SPOTLIGHT ON 100 after 1 year) of appropriate patients. Optimal outpatient treatment candidates generally have greater social support (employment, housing), or may transition from methadone after extended abstinence. 3. Naltrexone The final medication strategy is naltrexone, a full opioid antagonist. Used to treat both alcohol and opioid dependence, naltrexone fully blocks the mu receptor from opioid binding, so that the user feels no effects. It precipitates full withdrawal unless 7–10 days have elapsed since the last drug use. It is taken orally, or as a monthly depot intramuscular injection (Vivitrol). Warnings include the possibility of hepatic injury, and the inability to obtain pain relief from opioids. Naltrexone is most effective in those with long-term abstinence who do not desire an agonist for employment reasons (i.e. healthcare professionals). In residency, I’ve found working in an outpatient buprenorphine clinic to be rewarding. More than simply substituting one drug for another, MAT effectively removes the physiologic craving in order to address the underlying causes. Patients are not “high,” but are at homeostasis and functioning normally. I repeatedly hear how medication has “given them their lives back.” Steady employment, mended personal relationships, improved nutrition and medical care, financial stability, addressing other addictive behaviors, renewed hobbies and creative interests; all have been achieved where “willpower” alone was not enough. Given the great shortage of Oregon Treatment Programs (and long wait times), Oregon physicians can address an iatrogenic public health crisis by understanding the diagnosis of opioid use disorder and obtaining a buprenorphine waiver if practice circumstances permit. Further education and references may be found by starting at www.samhsa.gov/medicationassisted treatment. Amy Kerfoot, MD, MBI is a Chief Resident at OHSU Department of Preventive Medicine and Public Health and the Portland VA Medical Center. w ww.TheOMA.org Winter 2016 27
OMA Medicine in OR Winter 2015 2016
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