Direct providership by American Academy of Addiction Psychiatry
Christina Brezing, MD | Assistant Professor, Division on Substance Use Disorders, Columbia University Medical Center, New York State Psychiatric Institute
NOTE: This module has been updated by Dr. Brezing from an original 2014 module by Dr. Maria Sullivan and is being re-released with new information and sources. The module also includes an audio option with Dr. Brezing’s recording of her presentation.
This module describes the management of opioid withdrawal, including induction on to maintenance medication treatment, and overdose. Given the current dimensions of the opioid epidemic and elevated rates of prescribing high-potency opioids, we will focus on strategies for implementing effective treatments for opioid use disorder. Pharmacotherapies to support medically assisted opioid withdrawal and induction onto maintenance medication treatment are described, including oral and intramuscular naltrexone, buprenorphine, and methadone tapers. We consider existing barriers to antagonist treatment and address these. Recently developed strategies for outpatient treatment with intramuscular naltrexone are detailed and case based. In addition, we will discuss risk factors for opioid overdose. We consider the advantages and barriers to naloxone for overdose prevention. Several approaches to minimizing the risk of opioid overdose are reviewed.
At the conclusion of this activity participants should be able to:
- Gain familiarity with strategies for detoxification and maintenance treatments for Opioid Use Disorders
- Learn how to use the Clinical Opioid Withdrawal Scale (COWS)
- Be able to discuss the relative advantages of antagonist vs. agonist treatments, as well as medication-assisted treatments in general, for opioid dependence
- Be familiar with naloxone counseling for patients and their families and friends
Accreditation and Designation
American Academy of Addiction Psychiatry (AAAP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.American Academy of Addiction Psychiatry (AAAP) designates this enduring material for a maximum of 1 (one) AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. PAs may receive a maximum of 1 Category 1 credits for completing this activity.
Method of participation in the learning process
In order to receive a maximum of 1 AMA PRA Category 1 Credit™, participants must participate in the entire module, answer post-test questions, pass with a 70% pass rate and complete an evaluation at the end of the activity.