Medication-Assisted Treatment in Ohio

Opioid Epidemic in Ohio

Amid the ongoing opioid epidemic, Ohio has been significantly impacted, facing substantial challenges in combatting the crisis. Understanding the profound effects of the opioid crisis and examining overdose statistics is vital in comprehending the severity of the situation.

Impact of Opioid Crisis

In 2017, Ohio witnessed one of the highest combined costs of opioid use disorder and fatal opioid overdose among the jurisdictions studied, amounting to a staggering $72,583 million. The per capita combined costs in Ohio were $7,247, highlighting the economic strain and societal impact of the opioid crisis in the state.

The impact of the opioid crisis extends beyond financial burdens, affecting individuals, families, and communities. The rise in opioid addiction has led to devastating consequences, including increased rates of addiction, overdose deaths, and strain on healthcare and social services.

Overdose Statistics

Ohio has taken steps to increase the availability of medication-assisted treatment (MAT) for individuals struggling with opioid addiction. However, significant gaps remain in access, particularly in rural areas and in access to methadone, which is often the most cost-effective and efficacious therapy.

Three primary medications are approved for treating opioid dependence: Vivitrol, methadone, and buprenorphine, with Vivitrol being the most prevalent in Ohio. Studies have shown that methadone and buprenorphine are effective in reducing overdose deaths in the long term, with methadone demonstrating slightly better outcomes compared to Vivitrol, which has not shown the same long-term reductions in overdose deaths or opioid use.

It is essential to acknowledge the financial implications of medication-assisted treatment, as highlighted by Ohio's Medicaid program, which paid approximately $1,200 per monthly shot of Vivitrol in 2017 [2]. Understanding the overdose statistics and the prevalence of different treatment options is crucial in addressing the opioid epidemic and improving the accessibility and effectiveness of treatment in Ohio.

Treatment Costs and Accessibility

Amidst the opioid epidemic in Ohio, the costs and accessibility of medication-assisted treatment (MAT) play a significant role in combating opioid use disorders. Understanding both the financial implications and the availability of MAT options is crucial in addressing this pressing issue.

Cost of Opioid Treatment

The financial burden associated with opioid treatment in the United States is substantial. In 2013, the total costs of prescription opioid use disorders and overdoses were estimated to be $78 billion, with only 3.6% ($2.8 billion) earmarked for treatment. The cost of opioid treatment encompasses not only the medications themselves but also the expenses related to therapy, counseling, and medical monitoring.

It is essential for individuals seeking treatment in Ohio to consider the financial aspect of MAT. Understanding the costs involved and exploring potential financial assistance options can make treatment more accessible to those in need. For more information on mental health support and resources available in Ohio, visit mental health help for Ohio college students and Ohio mental health hotlines.

Availability of MAT in Ohio

Ohio has taken significant steps to increase the accessibility of medication-assisted treatment for individuals struggling with opioid addiction. The number of counties offering some form of MAT has risen, providing options for those seeking to overcome heroin and opioid dependencies. However, there are still notable gaps in access, particularly in rural areas and in the availability of methadone, which is often the most cost-effective and efficacious therapy for opioid use disorders.

In Ohio, three medications are approved for the treatment of opioid dependence: Vivitrol, methadone, and buprenorphine. Vivitrol is the most prevalent medication in the state; however, there has been a bias towards Vivitrol due to financial considerations rather than scientific evidence or patient needs, despite potential uncertainties regarding its effectiveness and outcomes.

For a more comprehensive look at the guidelines and regulations governing the use of opioids and MAT in Ohio, refer to the Ohio Academy of Family Physicians. These guidelines emphasize the adoption of non-opioid therapies, the importance of checking Ohio's Automated Rx Reporting System (OARRS) before prescribing opioids, and the necessity for regular patient reevaluation.

Ensuring the accessibility of MAT in Ohio involves not only expanding treatment options but also addressing financial barriers and promoting evidence-based practices. By enhancing the availability and affordability of opioid treatment, Ohio can make significant strides in supporting individuals affected by opioid use disorders and reducing the impact of the opioid epidemic in the state.

Medication-Assisted Treatment (MAT) Options

In the realm of addressing opioid use disorder (OUD), medication-assisted treatment (MAT) plays a crucial role in aiding individuals in their recovery journey. Understanding the different approved medications for OUD and assessing their effectiveness is paramount.

Approved Medications for Opioid Use Disorder

Three main medications are approved to treat individuals struggling with opioid dependence: Vivitrol, methadone, and buprenorphine. Among these, Vivitrol is notably the most widely available drug in Ohio. Each medication functions uniquely in addressing OUD:

• Vivitrol: This medication works by blocking the effects of opioids in the brain, reducing the cravings and effects of opioid use. It is administered monthly and is favored for its non-addictive nature.
• Methadone: Methadone has been proven to reduce overdose deaths in the long term and is somewhat more effective compared to Vivitrol in reducing opioid use over an extended period. It acts by targeting the same areas in the brain as opioids, without producing the euphoric high.
• Buprenorphine: Another effective medication for OUD, buprenorphine helps in reducing withdrawal symptoms, cravings, and the euphoric effects of opioids. It can be prescribed by qualified healthcare providers for home use, enhancing accessibility and flexibility in treatment.

Effectiveness of Different Medications

When considering the effectiveness of medications for OUD, it's essential to note that buprenorphine, methadone, and naltrexone are the primary choices recommended by the Substance Abuse and Mental Health Services Administration. These medications serve varying purposes in managing OUD effectively:

• Buprenorphine: This medication has been particularly effective in normalizing brain chemistry, alleviating cravings, and managing withdrawal symptoms without inducing the euphoric effects of opioids. It can be safely used for varying durations, ranging from months to potentially a lifetime.
• Methadone: Demonstrating promising results in reducing overdose deaths and curbing opioid use, methadone is a long-acting medication that aids individuals in managing OUD over the long term. It offers stability and control in medication-assisted treatment.
• Naltrexone: While less commonly used compared to buprenorphine and methadone, naltrexone is a viable option for some individuals. It functions by blocking the effects of opioids in the brain, preventing the euphoric high associated with opioid use. Regular counseling and patient supervision are critical for optimizing the benefits of naltrexone treatment.

By exploring the range of approved medications and assessing their efficacy in managing OUD, individuals battling opioid dependence in Ohio can make informed decisions in their treatment journey. It is essential to consult with healthcare professionals to determine the most suitable medication-assisted treatment plan tailored to individual needs and circumstances.

Advancements in Ohio's Approach

As Ohio continues to address the challenges posed by the opioid crisis, significant advancements have been made in shaping the state's approach to combating opioid misuse and promoting effective treatment strategies. Two key areas where notable progress has been achieved are state regulations on opioid prescribing and guidelines for opioid use disorder treatment.

State Regulations on Opioid Prescribing

The state of Ohio has implemented a series of regulations aimed at improving the prescribing practices of opioids to combat misuse and abuse. In April 2012, the GCOAT (Governor’s Cabinet Opiate Action Team) released Emergency and Acute Care Facility Opioid and Other Controlled Substances Prescribing Guidelines. These guidelines were designed to reduce "doctor shopping," limit the quantity of opioids prescribed, and ensure that patients are appropriately referred for evaluation, treatment, and monitoring of continuing pain [5].

Under provisions of House Bill 314, signed into law in June 2014, prescribers in Ohio are required to obtain written informed consent from a minor's parent, guardian, or other responsible person before issuing a controlled substance prescription to a minor. This regulation aims to enhance accountability and oversight in the prescription of controlled substances within the state.

Since December 2018, Ohio prescribers have been following new regulations for prescribing opioids for long-term and subacute pain to ensure that treatment is improving patients' quality of life without increasing the risk of misuse and addiction. These regulations reflect the state's proactive stance in combating the opioid epidemic through carefully monitored prescribing practices.

Guidelines for Opioid Use Disorder Treatment

In addition to enhancing regulations on opioid prescribing, Ohio has developed comprehensive guidelines for the treatment of opioid use disorder. These guidelines serve as a framework for healthcare providers to deliver effective and evidence-based care to individuals struggling with opioid addiction.

Guidelines for the Management of Acute Pain Outside of Emergency Departments were released in January 2016. These guidelines emphasize the importance of non-opioid therapies and pain medications when appropriate. Prescribers are encouraged to check Ohio's Automated Rx Reporting System (OARRS) before prescribing opioids and to reevaluate patients prescribed opioids at designated checkpoints.

By establishing clear guidelines and protocols for opioid use disorder treatment, Ohio aims to improve outcomes for individuals battling addiction and promote the responsible use of medications to address this public health crisis. The state's proactive measures underscore its commitment to combating the opioid epidemic and supporting individuals in their journey towards recovery.

Role of Advanced Practice Registered Nurses (APRNs)

In Ohio, Advanced Practice Registered Nurses (APRNs) play a crucial role in providing medication-assisted treatment (MAT) to individuals struggling with opioid use disorder. They are authorized to prescribe controlled substances under schedules III, IV, or V as part of MAT, following specific regulations outlined in the Ohio Administrative Code.

Providing Medication-Assisted Treatment

Under the Ohio Administrative Code, APRNs are empowered to offer office-based opioid treatment (OBOT) that includes medication-assisted treatment for opioid use disorder. This authorization allows APRNs to administer medications like buprenorphine and naltrexone, essential components of MAT that help individuals manage cravings and withdrawal symptoms effectively.

APRNs specializing in mental health are well-equipped to assess patients' needs, develop treatment plans, and monitor progress throughout the medication-assisted treatment process. Their expertise enables them to deliver comprehensive care that addresses both the physical and psychological aspects of opioid use disorder.

Protocols for Patient Care

Ohio's regulatory framework includes specific protocols that guide APRNs in providing office-based opioid treatment. These protocols outline the necessary steps for assessing patients, determining treatment plans, and monitoring outcomes. By adhering to these guidelines, APRNs ensure that patients receive safe and effective medication-assisted treatment tailored to their individual needs.

Moreover, APRNs administering buprenorphine products for medication-assisted treatment must follow the protocols established in the Ohio Administrative Code. These protocols help standardize care practices and ensure consistent delivery of evidence-based treatment to individuals seeking support for opioid use disorder.

By collaborating with other healthcare professionals, including physicians and counselors, APRNs in Ohio create a multidisciplinary approach to opioid use disorder treatment. This team-based care model enhances the quality of care provided to patients and improves treatment outcomes by addressing the complex nature of opioid addiction comprehensively.

In conclusion, APRNs in Ohio are instrumental in expanding access to medication-assisted treatment for individuals impacted by opioid use disorder. Their commitment to providing evidence-based care, adherence to regulatory protocols, and collaborative approach to patient management contribute significantly to addressing the opioid epidemic in Ohio and supporting individuals on their path to recovery.

Administration of Buprenorphine

When it comes to the administration of buprenorphine as part of medication-assisted treatment (MAT) for opioid use disorder, there are specific regulations, requirements, patient monitoring protocols, and education standards that must be followed to ensure the safe and effective use of this medication.

Regulations and Requirements

Advanced practice registered nurses (APRNs) in Ohio who are responsible for administering buprenorphine products as part of MAT are mandated to adhere to the FDA-approved Risk Evaluation and Mitigation Strategy. They are required to prescribe buprenorphine/naloxone combination products in most cases, with the obligation to document reasons for opting for buprenorphine mono-product in specific scenarios such as pregnancy, allergies, or intolerances. Co-prescribing buprenorphine with certain drugs is permissible under stringent conditions for medically necessary purposes, with the inclusion of tapering plans and patient education requirements. These regulations aim to ensure that buprenorphine is prescribed and managed responsibly to promote the well-being of patients.

Patient Monitoring and Education

In the context of buprenorphine administration, patient monitoring plays a crucial role in tracking treatment progress, detecting any adverse effects, and ensuring compliance with the prescribed regimen. The Ohio guidelines recommend weekly patient visits during the induction phase of buprenorphine treatment to closely monitor the patient's response and adjust the dosage as needed. This frequent monitoring helps healthcare providers assess the patient's tolerance to buprenorphine and address any emerging concerns promptly.

Additionally, specific dose restrictions are outlined during the stabilization phase of buprenorphine treatment to maintain a balance between therapeutic benefits and potential risks. By closely monitoring the patient's progress and adherence to the treatment plan, healthcare providers can optimize the effectiveness of buprenorphine therapy and minimize the likelihood of adverse outcomes.

Patient education is an integral component of buprenorphine administration within MAT. APRNs are responsible for educating patients on various aspects of their treatment, including the expected outcomes, potential side effects, proper medication usage, the importance of compliance, and strategies to manage any challenges that may arise during treatment. By empowering patients with comprehensive information and guidance, healthcare providers can enhance treatment outcomes and promote patient engagement in their recovery journey.

In conclusion, the administration of buprenorphine in Ohio under the guidelines and regulations set forth by state authorities is designed to ensure that patients receive safe, effective, and individualized care as part of their opioid use disorder treatment. Healthcare providers play a vital role in monitoring patients closely, providing ongoing education, and promoting a collaborative approach to MAT that prioritizes the well-being and recovery of individuals struggling with opioid addiction.

Treatment with Naltrexone

When considering medication-assisted treatment in Ohio for opioid use disorder, Naltrexone is one of the approved medications that play a significant role in managing this condition. Understanding the considerations for Naltrexone use, along with the necessity for counseling and patient supervision, is essential for effective treatment.

Considerations for Naltrexone Use

Naltrexone is an FDA-approved medication for opioid use disorder that works by blocking the effects of opioids in the brain, thereby reducing the cravings and reinforcing effects of opioids [4]. It is considered safe for long-term use and can help individuals maintain abstinence from opioid substances.

One crucial consideration for Naltrexone use is the need for individuals to be opioid-free for a certain period before starting treatment. This is to prevent precipitated withdrawal symptoms that can occur if Naltrexone is administered while opioids are still in the system. Patients must also be informed about the potential side effects of Naltrexone and the importance of adhering to the prescribed dosage.

Counseling and Patient Supervision

Incorporating counseling and patient supervision alongside Naltrexone treatment is vital for maximizing its effectiveness. Counseling sessions can provide essential support, behavioral therapy, and coping mechanisms to individuals undergoing treatment for opioid use disorder. It helps address underlying issues that may contribute to substance misuse and aids in building resilience and long-term recovery.

Moreover, patient supervision plays a critical role in monitoring the progress of individuals receiving Naltrexone treatment. Regular check-ins with healthcare providers help assess the response to the medication, address any concerns or side effects, and make necessary adjustments to the treatment plan. Continued support and monitoring contribute significantly to the success of Naltrexone therapy and the overall recovery process.

By understanding the considerations for Naltrexone use and the importance of counseling and patient supervision, healthcare providers and individuals with opioid use disorder can work together to achieve positive treatment outcomes in the journey towards overcoming opioid addiction. For additional mental health resources in Ohio, such as hotlines and support services, refer to Ohio mental health hotlines.

Comprehensive Approach to Opioid Use Disorder

Addressing opioid use disorder requires a comprehensive treatment approach that combines medication and therapy to effectively support individuals in their recovery journey. By integrating medication-assisted treatment (MAT) with therapeutic interventions, individuals with opioid use disorder can receive the comprehensive care needed to manage their condition and reduce the risk of relapse.

Combining Medication and Therapy

Research indicates that a combination of medication and therapy can be highly effective in treating substance use disorders and sustaining long-term recovery. Tailoring medication options to meet the unique needs of each patient is crucial in achieving positive outcomes. Medications approved for opioid use disorder, such as buprenorphine, methadone, and naltrexone, play a key role in normalizing brain chemistry, alleviating cravings, and managing withdrawal symptoms without inducing the euphoric effects associated with substance use.

The integration of therapy, including cognitive-behavioral therapy (CBT), counseling, and support groups, complements the pharmacological aspect of treatment by addressing the psychological and behavioral aspects of addiction. Therapy helps individuals develop coping mechanisms, improve self-awareness, and build a strong support network to navigate the challenges of recovery successfully.

Preventing Opioid Overdose

An integral component of addressing opioid use disorder is implementing strategies to prevent opioid overdose. Effective prevention measures include improved opioid prescribing practices, the availability of overdose education programs, coupled with naloxone distribution, and the utilization of approved medications like methadone, buprenorphine, or naltrexone.

Ensuring access to naloxone, an opioid antagonist that can reverse the effects of an opioid overdose, is crucial in emergency situations. Educating individuals at risk of overdose, as well as their families and caregivers, about the signs of an overdose and how to administer naloxone can save lives and prevent fatalities.

By adopting a comprehensive approach that combines medication-assisted treatment with therapy and overdose prevention strategies, Ohio can enhance its efforts to combat the opioid epidemic and support individuals grappling with opioid use disorder. This multifaceted approach aims to address the complex needs of individuals affected by opioid addiction and promote sustained recovery and wellness.

References

[1]: https://www.cdc.gov/mmwr/

[2]: https://www.harmreductionohio.org/

[3]: https://nida.nih.gov/publications/

[4]: https://www.samhsa.gov/medications-substance-use-disorders

[5]: https://www.ohioafp.org/public-policy/‍