2024 Addiction Medicine Board Certification Review Course-2024 - A Comprehensive Review of Methadone and Opioid Treatment Programs

Video Transcription

Video Summary

Julie Kmyk, an associate professor of psychiatry at the University of Pittsburgh School of Medicine, and medical director at UPMC's Narcotic Addiction Treatment Program, discusses the history, treatment, and regulations of methadone for opioid use disorder. Methadone, a full opioid agonist, has been researched since the 1960s and became widely used after the Dole and Eiswander study, demonstrating its efficacy in treating heroin addiction. Federal regulations have evolved since the 1970s to control methadone dosing and monitor patients to prevent misuse and ensure safety. Key criticisms include the burdensome regulations compared to other medications.<br /><br />Kmyk also covers modern practices and recent changes allowing more flexible take-home doses, especially during the COVID-19 pandemic, alongside telehealth adaptations. She emphasizes methadone's benefits in decreasing illicit opioid use, reducing harm, and retaining patients in treatment but acknowledges the challenges, such as potential for misuse and regulatory constraints. The presentation integrates a detailed history of regulations, therapeutic guidelines on initial dosing, and managing special circumstances like pregnancy, where methadone use helps prevent complications related to opioid withdrawal and misuse, although adjustments in dosing may be necessary due to increased metabolism during pregnancy.<br /><br />Kmyk provides insights on dealing with missed doses, risk factors for QT prolongation, and possible adverse effects like weight gain and dental issues. Patient confidentiality, especially in opioid treatment programs, and updated legal provisions enhance integrated care while protecting patient privacy. The document concludes with recommendations for resources like SAMHSA's TIP 63 and new federal regulations for additional details.

Keywords

Julie Kmyk

psychiatry

University of Pittsburgh

methadone

opioid use disorder

Narcotic Addiction Treatment Program

Dole and Eiswander study

federal regulations

COVID-19 pandemic

telehealth

pregnancy

QT prolongation

SAMHSA TIP 63

patient confidentiality