methadone) o Premise: produce tolerance to abuse-related effects, reduce

cravings, suppress relapse. ❧ Partial agonist approach

o do not fully activate opioid receptors even with very large doses (e.g., buprenorphine)

o Premise: act as agonist with no other opioids on board, act as antagonist during lapse.

Opioid Agonist

Medication Assisted Treatment

❧ Methadone

❧ Historically the gold standard

❧ Patient must be a part of an opioid treatment program (OTP)

❧ 2012: only 1,167 OTPs in the entire US

❧ Buprenorphine

❧ Drug Addiction Treatment Act of 2000 or “DATA 2000”

❧ Physicians could prescribe buprenorphine containing products, for the treatment of addiction ❧ Max 100 patients

❧ 2012: only 46% of US counties had a physician able to prescribe buprenorphine for the treatment of addiction

❧ Rural counties having the largest overall deficit

OPIOID ANTAGONIST MEDICATION ASSISTED TREATMENT

Naltrexone

• Competitive opioid antagonist

• Blocks the effects of endogenous and exogenous opiate

• Reduces alcohol craving, alcohol consumption, number of drinking days, and severity of relapse

• PO (ReVia®):

• Oral: Initial: 25 mg; if no withdrawal signs occur, administer 50 mg/day thereafter

• IM (Vivitrol®):

380 mg every 4 weeks

Alternate injection site between the two buttocks

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LOW TREATMENT CAPACITY

❧ 2013: 22.7 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem

❧ Only 2.5 million persons requiring treatment received treatment at a specialty facility such as an OTP

❧ majority of OTPs are currently operating at greater than 80% capacity ❧ A large percentage of US counties do not have even one

buprenorphine provider Max potential for patients in 2012

❧ Buprenorphine: 1,093,150 ❧ OTP: 311,718 ❧ Total: 1,404,868

TREATMENT-SEEKING BEHAVIOR

❧ In 2013, 20.2 million persons needed treatment for an illicit drug or alcohol use problem, but did not receive treatment at a specialty facility in the past year

❧ 908,000 of the 20.2 million people needing treatment for an illicit drug

or alcohol use problem reported that they perceived a need for treatment

❧ most commonly reported reasons for not receiving treatment

❧ Lack of health coverage and an inability to cover the cost ❧ Not feeling they were ready to quit ❧ Not knowing where to seek treatment

DATA - 2000

❧ 2000 - Drug Addiction Treatment Act (DATA 2000) approved by Congress

❧ Enables qualified physicians to obtain a waiver to prescribe and/or dispense specially approved Schedule III, IV, and V medications for the treatment of opioid addiction in treatment settings other than the traditional opioid treatment program (i.e., methadone clinic)

2015 Community Care Behavioral Health Organization

BACKGROUND

❧ 2002 - FDA approved buprenorphine (Subutex and Suboxone) for use in treating opioid addiction

❧ Subutex = buprenorphine

❧ Suboxone = buprenorphine + naloxone

❧ These became the first 2 drugs physicians could use to treat opioid dependence in an office setting


PHYSICIANS: BUPRENORPHINE PRESCRIBERS

• Year: 2018 | State: Pennsylvania

• Certified Physicians with 30 Patients: 489

• Certified Physicians with 100 Patients: 160

• Total Active Physicians in Pennsylvania: 39,863

• Total Primary Care Physicians: 12,744

• US – TOTAL Buprenorphine prescribers – 55,195

• 72.3% - 30 patient certified

• 19.7% - 100 patient certified

• 8% - 275 patient certified

DATA-WAIVER PATIENT LIMIT

❧ Initially limited to 30 patients per physician practice

❧ 2005 – 30 patients

❧ 2006 – 100 patients

❧ 2016 – 275 patients

Significant limitations in each category


MEDICATION-ASSISTED TREATMENT (MAT)

❧ The use of medications in combination with counseling and behavioral therapies, to provide a whole patient approach to the treatment of substance abuse disorders

❧ 12 step programs

❧ Certified peer recovery specialists

❧ Recovery coaches

❧ Safe housing

❧ Attention to educational, social and spiritual needs


AIN’T THIS JUST SUBSTITUTION?

Medications are the glue for life changes

• Suppress craving

• Normalize life

• Reduce morbidity and mortality

• Decrease overdose deaths

• Reduce transmission of infectious disease

• Increase treatment retention

• Improve social functioning

• Reduce criminal activity

MAT CONCERNS

• Concurrent issues

• Any CNS depressant

• Alcohol

• Benzodiazepines

• Sleep aids

• Muscle relaxants

• Sleep apnea

• Medications that interact with buprenorphine

• 3A4 interaction

SO…WHAT’S THE PROBLEM?

• Stigma

• Lack of understanding of the disease

• Risk of diversion

• Regulatory restrictions

• Reimbursement

• Theft and robbery concerns

• Insurance issues

• Clientele

• Inventory concerns

BUPRENORPHINE

❧ Schedule III medication approved for treatment of opioid substance use disorder

❧ High affinity partial agonist to the mu-opioid receptor ❧ Creates a ceiling to common agonist effects

❧ Analgesia ❧ Respiratory depression

❧ Can precipitate withdrawal when given in the presence of opioids or opioid metabolites, especially among physically dependent individuals ❧ Due to competing with other opioids and blocking their effects

WHY ADD NALOXONE?

❧ Naloxone is an opioid antagonist with low bioavailability when taken ❧ Orally

❧ Sublingually

❧ When the combination product is taken appropriately, naloxone has little effect on the action and efficacy of buprenorphine

❧ When injected can precipitate withdrawal

❧ Reduce diversion

❧ Buprenorphine/naloxone combination formulation preferred

❧ Exceptions

❧ Those with a demonstrated allergy

❧ Pregnant women

FORMULATIONS

❧ Sublingual tablet ❧ Soluble film for sublingual or buccal use ❧ SQ Injection ❧ SQ insert rods

WHY DO THE THE NEWER FORMULATIONS COME IN

LOWER DOSAGES?

A. Greater bioavailability

B. Greater affinity to the mu-opioid receptor

C. Increased dosing options

D. Reduced side effects

E. Still definitely maybe

DOSING RECOMMENDATIONS

Induction, Stabilization, Maintenance and Tapering off

INDUCTION

❧ Typically one-week duration

1. Ensure the patient is already experiencing signs of withdrawal

❧ Increases heart rate, sweating, GI upset, yawning several times per minute, tremor, dilated pupils

2. Minimizing the chance to precipitate withdrawal

3. Generally recommended to start with 8 to 12mg of suboxone

4. Conduct urine drug screen to detect other drugs of abuse and the presence of the buprenorphine metabolite on a weekly bases


URINE DRUG SCREENS

❧ What are we looking for?

❧ Use of illicit drugs and medications

❧ If the patient is using buprenorphine we are looking for buprenorphine and its metabolites

❧ Buprenorphine and nor-buprenorphoine

STABILIZATION

❧ Usually 1 to 2 months ❧ Begins when the person in recovery is experiencing no

withdrawal symptoms, minimal or no side effects, and minimal cravings

❧ Adjust dose as needed by 2 to 4 mg increments each week

❧ A daily dose is established when 1. the patient is not using illicit opioids

2. withdrawal symptoms are no longer present 3. the patient is no longer experiencing cravings

❧ Urine drug screens should still be conducted on a weekly basis

MAINTENANCE

❧ Can last up to 18 to 24 months ❧ After a period of time may decide to provide prescriptions lasting up

to a month

❧ Conduct urine drug screen on a biweekly or monthly basis

What Maintenance doses do you generally see in practice?

❧ 4 mg – 16 mg are typically effective for most patients ❧ 16 mg – 24 mg are at the upper limit of ❧ recommended doses

❧ Evaluate the patient very carefully

TAPERING OFF PHASE

❧ The duration of buprenorphine treatment should be individualized to meet the individual needs of each patient.

❧ Before discontinuing buprenorphine, patients must:

1. Express a desire to discontinue

2. Have stable housing and income

3. Have adequate psychosocial and recovery support

4. Agree to conditions for termination and contingencies for treatment and recovery support outlined in the treatment agreement

TRUE OR FALSE

❧ Maintenance treatment is as effective as Short term treatment followed by a taper. ❧ False

❧ Recent study found that even after 12 weeks of medication treatment with concurrent counseling, tapering was associated with very high relapse rates ❧ Higher than 90 percent 8 weeks following the taper

❧ Remember that effective medication assisted treatment includes additional services like counseling

SIDE EFFECTS

❧ Headache ❧ Opioid related side effects – many of which decrease over time with

continued exposure to buprenorphine ❧ Sweating, constipation, decreased libido

❧ Can cause elevated liver transaminases values ❧ Concerning with hepatitis C infected patients

❧ Most clinical trials have limited exposure to buprenorphine in subjects with transaminase values below 3-5 times normal ❧ More recent studies have demonstrated hepatic safety in more diverse

populations, but additional research is needed

❧ Unlike with methadone, QT interval prolongation does not appear to be a problem

OVERDOSE RISK

❧ Risk minimal except with concomitant use of

1. Another opioid

2. Benzodiazepines

3. Alcohol

4. Sedatives

5. Medications that interact with buprenorphine

❧ 3A4 interaction

NALTREXONE

• Competitive opioid antagonist • Blocks the effects of endogenous and exogenous opiate

• Reduces alcohol craving, alcohol consumption, number of drinking days, and severity of relapse

• PO (ReVia®): • Oral: Initial: 25 mg; if no withdrawal signs occur, administer 50

mg/day thereafter

• IM (Vivitrol®): 380 mg every 4 weeks

Alternate injection site between the two buttocks

Questions?

CITATIONS

1. NIH. Overdose Death Rates. 2015. http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.

2. Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014

3. DEA Philadelphia Divisionand the University of Pittsburgh, Analysis of Overdose Deaths in Pennsylvania, 2016. DEA-PHL-DIR-034-17, July 2017.

4. Mayor’s Task Force to Combat the Opioid Epidemic in Philadelphia [Internet]. Philadelphia (PA): Department of Public Health [c2018; cited 2018 Jan 20]. Available from: https://dbhids.org/opioid

5. Philadelphia Department of Public Health. Overdose deaths involving opioids in Philadelphia. CHART 2016;1(1):1-8.

6. Stakeholders’ challenges and red flag warning signs relate to prescribing and dispensing. nabp.pharmacy/wp-content/uploads/2016/07/Red-Flags-Controlled-Substances-03-2015.pdf. Accessed February 5, 2018

7. Room, R., Rehm, J., Trotter, R. T., II, Paglia, A., & Ustu n, T. B. (2001). Cross-cultural views on stigma valuation parity and societal attitudes towards disability. In T. B. Ustu n, S. Chatterji, J. E. Bickenbach, R. T. Trotter II, R. Room, & J. Rehm, et al. (Eds.), Disability and culture: Universalism and diversity (pp. 247–291). Seattle, WA: Hofgrebe & Huber.

8. Kelly JF, Westerhoff CM. Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. Int J Drug Policy. 2010 May;21(3):202-7.

9. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

10. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.

11. Substance Abuse and Mental Health Services Administration. Medications To Treat Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, Full Document. HHS Publication No. (SMA) 18- 5063FULLDOC. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018.

12. Greenwald MK, Johanson CE, Moody DE, Woods JH, Kilbourn MR, Koeppe RA,Schuster CR, Zubieta JK. Effects of buprenorphine maintenance dose on mu-opioid receptor availability, plasma concentrations, and antagonist blockade in heroin-dependent volunteers. Neuropsychopharmacology. 2003 Nov.

http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates









https://dbhids.org/opioid

STANDARD OF PRACTICE: INCORPORATING HARM REDUCTION STRATEGIES INTO THE PRACTICE OF

PHARMACY

Daniel Ventricelli, PharmD, MPH

University of the Sciences

Philadelphia College of Pharmacy

October 19, 2018

DISCLOSURES

The speaker has not received any commercial or financial support for this program.

The speaker will not discuss off-label or investigational use of medications.

LEARNING OBJECTIVES

At the completion of this activity, the participant will be able

to:

1. Summarize SUD harm reduction strategies and identify

the role of pharmacists can play.

2. Review outcomes of harm reduction strategies

(costs/infections/overdoses, etc.)

3. Apply harm reductions strategies into their practice and

community.

4. Recommend a design for providing MAT and harm

reduction for SUD patients. (Open dialog with panelists)

WHAT IS HARM REDUCTION

Harm reduction is a set of practical strategies

and ideas aimed at reducing negative

consequences associated with drug use. Harm

Reduction is also a movement for social

justice built on a belief in, and respect for, the

rights of people who use drugs.

WHAT IS HARM REDUCTION?

Focuses on strategies designed to reduce harms associated with drug use

At the core of the harm reduction is the belief that the development of a substance use disorder does not negate the basic and human rights of substance users.

Meeting people where they are at – Acknowledging the rights of substance users to determine when and how they enter recovery.

Social justice movement –The Harm Reduction Movement recognizes that substance users needs are diverse and advocates for policies, resources, and interventions that can meet the diverse needs of substance users and their community.

Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.

EVIDENCE-BASED STRATEGIES FOR

PREVENTING OPIOID OVERDOSE

• Targeted Naloxone Distribution

• Medication-Assisted Treatment (MAT)

• Academic Detailing

• Eliminating Prior-Authorization Requirements for Medications

for Opioid Use Disorder

• Screening for Fentanyl in Routine Clinical Toxicology Testing

• 911 Good Samaritan Laws

• Naloxone Distribution in Treatment Centers and Criminal

Justice Settings

• MAT in Criminal Justice Settings and Upon Release

• Initiating Buprenorphine-based MAT

in Emergency Departments

• Syringe Services Programs

Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States

TARGETED NALOXONE DISTRIBUTION

• Targeted distribution programs seek to train and equip individuals who are most likely to encounter or witness an overdose, especially people who use drugs and first responders, with naloxone kits.

• Targeted naloxone distribution programs work best when:

1. Naloxone is provided to people at high risk of experiencing or witnessing overdose.

2. Outreach workers, harm reduction staff, and trusted clinicians are properly educated and comfortable distributing naloxone to those using illicit opioids or receiving a high-risk opioid prescription.

3. People who use drugs and first responders are well informed as to the potential effects and actions of naloxone. Comfort with carrying and administering naloxone is crucial.


TARGETED NALOXONE DISTRIBUTION OUTCOMES

• A nation-wide study found that more than

80% of overdose reversals with naloxone in the U.S. were carried out by

individuals who also use drugs.1

• A similar study carried out in Massachusetts found that nearly 90% of overdose

reversals with naloxone were carried out by bystanders who also use drugs.2

• An observational study in Ohio found that increases in the number of law

enforcement officers trained and carrying naloxone was associated with a

reduction in opioid overdose deaths and an increase rate of survival among

opioid overdose victims in the surrounding area.3

1. Wheeler E, Davidson PJ, Jones TS, Irwin KS. Community-Based Opioid Overdose Prevention Programs Providing Naloxone—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(6):101-105.

2. Walley AY, Xuan Z, Hackman HH, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. The BMJ.

2013;346. doi:10.1136/bmj.f174

3.Rando J, Broering D, Olson JE, Marco C, Evans SB. Intranasal naloxone administration by police first responders is associated with decreased opioid overdose deaths. Am J Emerg Med.

2015;33(9):1201-1204. doi:10.1016/j.ajem.2015.05.022

MEDICATION-ASSISTED TREATMENT

• The World Health Organization has called MAT “one of the most effective types of pharmacological therapy of opioid dependence.”

• Numerous studies have shown that MAT contributes to significant reductions in opioid use, criminal activity, overdose, and other risky behaviors. MAT quells cravings and allows patients receiving it to stabilize their physical dependency. This stability allows MAT patients to achieve healthy social, psychological, and lifestyle changes.

• While all three medications (methadone, buprenorphine, and naltrexone) can be effective in the treatment of opioid use disorder, decades of research support the efficacy of opioid agonist medications (methadone and buprenorphine) in preventing overdose.

Addressing Challenges

• The challenges of receiving MAT are understood and mitigated. Many individuals face hurdles in receiving approval for MAT from their health insurance provider. Many methadone clinics require patients to attend daily to receive treatment.

SYRINGE SERVICE PROGRAMS

• Sometimes called “needle exchange” or “syringe exchange,” syringe services programs provide

access to clean and sterile equipment used for the preparation and consumption of drugs

• They may also provide tools for the prevention and reversal of opioid overdose, such as naloxone

training and distribution, fentanyl testing strips, and more.

• Comprehensive syringe services programs also provide additional social and medical services

such as:

1. safe disposal of syringes and needles

2. testing for HIV and hepatitis C infection and linkage to treatment

3. education about overdose and safer injection practices

4. referral and access to drug treatment programs, including MAT

5. tools to prevent HIV and other infectious disease, such as condoms, counseling, or vaccinations and

6. linkage to medical, mental health, and social services.

KEY SYRINGE SERVICE PROGRAMS OUTCOMES

• Syringe services program participants are five times more

likely to enter drug treatment and 3.5 times more likely to

cease injecting compared to those who don’t utilize these

programs.

• Some regions have begun implementing syringe access and

disposal services at pharmacies and have achieved success

in decreasing syringe sharing and reuse.

Pouget ER, Deren S, Fuller CM, et al. Receptive Syringe Sharing Among Injection Drug Users in Harlem and the Bronx During the New York State Expanded Syringe Access Demonstration Program. Jaids J Acquir

Immune Defic Syndr. 2005;39(4):471-477. doi:10.1097/01.qai.0000152395.82885.c0

SALES OF HYPODERMIC NEEDLES AND SYRINGES AT PHARMACIES

Filed for public inspection September 11, 2009

(s) Sales of hypodermic needles and syringes shall be made by a pharmacist or under the direct, immediate and personal supervision of a pharmacist in accordance with the following:

• (1) Hypodermic needles and syringes may be sold without a prescription.

• (2) Hypodermic needles and syringes shall be kept in the prescription area of the pharmacy, as defined in § 27.1 (relating to definitions), and be accessible only by pharmacists and pharmacy personnel authorized to be in the prescription area of the pharmacy while the pharmacy is open.

Kentucky community pharmacists willingness to participate

Conclusion: “Kentucky community pharmacists were more willing to provide clean needles than to dispose of used needles. Strategies to mitigate barriers to participation in syringe/needle exchange are warranted.”

Goodin A, Fallin-Bennett A, Green T, Freeman PR. Pharmacists' role in harm reduction: a survey assessment of Kentucky community pharmacists' willingness to participate in syringe/needle exchange. Harm Reduct J.

2018 Jan 25;15(1):4. doi: 10.1186/s12954-018-0211-4. PubMed PMID: 29370808; PubMed Central PMCID: PMC5785823.

COMPREHENSIVE USE ENGAGEMENT SITES

New Needle Point

Needle Point, used ONCE

Needle Point, used TWICE

Needle Point, used over six times

New Needle Point

Needle Point, used ONCE

Needle Point, used TWICE

Needle Point, used over six times

Skin is tough! Every time you hit, each time the needle goes through your skin it bends and barbs. Sadly, syringes are really cheaply manufactured and designed to be used once and destroyed. Damaged points can lead to: ■ Abscesses ■ Infections ■ Blown veins If you can…use a brand new syringe EVERY TIME you poke your skin or vein. Save your veins! ■ If you miss your vein and don’t get a register, re-load a new syringe and try again. ■ Don’t use the same spot and hit it over and over again. Rotate your sites to allow them time to heal. ■ Don’t try to sharpen a used point- this makes more barbs. ■ Don’t use the tip of your needle to mix your hit.

Safe Consumption Facilities (AKA: SIF, SIS, CUES)

• SCFs are facilities where drug use is legal.

• Clean injection equipment/sharps disposal

• Access to Medical Services and Referrals

• Naloxone at-the-ready

• Context:

• HIV/HCV Epidemic

• Overdose/Opioid Epidemic

• Harm Reduction Model

• Desired Outcomes

• Referrals to Treatment

• Reduction of OD-associated Morbidity/Mortality

• Reduction of HCV/HIV/SSTI

• Reduction of Consumption-related Risks via Prevention/Education

• Reduction of Public Nuisances Associated with Drug Use

INSITE: NORTH AMERICA’S FIRST LEGAL SUPERVISED

INJECTION SITE

• Opened in 2003

• Located in Vancouver Canada’s Downtown Eastside

• Location has a high number of long-term injection drug users

• Facility operates under a Health Canada exemption from prosecution under federal drug laws

• Insite operates on a harm-reduction model

• 175,464 visits by 7,301 individuals

• An average of 537 visits per day to the needle exchange service

• An average of 415 injection room visits per day

• 2,151 overdose interventions

• 3,708 clinical treatment interventions (such as wound care, pregnancy tests)

• Substances reported used were heroin (64% of instances), methamphetamine (25% of instances), and cocaine (6% of instances)

Bottom Line

• More than 3.6 million clients have injected illicit drugs under supervision by nurses at Insite since 2003.

• There have been 48,798 clinical treatment visits and 6,440 overdose interventions without any deaths.

2017 Insite user statistics (January 1 – December 31, 2017)

Insite User Statistics

Comprehensive Use Engagement Site Outcomes in the literature

• 35% reduction in mortality within 500 meters of the facility within three years of opening[1]

• increased understanding of hygienic and safe injecting practices[2], as well as a reduction in syringe sharing[3]

• Insite: 2003 and 2006, 46% of participants entered treatment[4]

• SCFs can reduce blood-borne disease transmission by providing clean needles and safer injection education [5, 6, 7]

• behaviors are changed, including a reduction in the reuse of syringes, using sterile water, less rushed injections, safe syringe disposal, and less public injecting[8]

• no significant increase or decrease in crime or disorder following the opening of the SCF[5]

• reductions in the number of drug users injecting in public, publicly discarded syringes, and injection-related litter[9]

10. Larson S, Padron N, Mason J, Bogaczyk T. Supervised Consumption Facilities – Review of the Evidence.

CHALLENGES TO CUES IN

PHILADELPHIA

• Common arguments against CUES

• Need more studies

• Heroin and fentanyl are so dangerous that the risk is too high already

• Legal concerns prevent CUES from operating

• Philadelphia Community Concerns

• Not in my back yard (NIMBY)

• Community Meetings

• How to ensure patient safety

EVIDENCE-BASED STRATEGIES FOR

PREVENTING OPIOID OVERDOSE

• Targeted Naloxone Distribution

• Medication-Assisted Treatment (MAT)

• Academic Detailing

• Eliminating Prior-Authorization Requirements for

Medications for Opioid Use Disorder

• Screening for Fentanyl in Routine Clinical Toxicology

Testing

• 911 Good Samaritan Laws

• Naloxone Distribution in Treatment Centers and

Criminal Justice Settings

• MAT in Criminal Justice Settings and Upon Release

• Initiating Buprenorphine-based MAT

in Emergency Departments

• Syringe Services Programs


ABOUT PAHRC

• The mission of PAHRC is to

promote the health, dignity, and

human rights of individuals who

use drugs and communities

impacted by drug use.

Recognizing that social inequity,

criminalization, and stigma

silence those affected most, we

advocate for policies that

improve the quality of life for

people who use drugs, people

in recovery, and their

communities.

JOIN THE PA SYRINGE SERVICES CAMPAIGN #PASS

• https://www.paharmreduction.org/pass

• In an effort to expand effective Syringe Service Programs in Pennsylvania, PAHRC has launched the Pennsylvania Syringe Services (PASS) advocacy campaign. Currently, Pennsylvania state law defines syringes as drug paraphernalia. This legislative barrier prevents the operation of syringe service programs throughout the commonwealth.

• Together, we can help remove this barrier to effective public health services in our state. To add your voice to the list of organizations that are speaking up for the well-being of all Pennsylvanians, sign up here.

https://www.paharmreduction.org/pass

Citations 1. Marshall, B.D., et al., Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-

based study. Lancet, 2011. 377(9775): p. 1429-37.

2. Peacy, J., Drug Consumption Rooms in Europe. Client Experience Survey in Amsterdam and Rotterdam. 2014, Regenboog Group, Correlation Network.

3. Milloy, M.J. and E. Wood, Emerging role of supervised injecting facilities in human immunodeficiency virus prevention. Addiction, 2009. 104(4): p. 620-1.

4. DeBeck, K., et al., Injection drug use cessation and use of North America's first medically supervised safer injecting facility. Drug Alcohol Depend, 2011. 113(2-3): p. 172-6.

5. Wood, E., et al., Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Substance abuse treatment, prevention, and policy, 2006. 1(1): p. 13.

6. Irwin, A., et al., A cost-benefit analysis of a potential supervised injection facility in San Francisco, California, USA. Journal of Drug Issues, 2016. 47(2): p. 164-184.

7. Kerr, T., et al., Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study. BMJ, 2006. 332(7535): p. 220-2.

8. Stoltz, J.-A., et al., Changes in injecting practices associated with the use of a medically supervised safer injection facility. Journal of Public Health, 2007. 29(1): p. 35-39.

9. Wood, E., et al., Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal, 2004. 171(7): p. 731-734.

10. Larson S, Padron N, Mason J, Bogaczyk T. Supervised Consumption Facilities – Review of the Evidence. Main Line Health Center Population Health Research. 2017;Lankenau I.

11. Centers for Disease Control and Prevention. Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2018. Accessed [date] from http://www. cdc.gov/drugoverdose/pdf/pubs/2018-evidence-based-strategies.pdf

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MEDICATION ASSISTED THERAPY AND THE ROLE OF THE … · MEDICATION-ASSISTED TREATMENT (MAT) The use of medications in combination with counseling and behavioral therapies, to provide