Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR) - Revision history

BasilSavitsky: /* Impactful Federal, State, and Local Policies */

2024-11-25T00:26:26Z

Impactful Federal, State, and Local Policies

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	*'''Canadian Guidelines.''' This document has details on the MAT Methadone guidelines from Canada. <ref>https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs/Advice-to-the-Profession-Prescribing-Drugs</ref>		*'''Canadian Guidelines.''' This document has details on the MAT Methadone guidelines from Canada. <ref>https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs/Advice-to-the-Profession-Prescribing-Drugs</ref>

	* The Mainstreaming Addiction Treatment Act of 2021 removes the requirement that a health care practitioner apply for a separate waiver through the Drug Enforcement Administration (DEA) to dispense certain narcotic drugs (e.g., ~~buprenorphine~~) for maintenance or detoxification treatment (i.e., substance use disorder treatment).<ref>https://www.congress.gov/bill/117th-congress/senate-bill/445</ref>		* The Mainstreaming Addiction Treatment Act of 2021 removes the requirement that a health care practitioner apply for a separate waiver through the Drug Enforcement Administration (DEA) to dispense certain narcotic drugs (e.g., Buprenorphine) for maintenance or detoxification treatment (i.e., substance use disorder treatment). <ref>https://www.congress.gov/bill/117th-congress/senate-bill/445</ref>

			*Outpatient Methadone treatment can only be used when the patient is enrolled in a state or federally certified opioid treatment program (i.e. Methadone clinics) that usually requires a daily visit. <ref>https://www.ncbi.nlm.nih.gov/books/NBK541393/</ref>

	*'''Congress''' has initiated bipartisan and bicameral steps calling for increased access to MAT. <ref>https://www.murkowski.senate.gov/press/release/bipartisan-bicameral-members-of-congress-call-for-increased-access-to-medication-assisted-treatment</ref>		*'''Congress''' has initiated bipartisan and bicameral steps calling for increased access to MAT. <ref>https://www.murkowski.senate.gov/press/release/bipartisan-bicameral-members-of-congress-call-for-increased-access-to-medication-assisted-treatment</ref>

BasilSavitsky: /* Impactful Federal, State, and Local Policies */

2024-08-15T23:32:57Z

Impactful Federal, State, and Local Policies

← Older revision		Revision as of 16:32, 15 August 2024
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	*'''Canadian Guidelines.''' This document has details on the MAT Methadone guidelines from Canada. <ref>https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs/Advice-to-the-Profession-Prescribing-Drugs</ref>		*'''Canadian Guidelines.''' This document has details on the MAT Methadone guidelines from Canada. <ref>https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs/Advice-to-the-Profession-Prescribing-Drugs</ref>

			* The Mainstreaming Addiction Treatment Act of 2021 removes the requirement that a health care practitioner apply for a separate waiver through the Drug Enforcement Administration (DEA) to dispense certain narcotic drugs (e.g., buprenorphine) for maintenance or detoxification treatment (i.e., substance use disorder treatment).<ref>https://www.congress.gov/bill/117th-congress/senate-bill/445</ref>

	*'''Congress''' has initiated bipartisan and bicameral steps calling for increased access to MAT. <ref>https://www.murkowski.senate.gov/press/release/bipartisan-bicameral-members-of-congress-call-for-increased-access-to-medication-assisted-treatment</ref>		*'''Congress''' has initiated bipartisan and bicameral steps calling for increased access to MAT. <ref>https://www.murkowski.senate.gov/press/release/bipartisan-bicameral-members-of-congress-call-for-increased-access-to-medication-assisted-treatment</ref>

BasilSavitsky: /* Relevant Research */

2024-07-31T21:26:18Z

Relevant Research

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	*'''This multi-agency report''' titled “Medications for Opioid Use Disorder Save Lives,” covers the efficacy of MAT in different populations. <ref>https://www.ncbi.nlm.nih.gov/books/NBK541398/</ref>		*'''This multi-agency report''' titled “Medications for Opioid Use Disorder Save Lives,” covers the efficacy of MAT in different populations. <ref>https://www.ncbi.nlm.nih.gov/books/NBK541398/</ref>

			*'''Criminal Justice Drug Abuse Treatment Studies (CJ-DATS).''' This study surveyed criminal justice agencies affiliated with the CJ-DATS to assess the use of MAT. It summarizes factors influencing use of MAT by survey responses according to availability, barriers & intentions. <ref> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295578/</ref>

	*''' Weiss and Carroll.''' In an article published in the American Journal of Psychiatry, Weiss and Carroll state: "Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in Buprenorphine treatment." <ref>https://pubmed.ncbi.nlm.nih.gov/27978771/</ref> Their report reveals the significant need for more studies that can yield additional insights to inform MAT practices. Current literature focuses mainly on the outcome of treatment retention and negative urine drug screens. Enhanced research would look at broader outcomes of social functioning including employment, stable housing, and other measures of well-being. Also, research would ideally generate information on co-occurring disorders and the types of behavioral treatments that would be appropriate for different individuals. Weiss and Carroll highlight the following key points:		*''' Weiss and Carroll.''' In an article published in the American Journal of Psychiatry, Weiss and Carroll state: "Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in Buprenorphine treatment." <ref>https://pubmed.ncbi.nlm.nih.gov/27978771/</ref> Their report reveals the significant need for more studies that can yield additional insights to inform MAT practices. Current literature focuses mainly on the outcome of treatment retention and negative urine drug screens. Enhanced research would look at broader outcomes of social functioning including employment, stable housing, and other measures of well-being. Also, research would ideally generate information on co-occurring disorders and the types of behavioral treatments that would be appropriate for different individuals. Weiss and Carroll highlight the following key points:

BasilSavitsky: /* Impactful Federal, State, and Local Policies */

2024-07-25T19:11:01Z

Impactful Federal, State, and Local Policies

← Older revision		Revision as of 12:11, 25 July 2024
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	*'''Canadian Guidelines.''' This document has details on the MAT Methadone guidelines from Canada. <ref>https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs/Advice-to-the-Profession-Prescribing-Drugs</ref>		*'''Canadian Guidelines.''' This document has details on the MAT Methadone guidelines from Canada. <ref>https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Prescribing-Drugs/Advice-to-the-Profession-Prescribing-Drugs</ref>

			*'''Congress''' has initiated bipartisan and bicameral steps calling for increased access to MAT. <ref>https://www.murkowski.senate.gov/press/release/bipartisan-bicameral-members-of-congress-call-for-increased-access-to-medication-assisted-treatment</ref>

	*'''SAMHSA''' provides a "Guide for Medications for Opioid Use Disorder.''' <ref>https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Executive-Summary/SMA18-5063EXSUMM</ref>		*'''SAMHSA''' provides a "Guide for Medications for Opioid Use Disorder.''' <ref>https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Executive-Summary/SMA18-5063EXSUMM</ref>

BasilSavitsky: /* Promising Practices */

2024-07-25T18:34:55Z

Promising Practices

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	**90% reduction in both illegal activities and police stops/arrests.		**90% reduction in both illegal activities and police stops/arrests.
	**Zero participants in treatment had overdosed in the 90 days leading up to the study interview, compared to 25% who had overdosed in the 90 days before entering treatment.		**Zero participants in treatment had overdosed in the 90 days leading up to the study interview, compared to 25% who had overdosed in the 90 days before entering treatment.
	**Decrease in family conflict and feelings of depression, anxiety and anger		**Decrease in family conflict and feelings of depression, anxiety and anger.
	**Participants reported being much more satisfied with their lives.		**Participants reported being much more satisfied with their lives.

BasilSavitsky: /* Available Tools and Resources */

2024-07-25T18:31:19Z

Available Tools and Resources

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	*'''PracticeFusion.''' This is a free entry-level electronic medical record system to monitor and update patient records.		*'''PracticeFusion.''' This is a free entry-level electronic medical record system to monitor and update patient records.

	*'''Clinician Training and Support''' Buprenorphine training sessions are offered at several locations and websites. The trainings typically take eight hours and can be attended in person, online, or a combination of both. Buprenorphine waiver training can be valuable to any clinician (medical or behavioral) as it covers the basics of opioid addiction and how Buprenorphine works. Clinicians can only prescribe Buprenorphine for addiction after receiving certified training and a Drug Enforcement Administration (DEA) waiver. However, any DEA-licensed clinician can prescribe ~~buprenorphine~~ for pain. Training opportunities are posted on the following websites: SAMHSA, American Academy of Addiction Psychiatry (AAAP), and American Osteopathic Academy of Addiction Medicine (AOAAM). Some of the following sites also offer other tools and resources:		*'''Clinician Training and Support''' Buprenorphine training sessions are offered at several locations and websites. The trainings typically take eight hours and can be attended in person, online, or a combination of both. Buprenorphine waiver training can be valuable to any clinician (medical or behavioral) as it covers the basics of opioid addiction and how Buprenorphine works. Clinicians can only prescribe Buprenorphine for addiction after receiving certified training and a Drug Enforcement Administration (DEA) waiver. However, any DEA-licensed clinician can prescribe Buprenorphine for pain. Training opportunities are posted on the following websites: SAMHSA, American Academy of Addiction Psychiatry (AAAP), and American Osteopathic Academy of Addiction Medicine (AOAAM). Some of the following sites also offer other tools and resources:
	**'''BupPractice''' is an accredited training resource that is supported by ASAM (the American Society of Addiction Medicine). BupPractice provides an 8-hour training for physicians and a 24-hour training session for physician assistants and nurse practitioners. It also offers up to 9 AMA PRA Category 1 Credits. <ref>https://bup.clinicalencounters.com/</ref>		**'''BupPractice''' is an accredited training resource that is supported by ASAM (the American Society of Addiction Medicine). BupPractice provides an 8-hour training for physicians and a 24-hour training session for physician assistants and nurse practitioners. It also offers up to 9 AMA PRA Category 1 Credits. <ref>https://bup.clinicalencounters.com/</ref>
	**'''The Provider's Clinical Support System (PCCSS)''' offers online mentorship. PCSS provides a variety of training modules for CME credit, many of which advance MAT and reduce stigma. <ref>https://pcssnow.org</ref>		**'''The Provider's Clinical Support System (PCCSS)''' offers online mentorship. PCSS provides a variety of training modules for CME credit, many of which advance MAT and reduce stigma. <ref>https://pcssnow.org</ref>

BasilSavitsky: /* Relevant Research */

2024-07-25T18:11:38Z

Relevant Research

BasilSavitsky: /* Naloxone */

2024-07-25T18:02:21Z

Naloxone

← Older revision		Revision as of 11:02, 25 July 2024
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	=== Naloxone ===		=== Naloxone ===

	Naloxone is commercially known as Narcan. It is an opioid antagonist used to reverse opioid overdose		Naloxone is commercially known as Narcan. It is an opioid antagonist used to reverse opioid overdose.
	*Naloxone is available in intravenous or intramuscular injection and nasal delivery options. Intramuscular injection or intranasal delivery is safe for administration by any person. <ref>Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>		*Naloxone is available in intravenous or intramuscular injection and nasal delivery options. Intramuscular injection or intranasal delivery is safe for administration by any person. <ref>Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/2019/08/1607NGAOpioidRoadMap.pdf</ref>
	*Naloxone works within minutes and effects last for up to an hour.		*Naloxone works within minutes and effects last for up to an hour.

BasilSavitsky: /* Stages of MAT with Buprenorphine */

2024-07-25T18:00:51Z

Stages of MAT with Buprenorphine

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	*'''Stabilization''' begins when a patient is experiencing no withdrawal symptoms, is experiencing minimal or no side effects, and no longer has uncontrollable cravings for opioid agonists. Dosage adjustments may be necessary during early stabilization, and frequent contact with the patient increases the likelihood of compliance.		*'''Stabilization''' begins when a patient is experiencing no withdrawal symptoms, is experiencing minimal or no side effects, and no longer has uncontrollable cravings for opioid agonists. Dosage adjustments may be necessary during early stabilization, and frequent contact with the patient increases the likelihood of compliance.

	*'''Maintenance.''' The longest period that a patient is on ~~buprenorphine~~ is the maintenance phase. This period may be indefinite. During the maintenance phase, attention must be focused on the psychosocial and family issues that have been identified during the course of treatment as contributing to a patient’s addiction.		*'''Maintenance.''' The longest period that a patient is on Buprenorphine is the maintenance phase. This period may be indefinite. During the maintenance phase, attention must be focused on the psychosocial and family issues that have been identified during the course of treatment as contributing to a patient’s addiction.

	*'''Medically Supervised Withdrawal (Detoxification).''' As an alternative to the three stages above, the goal of using Buprenorphine for medically supervised withdrawal from opioids is to provide a transition from the state of physical dependence on opioids to an opioid-free state, while minimizing withdrawal symptoms (and avoiding side effects of Buprenorphine). Medically supervised withdrawal with Buprenorphine consists of an induction phase and a dose-reduction phase. It is recommended that patients dependent on short-acting opioids (e.g., Hydromorphone, Oxycodone, heroin) who will be receiving medically supervised withdrawal be inducted directly onto Buprenorphine/Naloxone tablets. The use of Buprenorphine (either as Buprenorphine monotherapy or Buprenorphine/Naloxone combination treatment) to taper off long-acting opioids should be considered only for those patients who have evidence of sustained medical and psychosocial stability.		*'''Medically Supervised Withdrawal (Detoxification).''' As an alternative to the three stages above, the goal of using Buprenorphine for medically supervised withdrawal from opioids is to provide a transition from the state of physical dependence on opioids to an opioid-free state, while minimizing withdrawal symptoms (and avoiding side effects of Buprenorphine). Medically supervised withdrawal with Buprenorphine consists of an induction phase and a dose-reduction phase. It is recommended that patients dependent on short-acting opioids (e.g., Hydromorphone, Oxycodone, heroin) who will be receiving medically supervised withdrawal be inducted directly onto Buprenorphine/Naloxone tablets. The use of Buprenorphine (either as Buprenorphine monotherapy or Buprenorphine/Naloxone combination treatment) to taper off long-acting opioids should be considered only for those patients who have evidence of sustained medical and psychosocial stability.

BasilSavitsky: /* Medications Used in Addiction Treatment: */

2024-07-25T17:56:34Z

Medications Used in Addiction Treatment:

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	\| Any setting: prescribed or dispensed by a clinician, furnished by a pharmacy without a prescription (legal in several states), dispensed by lay staff in community settings (by standing order), or carried by law enforcement or other first responders.		\| Any setting: prescribed or dispensed by a clinician, furnished by a pharmacy without a prescription (legal in several states), dispensed by lay staff in community settings (by standing order), or carried by law enforcement or other first responders.
	\| To reverse respiratory suppression in suspected opioid overdose		\| To reverse respiratory suppression in suspected opioid overdose
	\| May require high doses for extremely high-potency illicit drug use (~~fentanyl~~ and ~~carfentanyl~~)		\| May require high doses for extremely high-potency illicit drug use (Fentanyl and Carfentanyl)
	\| Intranasal spray, or intravenous, intramuscular, or subcutaneous injectable		\| Intranasal spray, or intravenous, intramuscular, or subcutaneous injectable
	\|}		\|}

← Older revision		Revision as of 11:11, 25 July 2024
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	= Relevant Research =		= Relevant Research =

	*'''Emergency Department Treatment Protocols''' In a randomized trial performed by Yale, it was found that individuals who receive Buprenorphine while getting medical care within an emergency room are more likely to adhere to treatment protocols and have a better chance at ceasing opioid use when compared to those who have received referrals to receive the treatment, or those who received motivational support.<ref>Weiss, R. D., Potter, J. S., Griffin, M. L., Provost, S. E., Fitzmaurice, G. M., McDermott, K. A., … Carroll, K. M. (2015). Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study. Drug and Alcohol Dependence, 150, 112–119. https://doi.org/10.1016/j.drugalcdep.2015.02.030</ref> This can be an initiation point for treatment of opioid dependence and can be followed up by primary care facilities. ~~This~~ has shown to decrease the need for in-patient facilities~~. This~~ can be attributed to engaging patients at the optimal point of access. <ref>Health plan offers financial incentives for MAT training \| Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved December 5, 2019, from https://www.psychcongress.com/article/policy/health-plan-offers-financial-incentives-mat-training</ref>		*'''Emergency Department Treatment Protocols''' In a randomized trial performed by Yale, it was found that individuals who receive Buprenorphine while getting medical care within an emergency room are more likely to adhere to treatment protocols and have a better chance at ceasing opioid use when compared to those who have received referrals to receive the treatment, or those who received motivational support.<ref>Weiss, R. D., Potter, J. S., Griffin, M. L., Provost, S. E., Fitzmaurice, G. M., McDermott, K. A., … Carroll, K. M. (2015). Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study. Drug and Alcohol Dependence, 150, 112–119. https://doi.org/10.1016/j.drugalcdep.2015.02.030</ref> This can be an initiation point for treatment of opioid dependence and can be followed up by primary care facilities. ED treatment has shown to decrease the need for in-patient facilities and can be attributed to engaging patients at the optimal point of access. <ref>Health plan offers financial incentives for MAT training \| Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved December 5, 2019, from https://www.psychcongress.com/article/policy/health-plan-offers-financial-incentives-mat-training</ref>

	*'''Cost-Benefit Analysis.''' <ref>Krebs, E., Enns, B., Evans, E., Urada, D., Anglin, M. D., Rawson, R. A., … Nosyk, B. (2018). Cost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California. Annals of Internal Medicine, 168(1), 10. https://doi.org/10.7326/M17-0611</ref> In California, where more people have been diagnosed with opioid disorder than in any other U.S. state, publicly funded treatment programs require patients to “fail” - twice - at a three-week course of medically supervised withdrawal before they become eligible for ~~OAT~~. Policymakers likely maintained this medically managed withdrawal requirement under the belief it was saving money. This study demonstrates, however, that the policy creates significantly greater long-term costs for criminal justice and healthcare systems.		*'''Cost-Benefit Analysis.''' <ref>Krebs, E., Enns, B., Evans, E., Urada, D., Anglin, M. D., Rawson, R. A., … Nosyk, B. (2018). Cost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California. Annals of Internal Medicine, 168(1), 10. https://doi.org/10.7326/M17-0611</ref> In California, where more people have been diagnosed with opioid disorder than in any other U.S. state, publicly funded treatment programs require patients to “fail” twice, at a three-week course of medically supervised withdrawal, before they become eligible for MAT. Policymakers likely maintained this medically managed withdrawal requirement under the belief it was saving money. This study demonstrates, however, that the policy creates significantly greater long-term costs for criminal justice and healthcare systems.
	**~~OAT~~ would have saved as much as $850 million over five years, not including savings to the criminal justice system, and more than $2 billion, including the cost of arrests and prosecutions. Over 10 years, the total savings would rise to $2.87 billion.		**MAT would have saved as much as $850 million over five years, not including savings to the criminal justice system, and more than $2 billion, including the cost of arrests and prosecutions. Over 10 years, the total savings would rise to $2.87 billion.
	**“In order to see overdose deaths come down, we need to make sure people who have opioid addiction are able to access effective treatment more easily than they can access heroin, ~~fentanyl~~ or pain pills."		**“In order to see overdose deaths come down, we need to make sure people who have opioid addiction are able to access effective treatment more easily than they can access heroin, Fentanyl or pain pills."
	**"We need a model whereby patients can get immediate access to opioid-agonist treatment, a lifesaving intervention, without obstacles."		**"We need a model whereby patients can get immediate access to opioid-agonist treatment, a lifesaving intervention, without obstacles."
	**“Among experts in the field of addiction, we already know that detox doesn’t work, that they’re going to relapse and when they relapse, they’re going to be at great risk for an overdose, that they’ll be at great risk for hepatitis.”		**“Among experts in the field of addiction, we already know that detox doesn’t work, that they’re going to relapse and when they relapse, they’re going to be at great risk for an overdose, that they’ll be at great risk for hepatitis.”
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	*'''This multi-agency report''' titled “Medications for Opioid Use Disorder Save Lives,” covers the efficacy of MAT in different populations. <ref>https://www.ncbi.nlm.nih.gov/books/NBK541398/</ref>		*'''This multi-agency report''' titled “Medications for Opioid Use Disorder Save Lives,” covers the efficacy of MAT in different populations. <ref>https://www.ncbi.nlm.nih.gov/books/NBK541398/</ref>

	*''' Weiss and Carroll.''' In an article published in the American Journal of Psychiatry, Weiss and Carroll state: "Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in Buprenorphine treatment." <ref>https://pubmed.ncbi.nlm.nih.gov/27978771/</ref> Their report reveals the need for ~~significantly~~ more studies that can yield additional insights to inform MAT practices. Current literature focuses mainly on the outcome of treatment retention and negative urine drug screens. Enhanced research would look at broader outcomes of social functioning including employment, stable housing and other measures of well-being. Also, research would ideally ~~have information on many other factors such as~~ information on co-occurring disorders and the types of behavioral treatments that would be appropriate for different individuals. Weiss and Carroll highlight the following key points:		*''' Weiss and Carroll.''' In an article published in the American Journal of Psychiatry, Weiss and Carroll state: "Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in Buprenorphine treatment." <ref>https://pubmed.ncbi.nlm.nih.gov/27978771/</ref> Their report reveals the significant need for more studies that can yield additional insights to inform MAT practices. Current literature focuses mainly on the outcome of treatment retention and negative urine drug screens. Enhanced research would look at broader outcomes of social functioning including employment, stable housing, and other measures of well-being. Also, research would ideally generate information on co-occurring disorders and the types of behavioral treatments that would be appropriate for different individuals. Weiss and Carroll highlight the following key points:
	**Buprenorphine is an excellent medication, but there is still much room for improvement in how MAT is done.		**Buprenorphine is an excellent medication, but there is still much room for improvement in how MAT is done.
	**Research outcomes are influenced by design considerations, such as the intensity of medication management, the dose of Buprenorphine, and the characteristics of the group participants.		**Research outcomes are influenced by design considerations, such as the intensity of medication management, the dose of Buprenorphine, and the characteristics of the group participants.
	**Different sub-groups respond differently to different elements of treatment plans.		**Different sub-groups respond differently to different elements of treatment plans.
	**Early treatment response has a major impact on long-term success, and a better understanding of that insight may help decision-making. Patients who abstain from opioids in the first two weeks of treatment have a good chance of a ~~good~~ 12-week outcome. Patients who use opioids during the first two weeks of treatment have very little chance of abstaining by week 12.		**Early treatment response has a major impact on long-term success, and a better understanding of that insight may help decision-making. Patients who abstain from opioids in the first two weeks of treatment have a good chance of a positive 12-week outcome. Patients who use opioids during the first two weeks of treatment have very little chance of abstaining by week 12.
	**There is evidence that the use of Contingency Management (CM), including the use of computer-based therapies, seems to increase success rates. <ref>https://drugabuse.com/treatment/therapy/contingency-management/</ref>		**There is evidence that the use of Contingency Management (CM), including the use of computer-based therapies, seems to increase success rates. <ref>https://drugabuse.com/treatment/therapy/contingency-management/</ref>
	**Patients' dependent on prescription opioids seemed to respond more positively to Cognitive Behavioral Therapy (CBT) than those who were primarily heroin users.		**Patients dependent on prescription opioids seemed to respond more positively to Cognitive Behavioral Therapy (CBT) than those who were primarily heroin users.
	**Different treatment approaches appeal to different patients, and using approaches that appeal to the patients helps to increase their retention rates.		**Different treatment approaches appeal to different patients, and using approaches that appeal to the patients helps to increase their retention rates.
	**More data is needed to better understand what treatment options are best for different individuals.		**More data is needed to better understand what treatment options are best for different individuals.