OAT and Recovery - Recovery Capital Conference

Room – Herald Doll Room – 11:00 am to 12:30 pm. February 22nd, 2023, Hyatt Regency Centre, Calgary Alberta

Speakers Dr Imran Ghauri & Dr J Stryder Zobell

Session Description

Opioid Agonist Therapy (OAT) is the gold standard treatment for individuals suffering with opioid addiction or dependence. OAT typically refers to methadone and buprenorphine (Suboxone, sublocade and probuphine); each medication comes with advantages and disadvantages, as well as patient preferences based on their long-term recovery goals. Opioid addiction or dependence can affect anyone, including individuals using street-obtained opioids, or individuals being prescribed opioids due to a range of health issues, often chronic pain.

Addiction and recovery treatments, including harm reduction strategies, are an evolving field of research that is being utilized to inform policies and practices. Individuals accessing OAT are often ready to make healthy changes in their lives. Ensuring these individuals can access programs that support their wellness goals are imperative to address the overarching burden of opioid addiction and dependence for individuals, their families, communities, health care systems, and first responders. OAT reduces overdose rates, improves overall health outcomes of individuals and communities, and decreases the financial and physical burden on healthcare systems, incarceration rates, and first responders.

Traditional approaches to opioid addiction or dependence have centered on abstinence; however, recovery approaches are becoming increasingly popular as recovery recognizes that individuals are on a journey that can include relapses. Supportive programming helps eliminate the stigmatization that these individuals suffer from and the guilt that individuals experience when they do relapse.

Recovery capital focuses on the assets around an individual that aid them on their recovery journey and can include: supportive programs, socials supports, adequate and safe housing, financial health, food security, etc. As individuals stabilize during their recovery, recovery capital increases, which further supports an individual’s success with sustained recovery.OAT providers must focus on a patient-centered care framework; each individual must be supported through equitable programming, and have their recovery goals addressed.

Recovery goals often surround a desire to be “drug-free”, with many understanding they require OAT maintenance over a period of 2 years before they desire to taper off OAT. Despite the common desire to taper off OAT, oral tapers can be challenging; these challenges can be mitigated by the use of longer-acting OAT. Recovery can further promote economic benefits as individuals in recovery often desire to return to being productive members of society.

Learning Objectives

OAT medications: an introduction to current OAT medications, their associated advantages, and disadvantages. Understanding dosages and tapering, including the challenges with oral tapers. Medications that successfully support ease with tapering.
The purpose of tapering is driven by individual recovery goals and the long-term success of OAT and recovery. Abstinence Vs OAT-based recovery.
Recovery: as a focus of treatment goals, to support the individual’s desire to become “drug-free”. Understanding the role of recovery capital for individuals suffering with opioid addiction or dependence. The long-term benefits of recovery for individuals and society as a whole. Improving policies that support recovery-based programs, and the ongoing research required to inform policies, including program outcomes.
VODP’s approach to OAT, specifically long-acting buprenorphine: understanding how VODP operates. Program outcomes and statistics that support recovery and harm reduction approaches. Providing an overview of long-acting buprenorphine approaches with clients in VODP. Tailored approaches to individual patients

References

Evidence for/against tapering OAT (PubMed OAT AND tapering)I. Kosten TR, Baxter LE. Review article: Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment. Am J Addict. 2019 Feb;28(2):55-62. doi: 10.1111/ajad.12862. Epub 2019 Jan 31. PMID: 30701615; PMCID: PMC6590307.II. Srivastava AB, Mariani JJ, Levin FR. New directions in the treatment of opioid withdrawal. Lancet. 2020 Jun 20;395(10241):1938-1948. doi: 10.1016/S0140-6736(20)30852-7. PMID: 32563380; PMCID: PMC7385662.
Buprenorphine vs Methadone (PubMed OAT AND tapering)I. Gowing L, Ali R, White JM, Mbewe D. Buprenorphine for managing opioid withdrawal. Cochrane Database Syst Rev. 2017 Feb 21;2(2):CD002025. doi: 10.1002/14651858.CD002025.pub5. PMID: 28220474; PMCID: PMC6464315.II. Giang V, Thulien M, McNeil R, Sedgemore K, Anderson H, Fast D. Opioid agonist therapy trajectories among street entrenched youth in the context of a public health crisis. SSM Popul Health. 2020 Jun 4;11:100609. doi:
Other notables:V. Day, N., Wass, M. & Smith, K. Virtual opioid agonist treatment: Alberta’s virtual opioid dependency program and outcomes. Addict Sci Clin Pract 17, 40 (2022). https://doi.org/10.1186/s13722-022-00323-4

Bio

Dr Imran Ghauri MD CCFP AMI am a UK trained physician who developed an interest in Addiction Medicine while completing higher training in the Emergency Room, With so many overdoses repeatedly in the ER I decided that I would take the lead and start to prescribe OAT from the ER. I continued my work while further training in General Practice, working in both Addiction Clinics and in Prisons in the UK. I transitioned to Canada where I continued working with the addiction population and while doing so achieved my specialist designation with the College of Family Physicians.I currently am privileged to work with the Virtual Opioid Dependency Program in Alberta. This is a revolutionary program led by Dr Nathaniel Day which has changed the perception of OAT , following Evidence-Based Practice we are able to offer rapid care to Albertans in many different walks of life.