Historically, the treatment of Opioid Use Disorder in the United States as vacillated between efforts to treat the condition as a medical illness and/or a perceived moral failing of the afflicted. Various regulation efforts have been initiated to address opioid addiction, some of which have achieved greater success than others. In the 1960’s and 70’s, federal support for the use of methadone in the treatment of Opioid Use Disorder, most specifically with heroin addicts, began to escalate. This set the stage for a modernized approach to the treatment of Opioid Use Disorder as a chronic illness, one which could be treated with maintenance levels of medications such as Methadone. The introduction of Suboxone (Buprenorphine), an opioid partial-agonist and Naltrexone, an opioid full-antagonist, expanded medication treatment options to include a more comprehensive selection of pharmaceutical options which could be tailored to meet the specific needs of any given clinical case.
Medication assisted treatment (MAT) is the use of medications such as Suboxone and Naltrexone in combination with counseling and behavioral therapies for the treatment of substance use disorders. The medication and subsequent behavioral therapy selected is tailored to meet the needs of any given case factoring in a number of variables including specific condition, treatment history, and motivation for treatment. Generally speaking, a combination of medication and behavioral therapies is effective in the treatment of substance use disorders, and can help some people to sustain recovery.
In recent years, the United States has been firmly in the grip of an Opioid Epidemic of unprecedented proportion. Rooted in the relaxed opioid prescribing practices of the mid 1990’s, and the introduction of “Pain as the Fifth Vital Sign”, we have been increasingly confronted with an escalation in unintentional overdose deaths related to prescription and non-prescriptive use of Opioids. As a result, we have been forced to examine our approach to the treatment of Opioid Use Disorder with a high degree of scrutiny. This has included a re-examination and emphasis on the role of MAT in the treatment Opioid Use Disorder.
In June of 2015, the American Society of Addiction Medicine adopted its national practice guidelines which includes 13 areas of primary emphasis:
1. Assessment and Diagnosis of Opioid Use Disorder
2. Treatment Options
3. Treating Opioid Withdrawal
7. Psychosocial Treatment in Conjunction with Medications for the Treatment of Opioid Use Disorder
8. Special Populations: Pregnant Women
9. Special Populations: Individuals with Pain
10. Special Populations: Adolescents
11. Special Populations: Individuals with Co-Occurring Psychiatric Disorders
12. Special Populations: Individuals in the Criminal Justice System
13. Naloxone for the Treatment of Opioid Overdose
A guest speaker from the American Society of Addiction Medicine will lead this session, including a particular emphasis on Medication Options; Accessing Supportive Psychosocial Treatments; and Treating Special Populations.
Margaret A.E. Jarvis, MD, DFASAM
Dr. Jarvis has been a member of ASAM since the early 1990’s and became a Fellow of the Society in 2003. She has served on the Board of Directors for one term and currently is the co-chair of the Ruth Fox Planning; and a member of the Finance Committee and the Constitution and Bylaws Committee. She has also worked on Examination Committee for ASAM and now ABAM since 2000.