Medication Assisted Treatment

Medication-assisted treatment (MAT) is the use of medications with counseling and behavioral therapies to treat substance use disorders and prevent opioid overdose.

Healthcare

Discussing an emergency overdose/poisoning/oversedation plan and naloxone prescribing is an essential component of that dialogue.

Primary Care and Chronic Pain Settings

Medical providers can engage in proactive dialogue with patients to minimize poisoning, over sedation, and overdose risk with patients who need opioid medications to improve function. Discussing an emergency overdose/poisoning/oversedation plan and naloxone prescribing is an essential component of that dialogue.

In order to gauge overdose risk and patient history, providers can:

• Review medications
• Take a substance use history
• Check the prescription drug monitoring program (PDMP)
• Take an overdose history – Ask your patient whether they have:
  • Overdosed or had a bad reaction to taking opioid medications?
  • Witnessed an overdose?
  • Received training to prevent, recognize, or respond to an overdose or medication-related oversedation?

For more resources and clinical guidance about prescribing naloxone, please visit http://prescribetoprevent.org/prescribers/palliative/

Emergency Medicine Settings

Opioid overdose is a leading cause of death in the United States. Community overdose education and naloxone distribution programs have been shown to decrease overdose deaths and the emergency department (ED) is an ideal setting for opioid overdose death prevention through the distribution of overdose naloxone rescue kits, overdose prevention, and response education to patients and their friends and family.

Hospitals can also serve as access points to substance use disorder treatment services, including medication-assisted treatment, either directly or through referral. Several hospitals in Florida are utilizing Certified Peer Recovery Specialists in the ED to connect overdose patients to recovery support and harm reduction services. If a patient is ready for treatment, medication-assisted treatment can also begin in the ED, followed by linkage to a community-based provider upon discharge.

For more resources and clinical guidance about implementing an ED-based naloxone distribution program, please visit: http://prescribetoprevent.org/prescribers/emergency-medicine/

If a non-profit hospital in Florida is interested in starting a naloxone distribution program to provide take-home naloxone kits upon discharge to patients at risk of overdose and their friends and family, you may be eligible to receive free naloxone from DCF for this program. Please review DCF’s Overdose Prevention Program information and/or contact DCF’s Overdose Prevention Coordinator at Amanda.Muller@myFLfamilies.com

Substance Use Disorder Treatment Settings

Overdose is an ever-present issue in substance use disorder treatment, yet it is rarely directly addressed. While engagement in substance use disorder treatment can help individuals eliminate or reduce drug use, which can decrease overdose risk, it is also a tolerance changing event that can actually increase risk for overdose death.

In March 2015, SAMHSA updated Opioid Treatment Program guidelines, including new guidance on discussing overdose:

“Overdose prevention, including prescribing or dispensing naloxone, is an essential complement to both detoxification services as well as medically supervised withdrawal. Patients should be advised of the risks of relapse following detoxification and offered a relapse prevention program that includes counseling, naloxone and opioid antagonist therapy.”

Similarly, in June 2015, the American Society of Addiction Medicine (ASAM) developed National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use, including guidance on discussing overdose:

“The Guideline Committee, based on consensus opinion, recommends that patients who are being treated for opioid use disorder and their family members/significant others be given prescriptions for naloxone. Patients and family members/significant others should be trained in the use of naloxone in overdose.”

Opportunities to address overdose and distribute take-home naloxone kits in substance use disorder treatment:

• Waitlists
• Intake assessment
• Trauma screening
• Induction or orientation phase
• Individual or group counseling
• Routinely upon positive drug screen results
• At discharge
• When client overdoses
• International Overdose Awareness Day (August 31- the day before Recovery Month)
• Family support groups
• Consider developing an on-site emergency overdose response policy and provide staff training

If a non-profit substance abuse treatment provider in Florida is interested in implementing a naloxone distribution program to provide free take-home naloxone kits to the people they serve at risk of overdose and their friends and family, you may be eligible to receive free naloxone from DCF for this program. Please review DCF’s Overdose Prevention Program information and/or contact DCF’s Overdose Prevention Coordinator at Amanda.Muller@myFLfamilies.com