3.10 Medical tx for Opiate misuse Flashcards
What are the 4 main detoxification options for opiate misuse?
- Self-detoxification
- Reducing prescribed opioids- current drug or alt.
- A-2 adrenergic agonists- Lofexidine
- Adjunctive treatments- Loperamide, hypnotic, NSAIDS
What are the main opioid substitution therapies?
- Methadone
2. Buprenorphine
What is the pharmacological target/action of buprenorphine?
Partial antagonist of the mu opioid receptor
It is equally as effective as methadone; it may be added to naloxone
What is Opioid Substitution Therapy- Methadone associated with?
- Improved retention
- Reduced illicit opioid use/heroin use
- Reduced injection-related risk behaviours
Less consensus for:
- reducing other risk
- effects on criminal activity
- mortality
What is the philosophy behind heroin assisted treatment?
(This is not the ‘british system’)
There is evolving evidence for those who are at risk of harm, failing on traditional treatments
It is harm reduction
Very expensive delivery
What is the effect of higher doses of oral substitution treatment with methadone?
Higher retention rates
better at reducing opiate and cocaine use
Dose related finding
What is the guideline view on psycholgical interventions for each of the following groups?
- Opiate users
- Tranquiliser users
- Stimulant users
- Cannabis users
- Alcohol users
- opiate users- any psychological tx better than none.
- Tranquiliser users- CBT, effective in reducing drug use
- Stimulant users- any psychological tx better than none; CBT evidence is strongest, try combinations
- Cannabis users- Motivational interviewing, CBT, and family therapies most effective
- Alcohol users- CBT (+ motivational enhancement), 12 step, and family therapy.
What medical treatment should be used in non-opiate drug users?
There is little evidence for medical tx for non-opiate drug users.
