This document discusses the importance of treatment for opioid use disorders. It notes the rise in prescription pain medication abuse and related harms like overdoses. Treatment options like medication-assisted treatment with drugs like methadone and buprenorphine combined with counseling can effectively treat opioid addiction, improving health and social outcomes. The Substance Abuse and Mental Health Services Administration promotes such evidence-based treatment approaches and prevention efforts to address the prescription drug abuse epidemic.

1. Prescrip(on
Pain
Medica(on
Abuse:
The
Importance
of
Treatment
for
Opioid
Use
Disorders
Elinore F. McCance-Katz, MD, PhD
Chief Medical Officer
Substance Abuse and Mental Health Services Administration
Na#onal
RX
Drug
Abuse
Summit
Atlanta,
GA
April
22,
2014

2. SAMHSA:
A
PUBLIC
HEALTH
AGENCY
• Mission:
To
reduce
the
impact
of
hazardous
substance
use
and
mental
illness
on
America’s
communi#es
• Roles:
• Leadership
and
Voice
–
Influencing
Public
Policy
• Data
and
Surveillance
• Clinical
Educa>on
• Public
Educa>on
and
Communica>ons
• Regula>on
and
Standard
SeAng
• Prac>ce/Services
Improvement
• Funding
-­‐
Service
Capacity

3. Past
Month
Nonmedical
Use
of
Types
of
Psychotherapeu#c
Drugs
among
Persons
Aged
12
or
Older:
2002-­‐2012
3
+ Difference between this estimate and the 2012 estimate is statistically significant at the .05 level.
Percent Using in Past Month
Pain
Relievers
Tranquilizers
Sedatives
Stimulants
Source: National Survey on Drug Use and Health, SAMHSA, 2013.

4. More
Fallout
from
Prescrip#on
Pain
Medica#on
Abuse
Past Month and Past Year Heroin Use among Persons
Aged 12 or Older: 2002-2012
Source: National Survey on Drug Use and Health, SAMHSA, 2013.

5. Morbidity
and
Mortality
with
Prescrip#on
Pain
Medica#on
Abuse
• 2004-­‐2011:
Increases
in
Emergency
Department
visits
related
to
opioid
analgesic
misuse:
Men:
159%
Women:
146%
• 2010:
Deaths
related
to
opioid
analgesic
use:
16,651
(313%
increase
over
past
decade);
most
deaths
involved
opioids
+
other
drugs/alcohol
• For
every
death,
there
were:
• 11
treatment
admissions
• 33
Emergency
department
visits
• 880
non-­‐medical
users
CDC,
2013,
SAMHSA
TEDS,
2001-­‐11,
SAMHSA/DAWN,
2011

6. Specific
Illicit
Drug
Dependence
or
Abuse
in
the
Past
Year
among
Persons
Aged
12
or
Older:
2012
6
Numbers in Thousands
Source: National Survey on Drug Use and Health, SAMHSA, 2013.

7. SAMHSA’s
Efforts
to
Prevent
Prescrip#on
Drug
Abuse
• Partnerships
for
Success
grants
• Prescrip3on
Drug
Monitoring
Program
grants
• Preven3on
of
Prescrip3on
Abuse
in
the
Workplace
(PPAW)
Technical
Assistance
Center
• Promo3on
of
DEA’s
na3onal
take-­‐
back
day
(April
26,
2014)
• Not
Worth
the
Risk,
Even
If
It’s
Legal
(pamphlet
series)

8. SAMHSA’s
Efforts
to
Curb
Prescrip#on
Drug
Abuse
–
Prescriber
Educa#on
PCSS-O: Focus on Safe
Opioid Prescribing
www.pcss-o.org
Opioidprescribing.com:
focus on CME accredited
trainings on safe use of
opioids
PCSS-MAT: www.pcssmat.org
Focus on Treatment of Opioid
Use Disorders

9. SAMHSA’s
Efforts
to
Prevent
Prescrip#on
Drug
Overdose
• Opioid Overdose Prevention Toolkit -
http://store.samhsa.gov/product/Opioid-
Overdose-Prevention-Toolkit/
SMA13-4742
• Substance Abuse Prevention and
Treatment Block Grant:
• Primary prevention funds can be used for
overdose prevention education/training
• Treatment block grant funds can be used
for purchase of naloxone and overdose
kits.

10. Interven#ons
to
Address
Misuse
of
Prescrip#on
Medica#ons
• Prescrip#on
Drug
Monitoring
Programs
• Intrastate
and
interstate
data
• Enforcement
efforts
• Community
outreach
and
educa#on

11. Treatment
• Prescrip#on
pain
medica#ons
and
heroin
are
the
same
types
of
drugs:
opioids
• Treatments
are
the
same
• Medical
Withdrawal
(“Detoxifica#on”)
• >
90%
relapse
rate
in
the
year
following
treatment
• High
risk
for
overdose
when
relapse
occurs
• Should
not
be
a
stand
alone
treatment

12. Treatment
• Combina#on
of
FDA-­‐approved
medica#on:
• Naltrexone
• Methadone
• Buprenorphine/naloxone
With
psychosocial
treatments
and
ancillary
treatment
components:
• Counseling:
Coping
skills/relapse
preven>on
• Educa>on
• PDMP
use
• Toxicology
screening

13. Decisions
about
Medica#on
Assisted
Treatment
• Naltrexone:
• Prevents
opioid
effects
including
‘high’
• Effec>ve
in
people
with
strong
incen>ves
(legal,
employment)
and
in
those
not
wan>ng
to
use
an
opioid
medica>on
• Tablet
and
injectable
(addresses
issues
related
to
adherence)
• Can’t
be
used
in
people
needing
treatment
for
pain
• Doesn’t
help
craving

14. Methadone
and
Buprenorphine/Naloxone
• Long
ac#ng,
once
daily
medica#ons
• NOT
‘subs#tu#ng
one
drug
for
another’
• Medica#ons
are
#trated
to
a
therapeu#c
dose:
• Withdrawal
blocked
• Craving
reduced
or
stopped
• Tolerance
occurs
so
that
mood-­‐altering
effects
are
diminished

15. Methadone
• Only
available
through
methadone
maintenance
programs
(MMPs)
• Take
home
doses
con#ngent
on
progress
in
treatment
• A`ending
clinic
and
counseling
• Stopping
illicit
drug
use
• Large
majority
of
methadone
deaths
are
related
to
methadone
prescribed
for
pain;
not
from
MMPs

16. Buprenorphine/naloxone
• Opioid
par>al
agonist:
opioid
effects
not
as
strong
as
other
opioids:
oxycodone,
hydrocodone,
methadone,
heroin
• Binds
>ghtly
to
opioid
receptors
in
the
brain
so
can
par>ally
block
effects
of
other
opioids
• Naloxone
reduces
risk
of
injected
use
in
opioid-­‐
dependent
individuals
• Available
in
outpa>ent
seAngs
from
qualified
doctors

17. Medica#on
Assisted
Treatment
• Benefits:
• Lifestyle
stabiliza>on
• Improved
health
and
nutri>onal
status
• Decrease
in
criminal
behavior
• Employment
• Decrease
in
injec>on
drug
use/shared
needles:
reduc>ons
in
risk
for
HIV
and
viral
hepa>>s/
medical
complica>ons
of
injec>on
drug
use

18. Facts
about
Medica#on
Assisted
Treatment
(MAT)
• Opioid
dependent,
pregnant
women
are
at
high
risk
for
adverse
outcomes
without
MAT
• The
use
of
MAT
by
opioid-­‐dependent
women
with
children
is
an
effec>ve
treatment
that
helps
women
in
paren>ng
their
children
• Neonatal
abs>nence
syndrome
(NAS)
occurs
frequently
in
infants
of
mothers
treated
with
MAT;
approximately
50%
will
need
treatment
Buprenorphine
treatment
associated
with
lower
severity
of
NAS
symptoms
and
shorter
hospital
stays
rela>ve
to
methadone
(Jones,
et
al.
2010)

19. Myths
about
MAT
• ‘Detox’
is
the
best
approach
to
treatment
• People
only
need
a
few
weeks/months
of
treatment
• Opioid
use
disorders
are
chronic,
relapsing
condi>ons
• No
different
than
other
chronic
condi>ons:
diabetes,
high
blood
pressure,
obesity,
depression
• Medica#on
doses
should
be
‘held
low’
There
is
no
medical
basis
for:
• arbitrary
dosing
limits—use
FDA
and
SAMHSA
guidance
• for
limi>ng
treatment
dura>on—let
pa>ents
and
their
doctors
decide
these
issues

20. Ending
the
Epidemic
• Increase
access
to
treatment:
Train
physicians
and
other
clinicians
who
will
provide
treatment
for
opioid
use
disorders
• Con>nue
to
train
healthcare
professionals
in
safe
and
appropriate
use
of
opioids
and
alterna>ves
to
use
of
opioids
for
pain
• Con>nue
to
educate
the
public
about
the
dangers
of
misuse
of
pain
medica>ons
and
safe
use
when
necessary
including
safe
storage
and
disposal
• Use
PDMPs,
treatment
agreements,
and
toxicology
screens
to
increase
safety
• Provide
evidence-­‐based
treatment
to
all
who
need
it
for
as
long
as
it
is
clinically
indicated

21. Thank
you!
Elinore.McCance-­‐Katz@samhsa.hhs.gov