Medication Assisted Treatment Services

Buprenorphine: A patient should not begin buprenorphine treatment if they have used a short-acting opioid such as heroin less than 12 hours before induction, or a long-acting opioid such as methadone less than 24 hours. Therefore, patients should only be induced on buprenorphine if they are showing objective signs of opioid withdrawal or they have been opioid-free for at least several days.

Client Selection

Inclusion Criteria:

• Patient is at least 16 years old.
• Patient meets DSM-5 criteria for Opioid Use Disorder.

Exclusion Criteria:

• Patient has serious uncontrolled/untreated psychiatric problems (suicidality, active psychosis, etc.).
• Patient has a severe alcohol use disorder.
• Patient misuses benzodiazepines, sedatives or hypnotics.
• Patient has a known allergy/hypersensitivity to buprenorphine

VIVITROL is used in conjunction with counseling and social support to help individuals who are alcohol or opioid dependent to subsequently cease and/or decrease alcohol or opioid use.

SELECTION CRITERIA

Clients who currently meet the DSM criteria for Alcohol or Opioid Use Disorder (Moderate or Severe) are eligible for Vivitrol therapy. These clients must have recently received detoxification from opioids and should be opioid free for a minimum of 7 days to 10 days.

Clients who are currently receiving Chemical Dependency services at Power House within Partial Care, Intensive Outpatient and who have not recently received detoxification from opioids, may be eligible for Vivitrol therapy if the following criteria are met:

1. Eighteen years of age or older
2. Client has a history of opioid or alcohol use and meets DSM criteria for Alcohol or Opioid Use Disorder (Moderate or Severe).
3. Opioid Dependency clients including those being treated for alcohol dependence must be opioid free at the time of initial Vivitrol administration.
4. To prevent the occurrence of acute opiate withdrawal anyone who receives a VIVITROL injection must not use any type of opioid (must be opioid-free) including street drug, prescription pain medicines, cough, cold, or diarrhea or medicine that contain opioids, or opioids dependence treatments, Buprenorphine or Methadone, for at least 7 to 14 days starting VIVITROL.
5. Intent and ability to abstain from alcohol prior to administration and not actively drinking alcohol at the time of administration
6. Have completed a drug screen and Negative for all opioids
7. Are not currently displaying signs or symptoms of opioid withdrawal
8. Normal liver function
9. Not pregnant
10. Additionally, Client must meet at least one of the following criteria’s
11. Client currently reports cravings
12. Client is at high risk for relapse
13. Clients who are abstinent from use of alcohol.

EXCLUSIONARY CRITERIA:

Any patient with the following conditions will be deferred from Vivitrol therapy:

1. Clients with acute hepatitis or liver failure
2. Clients receiving opioid analgesics
3. Clients in acute opioid withdrawal
4. Clients with positive urine screens for opioids
5. A history of bleeding disorder or thrombocytopenia
6. Clients with renal insufficiency or ESRD
7. Clients with a known previous allergic response to Naltrexone or Vivitrol
8. Clients who fail a Naloxone challenge test
9. If withdrawal symptoms are present, the individual will be referred out to the appropriate level of care (i.e., detoxification service provider) to safely manage withdrawal process/symptoms.
10. Pregnant female
11. If client has any Benzodiazepine use within the past 11 – 14 days
12. Have not been sober for at least 1 day from Alcohol.
13. If client has used any Opioid Medication within the past 10 days (including Fentanyl, Vicodin, OxyContin, Tramadol, etc.)
14. Severe Renal Disease/Renal failure