Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated...
Transcript of Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated...
![Page 1: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/1.jpg)
Introduction toMedication-Assisted
Treatment
Erin Zerbo, MD
Assistant Professor of Psychiatry, Rutgers NJMS
Director, Northern NJ Center of Excellence in MAT
![Page 2: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/2.jpg)
Reward Pathway
Neurons start in the midbrain
release dopamine in the
nucleus accumbens
Baseline: steady dopamine
Drugs: burst of dopamine
(pleasure/salience/motivation)
Responsible for “hedonic tone”
![Page 3: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/3.jpg)
What is Hedonic Tone?
• Sense of well-being, happiness, pleasure, contentment
• “Set” in the reward pathway
• Range: Euphoria Dysphoria
• Altered by psychoactive activities/substances
• Reward Deficiency Syndrome?
Kenneth Blum: DRD2 allele lower D2
Slide courtesy of Dr. Ed Salsitz
![Page 4: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/4.jpg)
0
50
100
150
200
0 60 120 180
Time (min)
% o
f B
asa
l D
A O
utp
ut
Empty
Food Sex
Box Feeding
100
150
200
DA
Con
cen
tra
tio
n (
% B
ase
lin
e)
Sample
Number
1 2 3 4 5 6 7 8
Female Present
Natural Rewards and Dopamine Levels
Adapted from: Di Chiara et al, Neuroscience, 1999
Adapted from: Fiorino and Phillips, J Neuroscience, 1997
![Page 5: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/5.jpg)
5
0
100
200
300
400
0 1 2 3 4 5 hr
% o
f B
as
al R
ele
as
e
COCAINE
0
100
150
200
250
0 1 2 3 hr
% o
f B
as
al R
ele
as
e
NICOTINE
Effects of Drugs on Dopamine Levels
100
150
200
250
0 1 2 3 4hr
% o
f B
as
al R
ele
as
e
0.250.512.5
0
Dose (g/kg ip)
ALCOHOL
MORPHIN
E
% o
f B
asa
l R
ele
ase
0
100
150
200
250
0 1 2 3 4 5 hr
0.51.02.510
Dose mg/kg
Adapted from: Di Chiara and Imperato, Proceedings of the National Academy of Sciences USA, 1988; courtesy of Nora D Volkow, MD
![Page 6: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/6.jpg)
0
100
200
300
400
500
600
700
800
900
1000
1100
0 1 2 3 4 5 hr
% o
f B
as
al R
ele
as
e
DA
AMPHETAMINE
Adapted from: Di Chiara and Imperato, Proceedings of the National Academy of Sciences USA, 1988; courtesy of Nora D Volkow, MD
Effects of Drugs on Dopamine Levels
![Page 7: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/7.jpg)
Acute drug effects
Extra dopamine release changes in cell signaling
D1 DA receptor stimulation
cAMP-dependent protein kinase (PKA)
phosphorylation of CREB
immediate early gene products such as cFos
short-term neuroplastic changes for a few hrs/days
… but none of this explains long-lasting behavioral changes
![Page 8: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/8.jpg)
How to explain end-stage addiction?
Overwhelming desire to obtain drug
Diminished ability to control drug
seeking
Reduced pleasure from biological
rewards
![Page 9: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/9.jpg)
Transition to addiction
Repeated use brain changes that last for days-weeks
Long-acting proteins involved
∆ FosB = transcriptional regulator,
increases AMPA glutamate receptor subunits
Create new circuits based on glutamate, not dopamine
![Page 10: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/10.jpg)
New circuits created from prefrontal cortex (glutamate)
![Page 11: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/11.jpg)
![Page 12: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/12.jpg)
NIDA
And to make matters worse…
![Page 13: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/13.jpg)
Volkow ND, Baler RD. Addiction science: Uncovering neurobiological complexity. Neuropharmacology 2014;76:235-49.
![Page 14: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/14.jpg)
Blue =
mature state
![Page 15: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/15.jpg)
![Page 16: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/16.jpg)
What environmental factors make us vulnerable to addiction?
Blum K, Gardner E, Oscar-Berman M, et al. “Liking” and “Wanting” Linked to Reward Deficiency Syndrome (RSD). Curr Pharm Des 2012.
stress & social defeat
(interacting with our genes)
![Page 17: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/17.jpg)
Transformative Spiritual Experience
![Page 18: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/18.jpg)
“We’ve been doing this for over 40 years since Nixon… The drugs are more available, purer quality, and cheaper than they’ve ever been before… and we’ve destroyed more lives than drugs have by incarcerating people, hanging felony convictions on them, denying them education, denying them jobs… And we don’t even have one drug-free prison in America.”
- Retired police captain Peter Christ
![Page 19: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/19.jpg)
InSite in Vancouver: An overdose prevention center (i.e., a safe injection site)
![Page 20: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/20.jpg)
Courtesy of InSite
![Page 21: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/21.jpg)
Opioids
![Page 22: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/22.jpg)
Endogenous vs. Exogenous Opioids
![Page 23: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/23.jpg)
Classification of OpioidsTraditional Origin Function
Strong
morphine
fentanyl
remifentanil
Intermediate
buprenorphine
pentazocine
butorphanol
Weak
codeine
Naturally occurring
morphine, codeine, thebaine
Semisynthetic
oxycodone, hydrocodone,
hydromorphone,
buprenorphine
Synthetic
fentanyl
methadone
tramadol
Pure agonists
morphine, fentanyl,
remifentanil
Partial agonist
buprenorphine
Agonists-antagonists
pentazocine
nalbuphine
Pure antagonists
naloxone
naltrexone
![Page 24: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/24.jpg)
![Page 25: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/25.jpg)
Distress and Pain:Dorsal Anterior Cingulate Cortex
![Page 26: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/26.jpg)
Opioid Intoxication
• Euphoria experienced as a “rush” of intensely pleasurable feelings
• Reduced psychological pain:
Anxiety, depression, anger, paranoid ideation/psychosis
• GI: nausea, vomiting, constipation
• Miosis (pinpoint pupils)
• Respiratory suppression
![Page 27: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/27.jpg)
• Dysphoric mood
• Nausea/vomiting
• Muscle aches
• Lacrimation
• Rhinorrhea
• Pupil dilation
• Pilorection
• Sweating
• Diarrhea
• Yawning
• Fever
• Insomnia
Opioid Withdrawal
![Page 28: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/28.jpg)
![Page 29: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/29.jpg)
![Page 30: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/30.jpg)
![Page 31: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/31.jpg)
Treatment
![Page 32: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/32.jpg)
Detox
![Page 33: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/33.jpg)
Acute withdrawal
7 days for heroin
Up to 25 days for methadone
Post-Acute Withdrawal Syndrome (PAWS)
Can be up to 1 year
![Page 34: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/34.jpg)
Post-Acute Withdrawal Syndrome (PAWS)
![Page 35: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/35.jpg)
![Page 36: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/36.jpg)
![Page 37: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/37.jpg)
129 times
the overdose
death risk
as compared
to gen. pop.
![Page 38: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/38.jpg)
Methadone
Buprenorphine
Naltrexone
![Page 39: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/39.jpg)
Why do methadone and buprenorphine work?
![Page 40: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/40.jpg)
Volkow Koob
2016 NEJM
![Page 41: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/41.jpg)
![Page 42: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/42.jpg)
Methadone
![Page 43: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/43.jpg)
Buprenorphine
![Page 44: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/44.jpg)
XR-Naltrexone
380mg IM every 4 weeks
![Page 45: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/45.jpg)
The Duration Dilemma
BMJ 2017
![Page 46: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/46.jpg)
The Duration Dilemma
BMJ 2017
![Page 47: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/47.jpg)
Mortality:
4/20 in placebo
group
0/20 in
buprenorphine
group
Kakko et al, 2003
![Page 48: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/48.jpg)
If you do detox…
![Page 49: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/49.jpg)
When prescribing MAT…
Continue despite opioid
relapses
1
Continue despite other
substance use
2
Can start even if just
cravings and no relapse
3
![Page 50: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/50.jpg)
MAT: A Summary
1) Methadone Federally-regulated methadone maintenance programs (1970s)
Decreases overdose deaths, improves psychosocial adjustment, reduces criminal activity, decreases rates of HIV/HCV
2) Buprenorphine Similar outcomes as for methadone
Used since 2002
DATA 2000 waiver allows office-based prescriptions
3) XR- Naltrexone (Vivitrol® injection) Opioid antagonist (blocks receptor)
Much less evidence
80 - 120mg daily
8mg BID
380mg IM q 4 wks
![Page 51: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/51.jpg)
Opioids Are Different
• Post-acute withdrawal syndrome high relapse rates(we need our endogenous opiates)
• Detoxification doesn’t work
• Overdose death most likely after period of abstinence
Inpatient rehab
Incarceration
• MAT is the gold standard of treatment
![Page 52: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/52.jpg)
Friday, September 27, 2019
NJMS.Rutgers.edu/Psychiatry
![Page 53: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/53.jpg)
![Page 54: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/54.jpg)
njsams.rutgers.edu/TreatmentDirectory
![Page 55: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/55.jpg)
Northern COECounties
![Page 56: Introduction to Medication-Assisted Treatment · MAT: A Summary 1) Methadone Federally-regulated methadone maintenance programs (1970s) Decreases overdose deaths, improves psychosocial](https://reader030.fdocuments.us/reader030/viewer/2022040909/5e8102805e7e3158404cb5a3/html5/thumbnails/56.jpg)
Please reach out to us!
Northern: [email protected]
Southern: [email protected]
MAT Provider Hotline866-221-2611
(Monday - Friday, 8am - 8pm)