Download Ancillary Withdrawal webinar 11.2.16v2

ANCILLARY WITHDRAWAL AND MEDICATION ASSISTED TREATMENT
Critical Component of Successful Recovery
© The National Center on Addiction and Substance Abuse 2016
Goals For Today
§ Inform and educate
§ Encourage providers to adopt the service
§ Increase the number of providers that are designated and offering the service
§ Further the goal of providing evidence based care in all settings by making Ancillary Withdrawal and Medication Assisted Treatment readily available and easily accessible through out the state. 2
Ancillary Withdrawal Defined
§ A medical regimen, conducted under the supervision of a physician to stabilize the patient, systematically reduce the amount of the addictive substance in a patient’s body, provide reasonable control of active withdrawal symptoms and/or avert life threatening medical crisis related to the addictive substance. § Improve the patient’s ability to engage in treatment and recovery
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Key Concepts
§ Most substances with abuse potential have a withdrawal syndrome. § Withdrawal symptoms are the physiological reaction of the body to the absence of the substance. § In general, the withdrawal syndrome has the opposite symptoms of the substance taken as the body returns to equilibrium. § Treatment includes medication with a like substance to slowly taper the medication to reduce the severity of the reaction and slowly regain a substance free state or if using a long term medication assisted treatment to achieve a craving free state.
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Withdrawal Management Spectrum Severe Withdrawal § Withdrawal Symptoms that may be life threatening including: Delirium Tremens;; seizures, severe dehydration and vomiting
§ Physical Health Conditions that may be exacerbated by withdrawal or make withdrawal more serious.
§ Mental Health Conditions that make stabilization more complicated –for example, severe anxiety, suicidal thoughts or intent. Moderate Withdrawal
§ Symptoms of withdrawal are present and cause significant discomfort or distress.
§ Need for medication with slow taper and observation to ensure that the individual is not worsening to severe withdrawal. Mild/Minimal Withdrawal
§ Mild to Moderate or persistent withdrawal symptoms.
§ Admitted from another level of care, not in need of acute detox services.
§ Need for withdrawal symptom relief.
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Access to Withdrawal Management Services Across all Treatment Services of OASAS Create a Comprehensive Treatment Settings Crisis Services Inpatient Residential
Rehab Medically Managed Withdrawal and Stabilization Medically Supervised
Withdrawal and Stabilization
WMS provided Stabilization phase within the
New Residential Redesign System
Outpatient
Ancillary Withdrawal Management services Medically Supervised
Outpatient Withdrawal and Stabilization
Medically Monitored
Withdrawal and
Stabilization(phasing out) 6
This is Not Detox
§ Ancillary Withdrawal is a stabilization process for patients experiencing MILD to MODERATE withdrawal symptoms
§ Anyone presenting with or developing symptoms of severe withdrawal must be referred to a more intensive level of care.
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Mild to Moderate or Protracted Withdrawal
(Symptoms that can last for months after acute detoxification)
§ The service can provide medication management for symptom relief of mild to moderate or persistent withdrawal as differentiated from acute detoxification services. •
A patient is admitted directly from a detox service (Part 816) (mild to moderate or persistent withdrawal symptoms are present). •
A patient is admitted from another level of care or from home and has used substances several days earlier and it appears that he/she is not in need of acute detoxification services, but does require a degree of medical care to alleviate mild to moderate or persistent withdrawal symptoms and become engaged in treatment. •
A patient is admitted and is exhibiting mild to moderate or persistent withdrawal symptoms as can be seen in alcohol dependence, sedative dependence and opiate dependence. *ENGAGEMENT AT THE BEGINNING OF THE TREATMENT EXPERIENCE
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Withdrawal Symptoms
§ Protracted withdrawal are signs and symptoms which manifest over time after acute withdrawal. § Symptoms can be but not limited to:
• Anxiety, insomnia, restlessness, muscle tension, sleep difficulties, fatigue, persistent fatigue, irritability, depression, difficulty concentrating, drug cravings, mood instability, physical pain and other effects. § Addressing associated symptoms with MAT, education and counseling can make someone more comfortable in their recovery process
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Benefits
§ Research shows that combining treatment medications, where available, with behavioral therapy is the best way to ensure success for most patients. Treatment approaches must be tailored to address each patient's drug abuse patterns and drug-­related medical, psychiatric, and social problems. -­ SAMSHA
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Benefits Cont’
§ Engage patients in treatment directly at an earlier stage in their recovery, reducing opportunities to slip through care
§ Addressing symptoms of withdrawal can enhance engagement for all patients and reduce negative attitudes and behaviors in those experiencing protracted withdrawal
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Benefits Cont’
§ Providers offer a service that could reduce unnecessary use of inpatient level of care –
aligns with goals of a value-­based payment system
§ Can Improve Patient Experience – goal of the Triple Aim
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Alignment with MAT
§ Ancillary Withdrawal provides short term management of symptoms
§ MAT provides long term maintenance
§ Treatment Team and Patient can share the decisions to determine when and if to taper, how best to proceed if MAT is the shared decision.
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Definition of MAT/MSR
§ Medication-­Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-­patient approach to the treatment of substance use disorder. § Research shows that when treating substance-­use disorders, a combination of medication and behavioral therapies is most successful. Medication-­assisted treatment (MAT) is clinically driven with a focus on individualized patient care. – SAMHSA http://www.samhsa.gov/medication-­‐assisted-­‐treatment
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Medication Assisted Treatment
Nicotine Alcohol
• Varenicline
• NRT
• Bupropion •
•
•
Acamprostate
Naltrexone
Disulfuram
Opioids •
•
•
Methadone
Buprenorphine
Naltrexone
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Billing Guidance APG Rate
See the OASAS APG Policy and Medicaid Billing Guidance Manual:
https://oasas.ny.gov/admin/hcf/APG/documents/APGManual.pdf
Ancillary Withdrawal Services: pages 20-­21
MAT: pages 17-­19
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Designation Information
General Questions
See OASAS website:
https://www.oasas.ny.gov/admed/recommend/clin20121.cfm
Visit CTACNY.org under Trainings for Ancillary Withdrawal Videos
Contact Zoraida Diaz at:
[email protected]
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