ER Transition Protocol
Primary care providers, clinical behavior health specialists and behavior health directors.
Medication Assisted Treatment ECHO
This interactive web-based program provides essential guidelines and steps to implementing and integrating a successful MAT program into an outpatient primary care setting. The MAT program aims to improve access for patients suffering from opioid use disorder.
- Diagnosing Opioid Use Disorder
- Types of medications (naltrexone vs. buprenorphine) and requirements for each (labs, monitoring, etc.)
- Buprenorphine induction maintenance, relapse and tapering protocols
- Referral process, clinic flow
- Opiate withdrawal-treatment
- Drug screens
- Controlled substance agreement
- Multi-party consents
- Prior authorization requirements for buprenorphine (documentation, barriers, etc.)
- Clinic and community integration
In a recent study of over 150,000 National Health Service patients treated for opioid dependence, followed for a total of 442,950 patient years, treatment of opioid dependence with buprenorphine was found to reduce risk for opioid overdose death by one half versus patients with no treatment or psychosocial treatment only.
In a study of 33,923 Medicaid patients diagnosed with opioid dependence in Massachusetts, mortality during the four-year study period (2003-2007) was double among patients receiving no treatment versus patients treated with buprenorphine. Additionally, patients treated with buprenorphine experienced a 75% reduced mortality versus patients treated with psychosocial interventions alone.
Among the highest risk patients who inject heroin, treatment with methadone or buprenorphine for at least 5 cumulative years, is associated with a reduction in mortality from 25% at 25 years to 6%. The association between treatment and improved survival is likely multifactorial and mediated through reduced risk of HIV infection, improved social functioning, reduced criminality, and establishing long-term contact with health professionals. Importantly, survival benefit is not affected by cessation of injection drug use.
Bery Englebretson, MD (Moderator)
Medical Director, Primary Health Care, Inc.
Nicole Gastala, MD
Physician, Primary Health Care, Inc.
Joah Hogan (Moderator)
Distance Learning Specialist, Primary Health Care, Inc.
Pain Management Nurse/Coordinator, Primary Health Care, Inc.
Behavioral Health Consultant, Primary Health Care, Inc.
Relevant to the content of this CME activity, the planning committee, speakers, and moderators indicated they have no financial relationships with commercial interest companies to disclose.
- Pierce M, Bird SM, Hickman M, Marsden J, Dunn G, Jones A, and Millar T. Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England. Addiction. 2016;111(2):298-308. doi:10.1111/add.13193.
- Clark RE, SamnalievM, Baxter JD, and Leung GY. The evidence doesn't justify steps by state Medicaid programs to restrict opioid addiction treatment with buprenorphine. Health Aff (Millwood). 2011;30(8):1425-33. doi:10.1377/hlthaff.2010.0532.
- Kimber J, Copeland L, Hickman M, Macleod J, McKenzie J, De Angelis D, and Robertson JR. Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment. BMJ. 2010;341(jul01 1):c3172-c3172. doi:10.1136/bmj.c3172.
- Mattick RP, Breen C, Kimber J, and DavoliM. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;2:CD002207. doi:10.1002/14651858.CD002207.pub4.
- Fugelstad A, Stenbacka M, Leifman A, Nylander M, and Thiblin I. Methadone maintenance treatment: the balance between life-saving treatment and fatal poisonings. Addiction. 2007;102(3):406-12. doi:10.1111/j.1360-0443.2006.01714.x.
- Bell J, Trinh L, Butler B, Randall D, and Rubin G. Comparing retention in treatment and mortality in people after initial entry to methadone and buprenorphine treatment. Addiction. 2009;104(7):1193-200. doi:10.1111/j.1360-0443.2009.02627.x.
- Gowing L, Farrell M, Bornemann R, and Ali R. Substitution treatment of injecting opioid users for prevention of HIV infection. The Cochrane Library. 2004.
- Amato L, DavoliM, Perucci CA, Ferri M, Faggiano F, and Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J Subst Abuse Treat. 2005;28(4):321-9. doi:10.1016/j.jsat.2005.02.007.
- Sporer KA. Strategies for preventing heroin overdose. BMJ. 2003;326(7386):442-4. doi:10.1136/bmj.326.7386.442.
- Ward J, Hall W, and Mattick RP. Role of maintenance treatment in opioid dependence. Lancet. 1999;353(9148):221-6. doi:10.1016/S0140-6736(98)05356-2.
Continuing Education Credit
- DO: Des Moines University (DMU) is accredited by the American Osteopathic Association (AOA) to provide osteopathic continuing medical education for physicians. DMU designates this program for a maximum of 1.0 AOA Category 2-A credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in this activity.
- MD: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Iowa Medical Society (IMS) through the joint providership of Des Moines University (DMU) and Primary Health Care, Inc. DMU is accredited by IMS to provide continuing medical education for physicians. DMU designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
- Nurse: Des Moines University is Iowa Board of Nursing approved provider #112. This live activity has been reviewed and approved for 1.0 continuing education contact hour(s). No partial credit awarded.
- Other healthcare professionals: This live activity is designated for 1.0 AMA PRA Category 1 Credit(s)TM.
No commercial interest company provided financial support for this continuing education activity.
Everyone in a position to control the content of this educational activity will disclose to the CME provider and to attendees all relevant financial relationships with any commercial interest. They will also disclose if any pharmaceuticals or medical procedures and devices discussed are investigational or unapproved for use by the U.S. Food and Drug Administration (FDA). Determination of educational content and the selection of speakers is the responsibility of the activity director. Firms providing financial support did not have input in these areas. The information provided at this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition. The content of each presentation does not necessarily reflect the views of Des Moines University.
- 1.00 AMA PRA Category 1 Credits™
- 1.00 AOA Category 2A
- 1.00 CE Contact Hour(s)
- 1.00 IBON