Medical Education

Responding to the Epidemic

Prevention, Health Care, and Legal Professionals across Oklahoma are dedicated to seeing these three main branches of effort put into practice within health care systems, community coalition action plans, law enforcement and first responder protocols. Think SMART Oklahoma promotes these efforts, in addition to others, and has provided readers with information throughout the site on each of these strategies.


What is MAT? Why is it Important?

Regardless if the user took opioids for the feeling they cause, or under the direction and care of a licensed medical provider, extended opioid use can change the chemical function of the brain and cause illnesses like Opioid Use Disorder (OUD).

Medication Assisted Therapy, or MAT, combines behavioral health therapy and medication to treat patients with OUD. These medications stabilize the craving and withdrawal cycles users experience when they cannot find a high enough dose of opioids to prevent them; when withdrawal and craving is prevented, users in treatment can begin to make steps toward recovery.

Get Help Near You

If you or a loved one are struggling with opioid dependency and are ready to explore treatment options, click here to find a treatment provider near you.

Another Step on the road to recovery is becoming familiar with some key terms often used throughout the course of Medication Assisted Therapy. Explore these terms below.

Medication (a partial/mixed agonist) prescribed by certified doctors to treat opioid dependence. Buprenorphine is taken orally (either as a tablet or film), usually on a daily basis. Risk for both overdose and withdrawal is low with buprenorphine, and it has the most evidence for long-term effectiveness in preventing opioid overdose among people with an opioid use disorder.

Involves integrating medications (e.g., methadone, buprenorphine, or naltrexone) in conjunction with behavioral therapies and medications to treat substance use disorders.

Medication (opioid antagonist) administered to rapidly reverse opioid overdose. Naloxone is commonly sold under the brand names Narcan® and Evzio®. It is available through injectors, auto-injectors, and nasal sprays.

An opioid. Most bind with a particular type of opioid receptor (Mu) that is associated with of depression of the central nervous system, euphoria, acute pain relief (analgesia), physical dependence, and sedation.

Medication that blocks the body’s opioid receptors to prevent or discontinue interactions with opioids. Administration of an opioid antagonist, like naloxone, can halt an overdose before its potentially fatal symptoms (e.g. respiratory depression) take full effect. Another opioid antagonist, naltrexone, is medication used to treat opioid dependence after the individual has completed detoxification (for at least seven to ten days). If a person takes other opioids while on naltrexone, they will not have an opioid effect.

MAT Frequently Asked Questions

For most people who receive MAT, the medication weakens or stops cravings and withdrawal symptoms, and blocks the effects of other opioids. Research supports the use of MAT to treat an opioid use problem, as well as reduce the need for people with opioid use disorder to undergo inpatient detoxification when using the MAT buprenorphine.11,12,13,16

In communities where MAT is available and accessed, it decreases opioid-related overdose deaths, criminal activity associated with obtaining opioids, and lowers infectious disease transmission.14

Opioid Treatment Programs (OTPs) incorporate the use of MAT to treat participants with opioid use disorders because it is individually-tailored for each participant, providing a more holistic approach to medication and behavioral therapy.11 According to federal law, OTP participants are required to receive medical, counseling, vocational, and other assessment and treatment services. This additional support contributes to the person’s treatment and recovery journey; indeed, the research shows MAT increases social functioning and likelihood the patient will remain in therapy.11,14

Three medications are currently approved by the Federal Drug Administration to treat opioid use disorder: buprenorphine, methadone, and naltrexone. Buprenorphine is taken orally (either as a tablet or film), usually on a daily basis and can be prescribed by certified doctors for to allow the patient to take at home. Risk for both overdose and withdrawal is lower with buprenorphine than the other types of medications. Methadone is also taken orally, but in liquid form. It requires more oversight in its administration, often dispensed in daily dosages at addiction treatment clinics and OTPs. Methadone is the most effective MAT for people with extensive drug use histories.16

Both buprenorphine and methadone are partial opioid agonists, which means they bind to the same opioid receptors as opioid agonists (e.g. heroin, morphine, oxycodone), but produce a severely weakened opioid effect. When a person is used to using opioids, their body can become physically dependent on them in order to perform even basic functions. Hence removing all opioids from the can cause the person to begin severe withdrawal symptoms.15 To help the person’s body gradually adjust to having smaller and smaller doses of opioids, MAT often use medications containing partial opioid agonists, like buprenorphine and methadone. Among MATs, buprenorphine and methadone have the most evidence for long-term effectiveness in preventing opioid overdose among people with an opioid use disorder.13

Naltrexone is administered as a monthly injection. It is an opioid antagonist, so while it binds to the same opioid receptors as buprenorphine and methadone, it will not produce any opioid effect. It will not satisfy any physical dependence on opioids, which means that a detoxification period of seven to ten day is first required by the patient before beginning naltrexone. Otherwise, the person will experience withdrawal symptoms. This also means that if the person takes other opioids while on naltrexone, they will not be able to feel the opioid effects (e.g. euphoria, analgesia). This elevates their risk for overdose. Risk for overdose also increases when a person takes naltrexone for a period of time, then returns to using opioids because that person’s opioid tolerance will be much lower than it was before starting naltrexone. Research shows naltrexone can help people remain in treatment longer and recover from opioid use disorder.16

The minimal amount of time someone should receive methadone treatment is twelve months, but the medical needs of each individual are different. Many individuals stay on the medication for much longer.15

When people quit taking opioids suddenly, they will experience symptoms of withdrawal such as pain, diarrhea, nausea, and vomiting. They will also experience strong cravings to use opioids. Both the physical withdrawal symptoms and the strong psychological cravings make it difficult to quit using these drugs without medication assistance.14,15

Community Action Network recommends that all levels of providers strive to become waivered to offer MAT services. The pathways to opioid addiction often begin with legitimate medical conditions that require pain management. These are everyday patients who, through injury, now struggle with opioid addiction. These are your neighbors, colleagues, family members and friends. They deserve the opportunity to heal.

Will you become a part of their success story?

MAT Waiver Process

Physician Waiver

Qualified physicians may apply for waivers to treat opioid dependency with approved buprenorphine products.

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Nurse Practitioners & Physician Assistants Waiver

NPs and PAs who have completed the required training can apply for a waiver.

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MAT App

The MATx mobile app supports the medication-assisted treatment of opioid use disorder by leading practitioners through the process to become certified to prescribe buprenorphine.

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Oklahoma Medical Education

Project Echo allows providers to get expert addiction specialist knowledge in a virtual learning environment network with OSU Center for Health Sciences addiction medicine ECHO team. The curriculum is designed to expand expertise in treating substance use disorders in the primary care setting.

But why is greater access to treatment needed?

In Oklahoma, 1 in every 3.6 adults, between 700,000 and 950,000 Oklahomans, need services for substance abuse disorders (SUD). This ranks Oklahoma second in the nation for rates of any substance abuse disorder at almost 12%.

If you are interested in becoming a part of the solution, visit Project Echo for a list of educational topics and schedules.

Project Echo OSMA CME Resources OklahomaMAT Medical CME Resources OSU CME Course Catalog Osteopathic Founders

National Medical Education

In response to the growing opioid epidemic, physicians are expanding their knowledge on safe prescribing practices.

medicine

More than 549,000 health care professionals successfully completed continued education training programs in 2017.

Source: American Medical Association

SAMHSA funds continuing medical education courses on prescribing opioids for chronic pain developed by local and state health organizations across the United States. Most of these courses also include resources that address practice management, legal and regulatory issues, opioid pharmacology, and strategies for managing challenging patient situations.

SAMHSA-supported courses are planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education.

University of Texas at Austin’s Operation Naloxone Project

Continuing online education courses focusing on overdose prevention and response for pharmacists, physicians, nurses, psychologists and social workers.

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RX Pain Medications: Know the Opinions, Get the Facts

This SAMHSA funded publication provides 13 fact sheets designed to increase awareness of the risks associated with prescription opioid use and misuse, as well as educating patients prescribed opioids for pain about the risks and provide resources on methods for alternative pain management.

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Screening, Brief Intervention, and Referral to Treatment (SBIRT)

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs.

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American Academy of Addiction Psychiatry (AAAP)

The AAAP provides a number of continuing medical education opportunities for professionals seeking training on prescribing opioids for chronic pain.

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American Osteopathic Academy of Addiction Medicine (AOAAM)

The AOAAM offers a number of SAMHSA-supported prescribing courses, including a Self-Study Series developed by the Providers’ Clinical Support System for Medication Assisted Therapy.

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American Society for Pain Management Nursing (ASPMN)

The ASPMN sponsors prescribing courses developed by the Providers’ Clinical Support System for Opioid Therapies.

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American Society of Addiction Medicine (ASAM)

The American Society of Addiction Medicine sponsors a number of prescribing courses for MAT services providers. ASAM’s education website offers more than 300 hours of CME learning through live and online instruction.

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OpioidPrescribing.com

Safe and Effective Opioid Prescribing for Chronic Pain offers education in safely and competently using opioids to treat chronic pain.

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Division of Pharmacologic Therapies (DPT)

The Division of Pharmacologic Therapies, part of the SAMHSA Center for Substance Abuse Treatment, also provides buprenorphine training for physicians.

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Addiction Technology Transfer Center (ATTC)

The Addiction Technology Transfer Center Network, funded by SAMHSA, has a training course calendar to help you stay up-to-date on future prescription courses.

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End the Epidemic

The American Medical Association promotes the art and science of medicine and the betterment of public health.

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Provider and Patient Resources

Prescription painkillers (opioids) are the leading cause of injury death in the U.S., and now the most common class of drug involved in overdose deaths in Oklahoma.

Responsible opioid prescribing is an important part of any medical practice. Luckily, Oklahoma Medical Providers are making SMART choices when it comes to prescribing opioids, even though addiction is often reported to be an area of limited focus during their medical school years.

Community Action Network understands this concern and has compiled a variety of resources throughout this webpage to help providers offer a more comprehensive evaluation of their patients. CAN hopes you will take advantage of these resources to strengthen your medical practice surrounding responsible opioid prescribing. Explore the links below to access our State and National recommended prescribing guidelines.


References

11: Substance Abuse and Mental Health Services Administration (SAMHSA). (2015, September 28). Medication and counseling treatment. Link

12: Volkow, N. D., Frieden, T. R., Hyde, P. S., Cha, S. S. (2014). Medication-assisted therapies–Tackling the opioid-overdose epidemic. New England Journal of Medicine, 370(22), 2063-2066.

13: United Nations Office on Drugs and Crime & World Health Organization (UNODC/WHO). (2013, June). Opioid overdose: Preventing and reducing overdose mortality. Vienna, Austria: United Nations. Link

14: National Institute on Drug Abuse. (2016, November). Effective treatments for opioid addiction. Link.

15: National Institute of Drug Abuse (2018). Advancing addiction science: What are the treatments for heroin addiction? Link.

16: SAMHSA. (2016). Decisions in recovery: Treatment for opioid use disorder [Electronic decision Support Tool]. Link.