Course Summary

Opioids can be extremely valuable medications for pain management but the euphoric properties of opioids can often lead to a substance use disorder. Although the cycle of opioid misuse can be treated, opioid withdrawal is a difficult process that comes with its risks and side effects. Proper medical management of both acute and chronic withdrawal symptoms provides the best opportunity for a permanent positive outcome. Current evidence shows that medical-assisted treatment of opioid use disorder improves a patient’s recovery outcomes. There are ongoing studies on the relapse rate and overdose rate for patients continuing in medical-assisted treatment (MAT). This is particularly true for patients who have completed detoxification because of opioid use. It is vitally important that these patients who, after assessment, are found to have an opioid use disorder, be transitioned into a treatment program to address the opioid use disorder; otherwise, relapse is more likely. The benefit of agonist therapies, methadone and buprenorphine/naloxone are discussed. Reference is also made to the American Society of Addiction Medicine (ASAM) 2015 National Practice Guidelines, which informs providers who are medication-assisted treatment credentialed of current approved agents to treat opioid use and overdose.

Course Format

Homestudy

Course Syllabus

• I.      Introduction
• II.      Prescription and Illicit Opiates
• III.     Substance Use and Withdrawal
  • 1.   Physical Symptoms
  • 2.   Psychological Symptoms
• IV.      Treatment Programs for Opioid Withdrawal Symptoms
  • 1.   Outpatient Treatment
  • 2.   Inpatient Treatment
• V.      Potential Complications and Treatment Barriers
  • 1.   Pregnancy
  • 2.   Failure to Transition from Detoxification to Long-Term Treatment
  • 3.   Suicide Risk
• VI.     Pharmacologic Detoxification and Medication-assisted Treatment
  • 1.   Detoxification
  • 2.   Medication-assisted Treatment (MAT)
  • 3.   Treatment Options for Withdrawal and Substance Use Disorder
  • 4.   Cognitive Behavioral Therapy and Relapse Prevention
• VII.      Case Study 1: Opioid Use Disorder and Buprenorphine Treatment
• VIII.     Case Study 2: Case of Buprenorphine/Naloxone Rapid Taper
• IX.       Summary

Authors

Noah H. Carpenter, MD

Dr. Noah Carpenter is a Thoracic and Peripheral Vascular Surgeon. He completed his Bachelor of Science in chemistry and medical school and training at the University of Manitoba. Dr. Carpenter completed surgical residency and fellowship at the University of Edmonton and Affiliated Hospitals in Edmonton, Alberta, and an additional Adult Cardiovascular and Thoracic Surgery fellowship at the University of Edinburgh, Scotland. He has specialized in microsurgical techniques, vascular endoscopy, laser and laparoscopic surgery in Brandon, Manitoba and Vancouver, British Columbia, Canada and in Colorado, Texas, and California. Dr. Carpenter has an Honorary Doctorate of Law from the University of Calgary, and was appointed a Citizen Ambassador to China, and has served as a member of the Indigenous Physicians Association of Canada, the Canadian College of Health Service Executives, the Science Institute of the Northwest Territories, Canada Science Council, and the International Society of Endovascular Surgeons, among others. He has been an inspiration to youth, motivating them to understand the importance of achieving higher education.

Jennifer McAnally, DNP, PMHNP-BC

Jennifer McAnally holds a Doctor of Nursing Practice degree and specializes in the field of family psychiatry. She has worked in child and adult mental health and substance use treatment settings for over 10 years. She worked previously in academic research settings and as the medical device division manager of a biomedical firm and tissue bank. She has also worked in regulatory oversight of Medicaid programs at the state level. Jennifer’s earlier degrees include a Bachelor of Science in Nursing and Bachelor of Science in Microbiology with emphasis on whole-genome bioinformatics, both from Montana State University. Jennifer is a passionate activist in the field of mental health services, and is dedicated as a mother of two children, to family and to her community in Montana.

Kellie Wilson, PharmD

Kellie Wilson is a Doctor of Pharmacy practicing in Anaconda, Montana, where she lives with her husband and four children. She attended the University of Montana in Missoula where she graduated in 2009 with a doctorate in pharmacy. She later worked in Boise, Idaho for a large, retail pharmacy for 2 years, and then returned home to Montana to oversee an independently owned retail and long-term care pharmacy in Anaconda. As an independent retail pharmacist she has become very involved in psychiatric pharmacy for two major behavioral health organizations that are located around all of Montana. Kellie’s passion is retail pharmacy because she enjoys the interactions with customers as well as the challenges and rewards of staying current with the continuous changes in the pharmacy field.