Buprenorphine in the Treatment of Opioid Dependence - AAAP

Question 1

There are XXX,XXX-X,XXX,XXX chronic opioid (heroin) users.

Answer 1

There are 810,000-1 million chronic opioid (heroin) users.

Question 2

There are at least X.X million abusers of prescription narcotics.

Answer 2

There are at least 6.4 million abusers of prescription narcotics.

Question 3

What % of 12-17 year olds report prescription opioid abuse?

Answer 3

12-17 y.o.: 12%.

Question 4

What % of 18-25 y.o. 22% report prescription opioid abuse.

Answer 4

22 % of 18-25 y.o. report prescription opioid abuse.

Question 5

From 1994-2001 ED visits, there has been xxx% increase in oxycodone visits.

Answer 5

From 1994-2001 ED visits, there has been 352% increase in oxycodone visits.

Question 6

From 1994-2001 ED visits, there has been a xxx% increase in hydrocodone visits.

Answer 6

131% increase in hydrocodone visits.

Question 7

Currently there are [2 million/only 200,000±] patients receiving methadone maintenance.

Answer 7

Currently there are [only 200,000±] patients receiving methadone maintenance.

Question 8

In 4 states, and in some counties in other states, public policy [strongly encourages/prohibits] establishment of Opiate Treatment Programs.

Answer 8

In 4 states, and in some counties in other states, public policy prohibits establishment of Opiate Treatment Programs.

Question 9

Detoxification has been shown to be of [amazing/limited] long-term effectiveness.

Answer 9

Detoxification has been shown to be of limited long-term effectiveness.

Question 10

Access to treatment is greatly restricted/encouraged.

Answer 10

Access to treatment is greatly restricted

Question 11

There has been a dramatic [rise/decline] in the purity of heroin (from less than/more than xx percent in the 1970s to between yy and zz percent in the 1990s).

Answer 11

There has been a dramatic rise in the purity of heroin (from less than 10 percent in the 1970s to between 50 and 80 percent in the 1990s).

Question 12

The price of heroin has [decreased/increased.]

Answer 12

The price of heroin has decreased.

Question 13

Heroin is now [easier/more difficult] to use by non-injection routes, such as snorting and smoking.

Answer 13

Heroin is now easier to use by non-injection routes, such as snorting and smoking.

Question 14

Contrary to the belief of some new users, an overdose can only occur via IV administration. TRUE or FALSE

Answer 14

FALSE: Contrary to the belief of some new users, an overdose can occur via any route of administration.

Question 15

Data indicate that emergency room admissions involving heroin have declined/risen sharply (from XX,000 in 1991 to XX,409 in 1999), as have overdose deaths.

Answer 15

Data indicate that emergency room admissions involving heroin have risen sharply (from 36,000 in 1991 to 84,409 in 1999), as have overdose deaths.

Question 16

From 1994-2001, emergency department visits related to opioid pain medications [more than doubled/rose 6 fold] (SAMHSA Mortality Data, DAWN 2002).

Answer 16

From 1994-2001, emergency department visits related to opioid pain medications more than doubled (SAMHSA Mortality Data, DAWN 2002).

Question 17

In 2002, lifetime non medical use of prescription opioids was reported by XX,611,000 and in the past month X,377,000 endorsed non-medical use of prescription opioids.

Answer 17

In 2002, lifetime non medical use of prescription opioids was reported by 29,611,000 and in the past month 4,377,000 endorsed non-medical use of prescription opioids.

Question 18

3 web sites for epidemiology

Answer 18

The Website www.oas.samhsa.gov has information regarding the National Household Survey on Drug Abuse, The Drug and Alcohol Services Information System, the Drug Abuse Warning Network, and several special reports on special populations and substudies.
The Website www.monitoringthefuture.org provides summaries and data from the most recent and previous surveys of secondary school, high school, college, and young adults.

The Website www.nida.nih.gov provides substance abuse statistics from the Community Epidemiology Work Group as well as special reports and substudies.

Question 19

It is estimated that less than XX% of the XXX,000 heroin-addicted individuals in the U.S. are receiving methadone for the treatment of opioid addiction at one of the XXX methadone maintenance programs registered with the DEA. (American Methadone Treatment Association 1999)

Answer 19

It is estimated that less than 25 percent of the 810,000 heroin-addicted individuals in the U.S. are receiving methadone for the treatment of opioid addiction at one of the 947 methadone maintenance programs registered with the Drug Enforcement Administration (DEA) (American Methadone Treatment Association 1999).

Question 20

What is NATA? Why was it established? What was the effect?

Answer 20

The Narcotic Addict Treatment Act (NATA) was a series of bills passed by the United States Congress in 1974. It occurred following the Food and Drug Administration (FDA) approval in 1972 of methadone for the treatment of opioid dependence and the FDA’s regulations for methadone treatment that became effective in 1973.

NATA was a response, in part, to diversion and abuse of methadone. It established that the Department of Health and Human Services (DHHS) had responsibility for methadone treatment regulation. In effect, NATA resulted in a unique, three-level system for methadone treatment—that is, control by the FDA, the DEA, and the DHHS.

Question 21

Currently, two principal treatment modalities are available to opioid-addicted individuals. What are they?

Answer 21

Currently, two principal treatment modalities are available to opioid-addicted individuals: psychosocial approaches and pharmacotherapy.

Question 22

Name 2 psychosocial treatment approaches for addiction.

Answer 22

Psychosocial treatment approaches for addiction include, for example:

1) Residential therapeutic communities
2) Twelve-step mutual self-help programs (such as Narcotics Anonymous)

Question 23

the majority of individuals in 12-step-based programs are thought to be in treatment for either XXXX or XXXXX dependence.

Answer 23

The majority of individuals in 12-step-based programs are thought to be in treatment for either alcohol or cocaine dependence.

Question 24

What are the 3 pharmacotherapy treatment options for opioid addiction currently available?

Answer 24

Current pharmacotherapy treatment options for opioid addiction include:

1) Agonist maintenance with methadone; until 2004, L-alpha acetyl methadol (LAAM) had been available in the United States, but this medication is no longer being produced as a result of a black-box label warning about cardiac adverse events that may occur with its use
2) Antagonist maintenance using naltrexone
3) Use of medical withdrawal agents, such as methadone, naltrexone, clonidine, or lofexidine.

Question 25

How many pts are being treated for opioid dependence by agonist therapy? By antagonist therapy?

Answer 25

It is estimated that approximately 240,000 individuals with opioid addiction are methadone-maintained and fewer than 5,000 individuals are maintained on naltrexone for opioid addiction.

Question 26

Name 5 reasons why naltrexone should be an excellent drug for the treatment of opioid dependence.

Answer 26

Naltrexone is an opioid antagonist that blocks the effect of heroin and other opioids. From a purely pharmacological point of view, naltrexone should be an excellent drug for the treatment of opioid addiction for a number of reasons:

1) It does not have addictive or psychoactive properties.
2) It does not lead to tolerance.
3) It does not produce physical dependence.
4) It has a long half-life, and its therapeutic effects can last up to 3 days.
5) In addition, prescribing naltrexone can occur in the physician’s office; it is not restricted to use in a special treatment program, as is methadone

Question 27

Name 3 disadvantages that diminish the usefulness of Naltrexone for the treatment of opioid dependence.

Answer 27

However, naltrexone’s usefulness has been limited because of several disadvantages:

1) Compliance in taking naltrexone is often poor.
2) A patient must be fully withdrawn from heroin, methadone, or other opioids before beginning naltrexone treatment.
3) During the withdrawal period, many individuals relapse and do not pursue long-term treatment.

Question 28

Name 3 subgroups of opioid dependent individuals who may be highly motivated and thus be successful on Naltrexone.

Answer 28

Naltrexone is useful for some subgroups of addicted persons who are highly motivated for treatment and abstinence, such as 1) health care professionals, 2) business executives, and 3) individuals under pressure from the criminal justice system.

Question 29

What technique can used to enhance the effectiveness of Naltrexone? It also changes Antabuse from a useless medication to an effective one.

Answer 29

Circumstances under which an observer ensures patient compliance in taking naltrexone can also be an effective means for using naltrexone.

Question 30

Medically treated withdrawal from opioids does/does not constitute addiction treatment.

Answer 30

Simple withdrawal from opioids does not constitute addiction treatment.

Question 31

Well-run methadone maintenance programs that incorporate appropriate drug monitoring, counseling services, and vocational resources and referrals have been demonstrated to: 7 things

Answer 31

Methadone pharmacotherapy is the most common medication for heroin addiction treatment. Well-run methadone maintenance programs that incorporate appropriate drug monitoring, counseling services, and vocational resources and referrals have been demonstrated to 1) decrease heroin use and 2) related crime, 3) increase employment, improve 4) physical and 5) mental health (McLellan et al. 1993), and 6) markedly reduce the incidence of needle sharing (Metzger 1991). Methadone also 7) decreases craving for opioids.

Question 32

Some of the effects of buprenorphine are [increased/reversed] at high doses, possibly because of its actions at the [kappa/mu] opioid receptor.

Answer 32

Some of the effects of buprenorphine are reversed at high doses, possibly because of its actions at the kappa opioid receptor.

Question 33

In a person who is physically dependent on heroin, spontaneous withdrawal usually begins X to XX hours after the last dose and peaks in intensity YY to ZZ hours after the last use. The withdrawal syndrome lasts approximately D days.

Answer 33

In a person who is physically dependent on heroin, for example, spontaneous withdrawal usually begins 6 to 12 hours after the last dose and peaks in intensity 36 to 72 hours after the last use. The withdrawal syndrome lasts approximately 5 days.

Question 34

How long is the period before the onset of spontaneous withdrawal of methadone?

Answer 34

36 to 72 hours for methadone

Question 35

The strength with which a medication binds to a receptor is referred to as its xxxxxx for that receptor

Answer 35

The strength with which a medication binds to a receptor is referred to as its affinity for that receptor.

Question 36

he rate a medication uncouples from a receptor is referred to as DDDDDDDD.

Answer 36

The rate a medication uncouples from a receptor is referred to as dissociation.

Question 37

The abuse potential of a drug depends upon 1), 2) & 3)

Answer 37

The abuse potential of a drug depends upon 1) the route of administration, 2) the rate of onset of drug effects, and 3) the half-life of the drug