Management of Benzodiazepines in Management of Benzodiazepines in - PowerPoint PPT Presentation

Management of Benzodiazepines in Management of Benzodiazepines in Medication-Assisted Treatment: P Project Overview and Next Steps j O i d N S

Management of Benzodiazepines in g p Medication-Assisted Treatment Objectives: Objectives: • Overview of the development and next steps of the project • Description of the RAND/UCLA Appropriateness Method, which will be used to develop clinical guidelines for the management of g g benzodiazepines in MAT • Ways in which we need you to be involved.

The need for guidance and standards Th d f id d t d d • Use of benzodiazepines in Use of benzodiazepines in Treating the MAT is a complicated and multi- Addiction and faceted issue without clear Promoting clinical guidance clinical guidance Recovery y • Published literature, treatment protocols and guidelines Addressing demonstrate variation and d i i d Collateral inconsistency in clinical practice. Mental Illnesses • There is a need to establish a e e s a eed to estab s a set of principles for the appropriate use of benzodiazepines in MAT benzodiazepines in MAT

Development of the Project l f h j Out of discussions Out of discussions between providers and Roland Lamb at the Philadelphia Department Philadelphia Department of Behavioral Health Intellectual disABILITY Services, Office of Addiction Services came the suggestion of the model for developing best practices RAND/UCLA Appropriateness Study done by CCBH and IRETA in Western PA…

Development of the project D l t f th j t I iti ll Mi h Initially Michael Flaherty and later l Fl h t d l t Peter Luongo of IRETA • Developed and submitted a proposal to p p p DBHIDS to develop clinical guidelines Dr. James Schuster of CCBH • Shared experience with Buprenorphine project Shared experience with Buprenorphine project • Expressed interest in partnering in the development of guidelines for Benzodiazepines

Ki k Off C Kick Off Conference f

C Conference Planning f Pl i • Kick-Off Conference was planned for ~150 p stakeholders in Philadelphia, Pennsylvania and the larger region. • Expert panel members from Philadelphia and beyond E t l b f Phil d l hi d b d were selected to speak at the conference and participate in the guideline development process. g • Logistical support for the conference provided by SAMHSA

C Conference Agenda Highlights f A d Hi hli ht Rates of Benzodiazepine Use in Medication ‐ Assisted Treatment in Pennsylvania and Nationally Epidemiology, Morbidity and Mortality for Benzodiazepine Use – Jane C. Maxwell, PhD Rates of Benzodiazepine Use in MAT from CCBH counties – James Schuster, MD, MBA Rates of Benzodiazepine Use in MAT from CBH counties – Matthew O. Hurford, MD Settings and Coordination of Care Clinical Management of the Benzodiazepine ‐ dependent Patient – Laura F. McNicholas, MD, PhD l l f h d d d h l h Benzodiazepine Prescribing in Primary Care Settings: Issue for Concern? ‐ Louis E. Baxter, Sr., MD, FASAM Psychiatry and Co ‐ Occurring Disorders – Peter A. DeMaria, Jr., MD, FASAM, DFAPA Benzodiazepines and Buprenorphine in the OBOT Setting – Laura A. Murray, DO Benzodiazepines and the Pregnant Patient: Special Challenges – Karol Kaltenbach, PhD Panel discussion with audience participation Panel discussion with audience participation Drug Interactions Pharmacology (Drug ‐ Drug Interactions) – Antoine Douaihy, MD Treatment of Anxiety in the Methadone Maintained Patient – Abigail Kay, MD, ABPN, ABAM Risk Management and Patient Education Risk Management – Trusandra Taylor, MD, FASAM, MPH Patient Safety and Education – Jan Kusserow, RN, BSN, CCM Development of Clinical Guidelines Guidelines for Treating OMT Patients with Benzodiazepines: Can We Get Some Help Here? – Peter R. Cohen, MD

C Conference is a Success! f i S ! So… what’s next?

Recommending Guidelines to the Field R di G id li t th Fi ld • RAND/UCLA Appropriateness Method was / pp p developed in the 1980s to assist in identifying overuse/underuse of medical procedures. • This method was utilized by IRETA/CCBH/RAND to Thi th d tili d b IRETA/CCBH/RAND t develop a set of buprenorphine practice guidelines. • Report available at: Report available at: http://www.ccbh.com/providers/phealthchoices/articl es/current/buprenorphine.php

RAND/UCLA Appropriateness Method RAND/UCLA Appropriateness Method RAM used for: • Procedures that are used frequently P d th t d f tl • Procedures that are associated with a substantial amount of morbidity and/or substantial amount of morbidity and/or mortality • Procedures that consume significant g resources • Procedures with wide variations among geographic areas in rates of use hi i t f • Procedures whose use is controversial

RAND/UCLA A RAND/UCLA Appropriateness Method i t M th d Steps in the process Literature Rating g Clinical Review Process Guidelines

RAND/UCLA A RAND/UCLA Appropriateness Method i t M th d Steps in the process Literature Literature Rating Rating Clinical Clinical Review Process Guidelines • We need your input! • We need your input! • Development of background paper • Development of proposed clinical guidelines

RAND/UCLA A RAND/UCLA Appropriateness Method i t M th d Steps in the process Literature Rating Clinical Review R i P Process G id li Guidelines • Expert panel rates proposed clinical proposed clinical guidelines, using background paper to guide ratings • Round 1 Ratings • Round 1 Ratings • Expert Panel Meeting • Round 2 Ratings

RAND/UCLA A RAND/UCLA Appropriateness Method i t M th d Steps in the process Lit Literature t R ti Rating Clinical Cli i l Review Process Guidelines • Development of draft clinical guidelines • Draft clinical guidelines to be posted for public to be posted for public comment at DBHIDS

W We need your input! d i t! • Submitting resources during literature review Submitting resources during literature review • Clinical experience and/or research literature on any aspect of management of benzodiazepines in medication-assisted treatment • Submit resources via email to: dawn@ireta.org • Deadline for submission of resources: April 30, 2012 Deadline for submission of resources: April 30 2012 • Public comment on draft clinical guidelines, Public comment on draft clinical guidelines during September 2012.

Project Timetable Project Timetable PROJECT MILESTONE TARGET DATE Kick-Off Conference Held Kick-Off Conference Held February 2012 February 2012 Follow Up Webinar Held April 2012 Provider Input Solicited April 2012 Lit Review and Background Paper Completed May 2012 Preliminary Guidelines Drafted May 2012 First Round of Ratings Completed June 2012 Expert Panel Meeting Held July 2012 Second Round of Ratings Completed Second Round of Ratings Completed August 2012 August 2012 Final Report Provided to Philadelphia August 2012 Public Comment Solicited Public Comment Solicited September 2012 September 2012

Questions? Need More Information? Q i ? d f i ? Feel free to contact us. Dawn Lindsay, Ph.D. Director of Evaluation Services Institute for Research Education and Training in Addictions 425 6th Avenue, Suite 1710 Pittsburgh, PA 15219 412.258.8571 412.391.2528 (fax) ( ) dawn@ireta.org