Mental Health Monthly #12: Management of Opioid Use Disorder with MAT (Medication-Assisted Treatment)

In this special episode of MHM, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the implications of OUD in Colorado. As a substance use disorder specialist, Dr. Haddad provides an invaluable perspective on various treatment modalities for OUD in the outpatient and inpatient settings. Finally, Dr. Haddad and Dr. Dhaliwal discuss the implications of the newly introduced Colorado legislation affecting patients with OUD and their providers. 

 

Key Points:

 

• The classic Suboxone therapy for heroin or prescription opioid detox can precipitate severe withdrawal in street fentanyl users. 
• The three FDA-approved MATs include methadone (full opioid agonist), buprenorphine (partial opioid agonist), and naltrexone (opioid antagonist). 
• Street fentanyl does not behave like pharmaceutical-grade fentanyl; a recent study found that the chemical composition of a street pill varied and included opioid analogs and benzodiazepines
• Fentanyl attaches and detaches to/from the receptor more easily and quickly than buprenorphine. Dr. Haddad suspects that as fentanyl weans from the patient's system, there is not enough to compete with Suboxone, therefore precipitating withdrawal.
• Suboxone vs. naltrexone: Suboxone can be started sooner to treat post-acute withdrawal. Naltrexone helps to prevent relapse but may slow a patient's emotional return to baseline. 
• Dr. Haddad recently developed a new home induction program to provide patients with supportive measures for the withdrawal period, which include pharmacologic interventions like clonidine, trazodone, dicyclomine, or loperamide.
• Resources after discharge in Colorado include mental health centers, Front Range Clinic, Magnolia Mental Health
• The criminalization of substance use disorders moves people from treatment-focused settings to punitive settings and leads to prison population expansion without adequate mental healthcare resources.