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This educational web page was developed to provide support to providers and individuals seeking to gather information related to the use of medications to treat Opioid Use Disorder (OUD). Persons with OUD are dependent upon opioids (e.g. prescription pain pills oxycodone and hydrocodone), or the illicit opiate heroin) and receive medication assisted treatment (MAT) through Opioid Treatment Programs (OTP’s).
In the United States, the treatment of opioid dependence with medications is governed by the Certification of Opioid Treatment Programs, 42 Code of Federal Regulations (CFR) 8. This regulation created a system to accredit and certify opioid treatment programs (OTPs).
OTPs provide medication-assisted treatment (MAT) for people diagnosed with an opioid-use disorder. MAT patients also must receive counseling, which can include different forms of behavioral therapy. Learn more about medication and counseling treatment for substance use disorders.
The Office of Behavioral Health under the Colorado Department of Human Services further adds to the oversight of OTP’s in the Code of Colorado Regulations 2 CCR 502-1.
Prior to admitting applicants to treatment, OTP’s must initiate a clearance inquiry to OBH's Central Registry of opioid individuals by submitting applicant information in the prescribed format. Download the Central Registry Form here.
Opioid treatment programs (OTP) seeking to have their programs certified and licensed to dispense medications for the treatment of substance use disorders must complete the federal certification and state licensing process.
Methadone and buprenorphine DO NOT substitute one addiction for another. When someone is treated for an opioid addiction, the dosage of medication used does not get them high–it helps reduce opioid cravings and withdrawal. These medications restore balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery.
Opioid Use Disorder does not discriminate and affects every socioeconomic status, race, sex, and ethnicity. Most opioid use disorders begin with initial dependence on prescribed opiates which escalates to heroin for various reasons (e.g. physician stopped prescribing, cost of prescriptions where heroin is cheaper).
Treatment of opioid-dependent pregnant women with methadone or buprenorphine IMPROVES OUTCOMES for their babies; MAT reduces symptoms of neonatal abstinence syndrome and length of hospital stay. MAT is a recommended best practice for the care of pregnant women with opioid use disorder.
__________https://ncsacw.samhsa.gov/files/Collaborative_Approach_508.pdf. National Institute on Drug Abuse. Accessed 09/20/2017.
MAT DECREASES opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission.1
We wouldn’t tell our loved ones they need to stop their diabetes medication-so why are we telling opioid use disorder patients they need to get off of their Opioid Treatment Program prescribed medication of Methadone/Buprenorphine/Suboxone/Naltrexone? Because there is stigma attached to it and some are afraid of what they don’t know and are in need of education. For some it can simply come down to personal bias.
This treatment is also the most regulated treatment ranging from the State, DEA, and Federal guidelines. Please seek out information to keep yourself and your loved ones informed of the highest evidenced based treatment for opioid use disorder that is Medication Assisted Treatment.
Clear terminology is necessary for effective communication regarding medical issues. Scientists, clinicians, regulators and the lay public use disparate definitions of terms related to addiction. These disparities contribute to a misunderstanding of the nature of addiction and the risk of addiction, especially in situations in which opioids are used, or are being considered for use, to manage pain. Confusion regarding the treatment of pain results in unnecessary suffering, economic burdens to society, and inappropriate adverse actions against patients and professionals.
The American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, recognizes these terms and their definitions and recommend their use:
Addiction is uncontrollable compulsive behavior caused by alterations of parts of the brain from repeated exposure to high euphoric responses.
As a person takes opioids for an extended period of time, they become less sensitive to it and require more to achieve the same effect. Receptors in the brain become less sensitive. This means they need more and more opioid to achieve the same effect. This is called tolerance. When the body can no longer make enough natural opioids to satisfy the less sensitive receptors, the body becomes dependent on the external source. This is physical dependence.
"Physical Dependence" is a physiological state of adaptation to a substance, the absence of which produces symptoms and signs of withdrawal. It is possible to be physically dependent on a drug without being addicted to it. Physical dependence is the result of physical changes in the brain. It is not a matter of willpower rather it is actual physiology.
Addiction is defined as a behavioral syndrome characterized by the repeated, compulsive seeking (psychological dependence) or use of a substance despite adverse social, psychological, and/or physical consequences, along with the physical need for an increased amount of a substance as time goes on to achieve the same desired effect. Addiction is often (but not always, as with an addiction to gambling) accompanied by tolerance, physical dependence, and withdrawal syndrome.
People are dependent on water and food but are not addicted to them. If a cancer patient is taking large doses of painkillers, he/she will become tolerant and physically dependent on them (meaning they will experience withdrawal symptoms if the drug is abruptly removed) but they are not necessarily addicted to it (meaning they will not seek out the drug despite adverse consequences once the drug is no longer needed for pain).
Addiction is a disorder that requires treatment while physical dependence is not. This is important to understand in order to be able to discern between switching one addiction for another and treatment.
Opioids attach to receptors in the brain. Normally these opioids are the endogenous variety that is created naturally in the body. Once attached, they send signals to the brain of the "opioid effect" which blocks pain, slows breathing, and has a general calming and anti-depressing effect. The body cannot produce enough natural opioids to stop severe or chronic pain nor can it produce enough to cause an overdose.
Opioids can activate receptors because their chemical structure mimics that of a natural neurotransmitter. This similarity in structure "fools" receptors and allows the drugs to lock onto and activate the nerve cells. Although these drugs mimic brain chemicals, they don't activate nerve cells in the same way as a natural neurotransmitter, and they lead to abnormal messages being transmitted through the network.
Opioids target the brain's reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who misuse drugs and teaches them to repeat the behavior.
Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way.
Withdrawal syndrome consists of a predictable group of signs and symptoms resulting from abrupt removal of, or a rapid decrease in the regular dosage of, a psychoactive substance. The syndrome is often characterized by over activity of the physiological functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug. In other words, opposite of what the drug did. Example, if the substance suppressed pain then the person will experience pain while in withdrawal.
Withdrawal from opioids can be severe and excruciating. Withdrawal generally begins between 4 to 72 hours after the last opioid use (depending on dose and opioid), The symptoms are both physical and emotional and include: dilated pupils, goose bumps, watery eyes, runny nose, yawning, loss of appetite, tremors, panic, chills, nausea, vomiting, muscle cramps, insomnia, stomach cramps, diarrhea, shaking, chills or profuse sweating, depression, irritability, jitters, and increased sensitivity to pain.
Withdrawal is a symptom of physical dependence. If you are not physically dependent on a substance you will not experience withdrawal from it. To achieve a comfortable transition off a medication you have become physically dependent on requires matching your taper off of the drug with your brain's ability to adapt to each decrease. Too fast will cause discomfort.
Substance use providers may have a wait to get in. If you need immediate assistance, including access to a professional counselor, the Colorado Crisis Line is available 24/7. Call 1-844-493-8255 or Text “TALK” to 38255.
Forms for providers
Abstinence is an intentional choice not to use alcohol or drugs, or to abuse medications. It is a commitment many people make when they want to overcome an addiction.
Addiction is physical dependence on a drug and compulsive using behavior that causes problems in many life areas.
AIDS (acquired immunodeficiency syndrome) is an incurable disease caused by a virus (see HIV). It can be passed on through sexual contact or injection drug use. When someone has AIDS, it means the virus has affected the body's ability to fight diseases. It can be fatal. New medications can be life-saving if HIV/AIDS is detected and treated.
Assessment is a standard set of questions that help doctors, counselors, or other providers tell how severe a person’s drug problem is. It lets them know what treatment approach is best and what other services are needed.
Belief system is a set of ideas and thoughts people hold as true about themselves and the world around them. These include beliefs about what is right or wrong. Individuals, groups, communities, and cultures can have belief systems that influence the way they see things.
Benzodiazepines are a group of addictive medications used for anxiety. They have sedative and relaxing effects. These drugs include Valium, Ativan, and others. They can be fatal when mixed with some medications used to treat opioid use disorder.
Cognitive behavioral therapy (CBT) is a type of counseling that works well for people with drug problems. The counselor helps the person change the thoughts and feelings that lead to using. Then they practice new coping skills.
Cognitive skills are thinking skills. They include the ability to learn, to put ideas together, to remember, and to communicate. Cognitive skills are used to solve problems and make decisions.
Cold turkey is a term for quitting opioids with no medical help or preparation. It involves abruptly stopping drug use in an effort to quit for good. The term refers to one of the symptoms of withdrawal, "goose flesh" (horripilation).
Complementary treatments are helpful things like vitamins, yoga, or exercise. People may do them along with their drug treatment and as an ongoing part of their recovery.
Confidentiality in drug treatment is governed by law. It means information about people in drug treatment is private and cannot be given out without permission.
Counseling in addiction treatment usually includes working on a treatment plan and checking in on progress. It teaches skills that help people stay away from drug use. It also helps people work out other problems and connects them to other services as needed.
Craving is an urgent, overpowering need to use a substance. Anxious, depressive, or negative feelings usually go along with it. The urges are intense because they are related to changes in the brain that result from addiction.
Dependence is a physical change that the body goes through when it gets used to having a substance. Once it happens, people have withdrawal symptoms when they stop or rapidly decrease the drug.
Detox/Detoxification is supervised stopping of drug use. Medications are often used for a short period to help and medical supervision is often required.
Drug interaction is when two drugs do not mix well when they are taken together. Drug interactions can be very dangerous. A prescription medication can interact with a street drug or two or more prescriptions can interact, as can two or more street drugs.
ECG/EKG is an electrocardiogram. It is a test that measures the electrical activity of the heart to see if it is functioning normally.
Heart problems include a change in the heartbeat that puts people at risk for abnormal heart rhythm and sudden death. Methadone use increases the risk of this kind of problem.
Hepatitis C virus (HCV) is an infectious disease that affects the liver. There is a high rate of HCV infection among people who use drugs. It can be passed to others. Some of the ways it gets passed include tattooing, sharing razors, and especially sharing needles, spoons, and other things used to inject drugs. There is also a small risk of getting it through sexual contact with a person who has it. A simple and quick blood test can tell if someone is infected.
Hereditary means something is passed down from parents to children. Each parent gives a set of genes to their children. The genes determine eye color, hair color, and can make children prone to the same illnesses as their parents.
Highly motivated describes people who are ready to make a change. They have important reasons for doing so and are committed. Motivation can change as people become more certain they want to stop using.
HIV (human immunodeficiency virus) is an infection that can lead to AIDS. It is a virus that can be passed on to someone through sexual contact or though sharing needles, spoons, and other things used to inject drugs. A simple and quick test can tell if someone is infected with HIV. When people know they have it, they can get treatment.
Induction is the beginning of MAT, when people start the medication and get used to it.
Infectious diseases are also called communicable diseases because they can spread among groups of people. They are caused by things like bacteria and viruses on shared drug paraphernalia.
Inpatient or residential treatment programs are centers where people live for a period of time while they get counseling and support. Some programs are long-term and offer housing and other services.
Intensive outpatient treatment programs are recovery services people can attend 3–5 times a week for several hours while living at home. They treat severe to moderate substance addiction.
Interferon is a medication used to treat Hepatitis C virus (HCV).
Liver function tests are blood tests that check how well the liver is working.
Maintenance is the long-term part of MAT. People in maintenance may stay on medication for a long time or they may gradually cut down their dosage under medical supervision.
Mutual aid groups are also known as self-help groups. They are made up of people recovering from addiction who help and support each other. Peer support groups like AA and NA are one type of mutual aid group.
Neonatal abstinence syndrome (NAS) is something that happens with babies born to mothers who are using opioids. The infant goes through some degree of withdrawal after birth, which can require medical care. This also can occur when the mother is receiving MAT. About half of the time medical care is required before the infant goes home.
Opiates are a class of drugs that come from the opium poppy, but many people use the word to mean all drugs that belong to the same class, including synthetic opioids.
Opioid drugs are synthetic or natural substances that have a very specific action on the brain and body. They are often used in medicine to relieve pain. They create a feeling of well-being, have sedating effects, and can easily result in physical addiction. Large doses can cause respiratory failure and death.
Outpatient treatment services are often scheduled weekly and may include both group and individual counseling.
Peer recovery support services are provided by a person in recovery. They can include coaching or mentoring, assistance locating housing and employment, and support developing a recovering social network. They are usually offered by Peer Specialists through a recovery community organization or treatment center.
Peer support is when people who are in recovery from addiction give and receive help to others in or seeking recovery.
Prenatal care is working with a doctor and others to take care of yourself and your baby during pregnancy.
Prescribed medications are given to you by a doctor to help with a medical problem. For opioid use disorder, they include methadone, buprenorphine, and naltrexone.
Providers are professionals who give services to people in need of drug and alcohol treatment and other health-related services.
One way of defining recovery is as a process of change through which people work to improve their health and well-being, live a self-directed life, and strive to achieve their full potential. Many people with addiction achieve recovery by abstaining from alcohol and illegal or non-medically required drug use.
Recovery community is made up of people and families who are in recovery from drug and alcohol problems. They share common interests and activities. They support each other and serve as a voice of recovery in the greater community. They sometimes form advocacy or support organizations.
Recovery lifestyle begins when people choose to try and overcome a problem with substances and live a healthier and more fulfilling life, often by adding new goals, activities, and social connections.
Recovery pathways are individual routes to overcoming addiction. There is no one single pathway to recovery and no single definition of recovery that works for everyone. People find their recovery pathway by looking at what has worked for others and trying out approaches they think might work for them.
Recovery skill building is learning strategies and skills to avoid risky situations, seek help when one is having difficulty and/or experiencing cravings or a desire to use, and learning to cope with challenges without using drugs or alcohol.
Recovery supports are people, places, and things that help with staying clean and sober. Each person has different needs such as rides, housing, childcare, job training, or social contacts.
Relapse is a setback that people who are trying to stop using drugs sometimes go through. It can begin with a lot of stress, on top of triggers that lead to cravings. This is often followed by a breakdown in coping skills and isolation from supportive people. Eventually the result is a return to substance use.
Screening is a way of identifying people who may have a problem or condition. When people are screened, it usually means they have some signs that require a closer look.
Sexual problems can include having less than normal interest in sex. Women may have a hard time reaching orgasm and men may have difficulty becoming aroused.
Stabilization is when the person is on the right dose of medication and has adjusted to it.
Stigma is when someone is judged harshly or discriminated against because of their addiction or because of their choice of treatment.
Stress is a feeling of anxiety or worry in your life. Stress is often caused by problems with money, health, relationships, work, housing, and other pressures.
Sudden cardiac death is caused when the electrical system to the heart functions abnormally. The heart is not able to keep blood moving through the body.
Support system is the combination of people and things that help a person get in and stay in recovery.
Thought patterns are set ways of thinking. Sometimes they center on a set of assumptions that may or may not be true. For example: If I can’t get high, I’ll never be able to have fun again. Often changing thought patterns is part of changing behavior.
Tolerance is the body’s adaptation to regular use of a drug. As the body gets used to having the drug, one or more of the drug’s effects decrease over time. It begins to take larger amounts to get the desired effect.
Trauma is an experience that a person finds threatening and frightening, that may have a long-lasting effect. Trauma can relate to childhood experiences such as sexual abuse, domestic violence, or loss, or to later experiences, such as combat, street violence, domestic violence, or sexual assault. People who are addicted to substances or have a history of addiction often have traumatic past experiences that affect them in the present.
Treatment plan is a written document mapping out the approach that the client and the treatment provider have agreed to try.
Treatment programs are usually licensed. They provide counseling, groups, medications, and other services to people seeking help with drug and alcohol problems.
Urine retention is when people have a hard time urinating (peeing) or emptying their bladders.
Withdrawal is what happens when someone is physically dependent on a drug and stops taking it or decreases the amount abruptly. Withdrawal from opioids can be intensely uncomfortable.
Withdrawal symptoms are physical and psychological. They begin shortly after someone stops taking a drug they are physically addicted to. Most of the intense withdrawal symptoms improve with time.
For more information about OBH opioid treatment programs and services, please contact:
Amy Cooper, State Opioid Treatment Authority and Controlled Substance Administrator
Office of Behavioral Health
firstname.lastname@example.org | 303.866.7718