MAT 8 hour study guide
What was learned from the early methadone research?
A. Methadone treatment was corrective, but patients can’t taper from it
B. Patients experienced intoxication from methadone similar to heroin
C. Patients experienced ceiling agonist effects therefore did not have blockade from the short- acting opioids
D. Methadone treatment reduced death, crime days, decreased HIV seroconversion, Intravenous drug use, and increased social function
Increasing mortality has been seen in the US due to the opioid epidemic compared to six other countries in which group?
A. Young adults
B. Middle aged white men
C. African Americans
D. Middle aged white women
B. Middle aged white men
Each of the following is a means by which a prescriber could qualify to obtain the waiver needed to engage in office-based treatment of opioid addiction except:
A. Board-certified in Addiction Psychiatry
B. At least 100 hours in addiction medicine practice that has been reviewed and approved by SAMHSA
C. Completed approved 8-hour training offered by a group named in DATA 2000
D. Completed 8 hours of training offered by the American Medical Association
E. NP or PA who completed the 24 hours of addiction curriculum training
A provider completes the required training and is eligible for the waiver to offer office-based treatment of opioid dependence. The provider practices in a community with epidemic opioid addiction and has 38 opioid-dependent individuals who have inquired about this treatment and asked to be treated when the provider starts the buprenorphine/naloxone practice. Which of the following is the appropriate course of action:
A. Completion of the course and submission of the Notification of Intent form is sufficient to start practice.
B. The provider needs to wait up to 45 days to receive their waiver and treat up to 30 patients at one time.
C. The provider can apply for an extended waiver to 100 upon receipt of waiver.
D. The provider may treat these patients with buprenorphine/naloxone off-label.
E. The provider may treat all of these individuals by completing an additional notification to the DEA of the urgent need in the community.
The Drug Addiction Treatment Act of 2000 (DATA 2000) allows waivered providers to provide Office Based Opioid Treatment which includes all except:
A. FDA approved medications for maintenance or detoxification
B. Medications in schedules III, IV, or V
C. Buprenorphine or Buprenorphine/naloxone
D. Methadone
Prescriber are required under DATA 2000 to fulfill the following requirements except:
A. Mandatory counseling of all patients
B. Completion of an approved 8-hour waiver course
C. Completion of 16 additional curriculum hours for NP’s and PA’s
D. The ability to provide or refer patients to appropriate counseling
Which of the following drugs and drug formulations have been approved for office-based treatment of opioid dependence:
A. Buprenorphine/naloxone sublingual film
B. Buprenorphine transdermal patches
C. Buprenorphine sublingual tablets and buccal film
D. A and B
E. A and C
The affinity of buprenorphine results in:
A. A very strong bond to the opioid receptor.
B. Partial activation of mu receptor.
C. Can precipitate withdrawal if full agonist on board.
D. A, B and C
Buprenorphine can be used for medical withdrawal from opioids.
A. True
B. False
Using DSM 5 includes:
A. There is tolerance
B. There are withdrawal symptoms on discontinuation of the drug
C. There is compulsive use in the face of bad outcomes
D. Pain is the primary drive to continued use of the drug
E. A, B, and C
During Susie’s inpatient stay she reports to the providers that she is prescribed: trazodone, clonidine, lamictal, gabapentin, and lorazepam. Wanting to provide care for all of Susie’s medical issues and avoid seizures the provider writes for the medications and discharges her with prescriptions to provide for continuity of care and started her on buprenorphine/naloxone. What could the provider have done differently?
A. Called Susie’s mother
B. Discontinued all of her medications
C. Called her counselor
D. Searched the PDMP if available
An opioid-dependent patient presents for buprenorphine/naloxone induction. The COWS score is 5. Buprenorphine/naloxone 4/1 mg is given. Twenty minutes later the patient complains of nausea and vomits as well as complaining of back and neck pain. The most likely explanation for these symptoms is:
A. Severe opioid withdrawal not relieved by buprenorphine
B. Precipitated opioid withdrawal
C. Exacerbation of co-occurring pancreatitis
D. Alcohol withdrawal
E. Naloxone absorption with increased opioid withdrawal severity
Acute withdrawal from opioid dependence using buprenorphine:
A. Does not completely suppress opioid withdrawal symptoms
B. Results in long-term opioid abstinence
C. Is unlikely to result in long term abstinence
D. Can start at any time following the use of an opioid
C. Is unlikely to result in long term abstinence
In establishing buprenorphine stabilization and maintenance the patient should be:
A. Taking the medication as frequently as illicit use
B. On between 24 and 32 mg a day
C. On a stable dose without cravings or withdrawal
D. Taking as directed with PRN doses as needed
Would you give the patient a dose of buprenorphine/naloxone now?
A. Yes
B. No
C. Not enough information to decide
What dose of Buprenorphine/Naloxone would you give him?
A. 8mg
B. 12mg
C. 4mg
D. 16mg
What would you do after giving him the first dose?
A. Send him home with a prescription for one week
B. Have him hang out and reassess his symptoms in 30-60 minutes
C. Tell him to go home and come back in the morning to be reassessed
D. Write him a prescription for a month with a follow up visit
What areas should be addressed over the subsequent days and weeks?
A. Continued stabilization, monitoring
B. Monitor side effects, how well he is tolerating the medication, educate on administration
C. Address cocaine use and illicit methadone
D. Set up counseling
E. All of the above
Because buprenorphine is a mu opioid-receptor partial agonist it is not abusable unless combined with another central nervous system depressant.
A. True
B. False
A patient gives a history of 3 years of daily opioid misuse and asks to be started on buprenorphine. Which of the following should be completed as part of the determination regarding whether to prescribe this medication:
A. Medical, psychiatric and substance abuse history
B. Urine toxicology screen
C. Physical examination
D. Check state prescription drug monitoring program if available
E. A, B, C and D
The goals of buprenorphine maintenance treatment include:
A. Discontinued or markedly reduced use of other opioids
B. Persistent craving
C. Persistent withdrawal symptoms
D. The expectation of sedation
A patient in your treatment program, who has been doing very well for months, provides a urine that is below body temperature. You suspect this is a tampered urine. Which of the following is the best response when meeting with the patient?
A. Assume that there is a logical explanation for the cold temperature and accept the urine. The patient has been very stable and will let you know if they relapsed.
B. Inform patient “Your urine is cold so I cannot accept it today. Tampering with urine screens is a violation of our treatment agreement. Per protocol, you will be discharged from the program, but are welcome back after completing detox.”
C. Inform patient “The urine you provided today is below body temp. I am concerned that this is a tampered urine. I will need another urine sample today, but I hope you know that if you are struggling, it is better to let your treatment team know so that we can help you. So are there any issues we need to address? Any recent substance use?”
A patient with polysubstance dependence (including opioid addiction) and HCV infection with mild fibrosis prescribed buprenorphine/naloxone is found non-responsive and dies several hours after being brought to the ED. Blood levels of buprenorphine are consistent with the prescribed dose. Which of the following is the most likely explanation for the death:
A. Liver impairment resulted in buprenorphine accumulation
B. Illicit benzodiazepine use with buprenorphine/naloxone produced a toxic pharmacodynamic drug-drug interaction
C. Buprenorphine-associated cardiac arrhythmia
D. Liver and renal impairment resulted in accumulation of buprenorphine metabolites
E. Acute liver failure related to buprenorphine/naloxone use
Patients with substance use disorder who undergo surgical procedures don’t need additional analgesics management when prescribed buprenorphine or methadone for opioid use disorder.
A. True
B. False
In patients prescribed buprenorphine for opioid use disorder with acute pain, which of the following statements is true?
A. Clinicians should avoid treating acute pain with opioids because it will lead to relapse
B. The acute pain is likely to be psychomatic and does not require treatment
C. Treating the acute pain with opioids does not increase the risk of relapse
D. Multimodal approaches have been shown to be ineffective.
This patient presents with:
A. Gastroenteritis
B. Opioid Use Disorder
C. Physical dependence
C. Physical dependence
What is your initial treatment plan?
A. Medical withdrawal from oxycodone followed by counseling
B. Medical withdrawal from oxycodone followed by counseling and oral naltrexone
C. Opioid agonist treatment with methadone or buprenorphine
Does the patient require any other forms of treatment?
A. Assessment to rule out a substance-induced psychiatric disorder
B. Pharmacotherapy for depression
C. Pharmacotherapy for attention-deficit hyperactivity disorder (ADHD)
Would you prescribe buprenorphine now? If so, what dose?
A. No, he is not yet in significant opioid withdrawal
B. Yes, I would begin with buprenorphine/naloxone 4/1 mg SL
How should he be managed at this point?
A. Withdrawal symptoms are worse, suggesting precipitated withdrawal. Pt should be sent home and asked to return tomorrow to attempt another induction.
B. Withdrawal symptoms are somewhat worse, suggesting a partial response to the initial dose of buprenorphine/naloxone. He should be given an additional dose of 2/0.5 mg
C. It is too soon to see much effect from the original dose. He will likely improve over the next 6 hours. He should be sent home and given “comfort meds” to manage any ancillary symptoms
Should his buprenorphine dose be increased at this time?
A. Yes, he still reports craving to use oxycodone
B. No, you can still expect further response to his current dose
B. No, you can still expect further response to his current dose
Does he need additional treatment?
A. These are symptoms of prolonged opioid withdrawal and will respond to a dose increase of buprenorphine
B. The patient is depressed and needs antidepressant treatment.
C. Guilt for past behavior is very common in early treatment and should best be handled with psychotherapy and further involvement in self-help programs
How would you manage his request to stop his medications?
A. Since the patient has done well in treatment it is reasonable to discontinue his medications.
B. Provide the patient with more education about the benefits of treatment and the risks of detoxification, but decline to stop either medication.
C. Encourage the patient to stay on buprenorphine, but suggest a switch to an alternative antidepressant.
D. Suggest he explore an alternative NA group.
E. B and D
How would you manage this situation?
A. Since the patient failed to comply with his previous outpatient treatment plan he should be referred to a substance abuse treatment program.
B. The patient still sounds motivated for treatment so you agree to resume treatment with buprenorphine and citalopram. His suicidal thoughts will clear once he is back on antidepressant medication.
C. Suicidal ideation is a serious concern in any drug dependent person. He needs to be assessed immediately to determine the severity of suicide risk.
How would you assess his current presentation?
A. You are pleased that he is doing so well, but concerned about his lack of sleep.
You agree to his request for sleep medication (a benzodiazepine) since you think it will also help reduce his anxiety. You agree with the patient that his alcohol use is risky.
B. You try to talk him out of the trip to Hollywood since his plans seem very unrealistic. You then offer him trazodone 50 mg for his insomnia because that drug has minimal abuse potential and you warn him of the risks of taking benzodiazepines (or alcohol) in combination with buprenorphine.
C. The patient’s symptoms suggest hypomania. You call his psychiatrist to request an emergency evaluation and a re-evaluation of his pharmacotherapy plan.
D. You congratulate the patient on his plans to share his ideas about addiction and recovery, but warn him about the risks of drinking. You provide him with education about good sleep hygiene and discourage any ideas of using medications to assist with his sleep problem.
Which of the following should be regular components of office-based treatment of opioid dependence with buprenorphine/naloxone?
A. Random urine drug screening
B. Regular updating of Treatment Agreement
C. Random call-backs and medication checks
D. A and C
E. A, B and C
Treatment Agreements are recommended for use in office-based treatment of opioid addiction. Which of the following is a component of Treatment Agreements:
A. Risks associated with medication treatments
B. Use of one provider and one pharmacy
C. Description of concomitant therapies
D. Alternative treatments
E. A, B, C and D
Which of the following increases overdose risk for those who use opioids?
A. Reduced tolerance after a period of sobriety
B. Mixing of medication and/or with alcohol
C. Using a friend’s buprenorphine (suboxone) to manage opioid withdrawal
D. A, and B
Which of the following are effective overdose prevention strategies?
A. Provide access and training to Naloxone
B. Try a little bit of a drug prior to using a normal dose, especially if it is from a new source
C. Take a cold shower
D. A and B
Which of the following are effective harm reduction strategies to reduce injection drug related risk?
A. Use a new, sterile syringe every time
B. Use the same injection site
C. Only use on weekends