Download MAT- High risk and Low Risk Options

MAT- High risk and
Low Risk Options
CAPTASA- JAN 28, 2017
LEXINGTON, KY
How it may feel sometimes
Learning Objectives
PARTICIPANTS WILL BE ABLE TO REVIEW THE AVAILABLE DRUGS
APPROVED FOR MAT AND THE CHARACTERISTICS OF PATIENTS MOST
APPROPRIATE TO THESE
•
• PARTICIPANTS WILL BE ABLE TO IDENTIFY THOSE DRUGS WITH A
HIGH ABUSE POTENTIAL AND THOSE WITH LOWER ABUSE POTENTIAL
• PARTICIPANTS WILL BE ABLE TO REVIEW THE
NEUROPHARMACOLOGY OF THE DRUGS INVOLVED AND THE
STRENGTHS AND WEAKNESSES FOR EACH WHEN THEY ARE USED IN MAT
These are the Drugs we will
consider today
High Risk(Buprenorphine)
Low Risk(Naltrexone)
These are the Drugs we will
consider today
High Risk(Methadone)
Low Risk(Acamprosate)
For comparison, structures of
Opioids and activity
A little History

Buprenorphine

We’ll hear lots more later

Designed to be a non addictive
pain med. As a pain med, did not
sell well, became an Addiction
treatment that made lots of money,
now getting a come back as a pain
med

Naltrexone

Naltrexone was originally synthesized
in 1963 and patented in 1967 by
Endo Laboratories- which was
bought by Dupont

In June of 1971, President Richard
Nixon created the Special Action
Office for Drug Abuse Prevention
(SAODAP). The first director, Dr.
Jerome Taffe, was determined to
improve access to drug abuse
treatment by shifting services from
prisons and hospitals to communitybased services. “I regarded the
development of naltrexone as one
of my high priorities,” said Dr. Taffe
A little History

Methadone

Acamprosate

Methadone was developed in
Germany around 1937 to 1939- those
scientists were trying to develop a
pain reliever with less addictive
properties than morphine

It is the first new medication
approved for the purpose of treating
alcoholism in a decade. FDA
approved acamprosate in July 2004
had been used in Europe since 1988.

Also served as an alternative to
Morphine during WWII, when
supplies of opium to the Third Reich
were limited.

It is thought that acamprosate helps
modulate brain activity, particularly
in the glutamate and gammaaminobutyric acid (GABA) systems.
Although acamprosate’s
mechanism of action has not been
clearly established
Methadone- pure Mu
agonist
WHO IS A GOOD CANDIDATE
FOR THIS THERAPY?
Buprenorphine- partial
Mu agonist
WHO IS A GOOD CANDIDATE
FOR THIS THERAPY?
Naltrexone- pure
Mu antagonist
WHO IS A GOOD CANDIDATE
FOR THIS THERAPY?
Acamprosate- ?
Glutamate and GABA ?
WHO IS A GOOD CANDIDATE
FOR THIS THERAPY?
Ever Use
Antabuse?
NOT OFTEN ANY MORE, BUT
HERE’S WHEN IT CAN HELP
I still feel this way often
Greg L Jones, MD
Associate Professor UF College
of Medicine
Florida Recovery Center
4001 SW 13th Street
Gainesville, FL 32608
[email protected]
(352)265-5549