Summary 16 hour, MAT waiver content: Complete
Solution Q&A 2023.
Dopamine release leads to subjective feelings of ______
pleasure, reward
Why would addiction be considered a disease?
Dz= a disorder of structure or function that produces specific signs or symptoms
Addiction has defined causes (genetics, environment) and observable consequences (behavioral,
biological)
underlying change in brain circuits may persist beyond detoxification, particularly in individuals with
severe disorders. (varies with drugs and intensity of use. Amphetamine may take a year of abstinence to
regain brain dopamine functionality)
Should buprenorphine be prescribed from Emergency rooms?
Twice as likely to follow-up for addiction treatment vs referral alone
What studies support group/social interactions in recovery?
Skinner box with rats: they use more drugs when caged than when in group
65% of vietnam soldiers that were addicted in vietnam did not use opioids on return to USA.
physical exam should always include
looking for injection site marks
-pupils
-bowel sounds
-neuro exam
lab tests at OUD evaluation
HCV, HIV, LFTs, pregnancy test, urine drug screening
Most common formulation of methadone
liquid concentrate or powder used in OTPs
-tablets MC outside of OTPs
define detox program and goal
, narcotic drug is dispensed in decreasing doses, not exceeding one hundred and eighty days, "to alleviate
adverse physiological or psychological effects incident to withdrawal from the continuous or sustained
use of a narcotic drug," with the ultimate goal of bringing a patient to a narcotic drug-free state
What did CARA (Comprehensive Addiction and Recovery Act) 2016 accomplish?
CARA temporarily expands the types of practitioners who may dispense a narcotic drug in Schedule III,
IV, or V for the purpose of maintenance treatment or detoxification treatment without being
separately registered as a narcotic treatment program. Whereas prior to the CARA, only
qualified physicians were permitted to dispense narcotic drugs in this manner, the CARA now
temporarily permits certain nurse practitioners and physician assistants to qualify to do so.
Timing of buprenorphine induction
Pt should be in mild to moderate withdrawal at time of induction. Use COWS assessment (Clinical Opiate
Withdrawal Scale)
-COWS ≥ 8 , 11 or 12 not unreasonable
-COWS< 8 ok if UDS is neg and no self-reported opioid use in past 3 days
-Write Buprenorphine prescription ahead of time so pt can bring it to office and avoid prior-
authorization issues
How many mg can pt get on day 1 of buprenorphine induction?
12 mg
how long is induction phase with buprenorphine/naloxone ?
1-3 days
addiction
a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite
harmful consequences
Why is addiciton considered a brain dz?
Drugs change the brain, they change its structure and how it works. Those brain changes can be long
lasting and lead to many harmful, often self-destructive, behaviors
brain areas affected
amygdala: emotional responses
nucleus accumbens: reward center
cortex: our understanding of drug
denial vs. lying
denial: your perception is off and you act in accordance with your perception
lying: you know something is wrong and fabricate story to clear you of guilt
Solution Q&A 2023.
Dopamine release leads to subjective feelings of ______
pleasure, reward
Why would addiction be considered a disease?
Dz= a disorder of structure or function that produces specific signs or symptoms
Addiction has defined causes (genetics, environment) and observable consequences (behavioral,
biological)
underlying change in brain circuits may persist beyond detoxification, particularly in individuals with
severe disorders. (varies with drugs and intensity of use. Amphetamine may take a year of abstinence to
regain brain dopamine functionality)
Should buprenorphine be prescribed from Emergency rooms?
Twice as likely to follow-up for addiction treatment vs referral alone
What studies support group/social interactions in recovery?
Skinner box with rats: they use more drugs when caged than when in group
65% of vietnam soldiers that were addicted in vietnam did not use opioids on return to USA.
physical exam should always include
looking for injection site marks
-pupils
-bowel sounds
-neuro exam
lab tests at OUD evaluation
HCV, HIV, LFTs, pregnancy test, urine drug screening
Most common formulation of methadone
liquid concentrate or powder used in OTPs
-tablets MC outside of OTPs
define detox program and goal
, narcotic drug is dispensed in decreasing doses, not exceeding one hundred and eighty days, "to alleviate
adverse physiological or psychological effects incident to withdrawal from the continuous or sustained
use of a narcotic drug," with the ultimate goal of bringing a patient to a narcotic drug-free state
What did CARA (Comprehensive Addiction and Recovery Act) 2016 accomplish?
CARA temporarily expands the types of practitioners who may dispense a narcotic drug in Schedule III,
IV, or V for the purpose of maintenance treatment or detoxification treatment without being
separately registered as a narcotic treatment program. Whereas prior to the CARA, only
qualified physicians were permitted to dispense narcotic drugs in this manner, the CARA now
temporarily permits certain nurse practitioners and physician assistants to qualify to do so.
Timing of buprenorphine induction
Pt should be in mild to moderate withdrawal at time of induction. Use COWS assessment (Clinical Opiate
Withdrawal Scale)
-COWS ≥ 8 , 11 or 12 not unreasonable
-COWS< 8 ok if UDS is neg and no self-reported opioid use in past 3 days
-Write Buprenorphine prescription ahead of time so pt can bring it to office and avoid prior-
authorization issues
How many mg can pt get on day 1 of buprenorphine induction?
12 mg
how long is induction phase with buprenorphine/naloxone ?
1-3 days
addiction
a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite
harmful consequences
Why is addiciton considered a brain dz?
Drugs change the brain, they change its structure and how it works. Those brain changes can be long
lasting and lead to many harmful, often self-destructive, behaviors
brain areas affected
amygdala: emotional responses
nucleus accumbens: reward center
cortex: our understanding of drug
denial vs. lying
denial: your perception is off and you act in accordance with your perception
lying: you know something is wrong and fabricate story to clear you of guilt
