An Assertive Approach for Youth OUD: Family Engagement and Medication Home Delivery (1.5 CME)
(1.5 CME) In this conference recording from the 2019 Annual Conference, you will learn:
|Young people are disproportionately affected by the current opioid epidemic, with catastrophic consequences for youth and their families. But adolescents and young adults with OUD generally have poor engagement in care, and worse treatment outcomes than older adults. Fewer than 25% of adolescents with OUD receive any relapse prevention medication. Despite the clear and urgent need, there is still a lack of research and clinical consensus on youth-specific treatment models. In particular, while we have evidence for effectiveness of medications, we have little evidence for the most effective delivery models for these medications. We have a long way to go in optimizing engagement and retention. Assertive interventions, including home delivery of medication,s have had a role in overcoming barriers to retention and adherence in numerous chronic relapsing-remitting illnesses, including Assertive Community Treatment (ACT) for severe and persistent mental illness. This session will feature an innovative approach to treatment for high-severity OUD in youth, including assertive outreach, family engagement and home delivery of relapse prevention medications. The session will begin with a description of the intervention. Family engagement empowers families, providing guidance for monitoring and improving adherence for youth in treatment. Confidentiality is sometimes seen as a barrier, and young adults may have developmentally normative resistance to involving their families. But respecting the emerging autonomy of youth and including families are not incompatible with one another. In fact, treatment of youth proceeds best as a collaboration among youth, parents and the treatment team. Additionally, clinic-based treatment can present barriers to treatment access. Home-based services, including monthly administration of extended release naltrexone or extended release buprenorphine, have the potential to overcome many of these barriers. By literally meeting youth and families where they are, in their homes, we may be able to engage and retain youth that are not be likely to succeed in clinic-based settings. The workshop will continue with an interactive discussion of cases vignettes that illustrate the non-linear clinical courses characteristic of this patient population, the decision points in clinical trajectories, and the conundrums in management. There will be a particular focus on practical clinical strategies in leveraging family involvement. Finally, the session will summarize results to date in evaluating the model. Our small published case series (Vo et al , 2017) showed promising results with an increase in retention and number of doses received, compared to a historical comparison group of clinic-based treatment as usual. In an interim analysis of the first 25 subjects in a randomized trial currently underway, preliminary results show that the intervention group had a significantly greater mean number of doses over the first 3 months (2.5 doses) compared to the usual care control (0.3 doses). The intervention group also had a lower rate of OUD relapse (27%) than the control group (91%). There will also be ample opportunity throughout for Q&A and discussion.|
|1.) Describe limitations to clinic based clinical models for the treatment of youth with opioid use disorders|
developmental vulnerabilities of youth that act as barriers to access,
engagement and retention |
|3.) Describe approaches to overcoming barriers to care for youth with OUDs|
Marc J. Fishman
Marc Fishman MD is board certified in addiction psychiatry and addiction medicine. A faculty member of the Johns Hopkins University School of Medicine, he is Medical Director and CEO of Maryland Treatment Centers, a regional behavioral health care provider, with inpatient and outpatient facilities for adolescents and adults. His clinical specialties include treatment of drug-involved and dual-diagnosis adolescents, opioid dependence in adolescents and adults, and co-occurring disorders. He has been principal investigator or collaborator for several NIDA- and CSAT-funded projects to improve and evaluate adolescent treatment, as well as pharmacotherapy trials in adults. He is the author of numerous articles and book chapters on addiction treatment, and lectures widely on a variety of topics including adolescent treatment, youth opioid treatment, placement and treatment matching strategies. Dr. Fishman served as a co-editor for the most recent editions of ASAMs Patient Placement Criteria, leading the adolescent section, and served as the chief editor for the ASAM PPC Supplement on Pharmacotherapies for Alcohol Use Disorders. He is the chair of the Adolescent Committee for ASAM. He is a Past President of the Maryland Society of Addiction Medicine.
ACCME Accreditation Statement
The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
AMA Credit Designation Statement
The American Society of Addiction Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
ABPM Maintenance of Certification (MOC)
The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1.5 LLSA credits towards ABPM MOC Part II requirements.
ABAM Transitional Maintenance of Certification (tMOC)
This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of 1.5 AMA PRA Category 1 Credit(s)™ for completing this course.
ABIM Maintenance of Certification (MOC)
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn 1.5 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.