Lecture 18 - Opioids II

Question 1

dopamine is involved in:

Answer 1

motivated behaviour

Question 2

where are dopamine neurons located?

Answer 2

primarily in the ventral tegmental area (VTA)

Question 3

mu opioid receptors in the VTA are located on:

Answer 3

inhibitory GABAergic interneurons

Question 4

do mu opioid agonists lead to increased or decreased dopamine release?

Answer 4

increased dopamine release (inhibits inhibitory GABAergic interneurons)

Question 5

how do opioid receptors inhibit pain?

Answer 5

1) decreasing nociception at the level of the nociceptor, in the spinal cord, and in the brain stem
2) decreasing the emotional and cognitive aspects of pain (make pain bother you less)

Question 6

which are better analgesics: drugs that target the sensory aspects of pain, or drugs that target the cognitive/emotional aspects of pain?

Answer 6

sensory

Question 7

what is the problem with trying to develop good non-addictive analgesics?

Answer 7

opioids are good analgesics because they are rewarding

Question 8

decreased response to the effects of the drug, necessitating even larger doses to achieve the same effect

Answer 8

tolerance

Question 9

how large a dose can an opioid tolerant person take?

Answer 9

2g (lethal dose for a drug naive individual is ~30mg)

Question 10

how does opioid desensitization work?

Answer 10

following agonist binding and G-protein signalling, beta-arrestin is recruited to shut-off signalling

Question 11

when the receptor agonist complex is pulled off the membrane and recycled in an endosome, then it is either:

Answer 11

degraded or recycled back to the membrane

Question 12

repeated opioid use leads to:

Answer 12

less opioid receptors on the membrane –> reduced agonist effect (tolerance)

Question 13

develops following chronic opioid use and is revealed following abrupt discontinuance of drug as withdrawl

Answer 13

physical dependence

Question 14

acute opioid withdrawl includes:

Answer 14

• rhinorrhea (runny nose)
• lacrimation (tearing eyes)
• chills
• muscle aches
• diarrhea
• yawning
• anxiety

Question 15

aversion to withdrawl symptoms can drive the transition to:

Answer 15

addiction

Question 16

true or false: drug addiction is the same thing as drug dependence

Answer 16

false

Question 17

a brain disease driven by dysfunction in reward, motivation, and memory circuitry

Answer 17

addiction

Question 18

what are the five major characteristics of addiction?

Answer 18

• inability to abstain consistently
• impairment of behaviour control
• drug craving
• diminished recognition of significant problems with ones behaviours and interpersonal relationships
• dysfunctional emotional response

Question 19

what type of disease is substance use disorder?

Answer 19

a biopsychosocial disease

Question 20

can increase your likelihood of developing an addiction and can promote continued drug use

Answer 20

biological factors

Question 21

risky drug use is highly correlated with:

Answer 21

• socioeconomic status (poverty)
• homelessness
• social isolation
• early life trauma

Question 22

interventions in drug addiction need to target:

Answer 22

both psychosocial and biological factors

Question 23

the rise in opioid overdoses in Canada was initially blamed on:

Answer 23

reckless prescribing of supposedly ‘safer’ opioids like oxycodone

Question 24

what are the three waves of the opioid crisis?

Answer 24

1) early 2000s - prescription opioid drugs (oxycodone)
2) early 2010s - cheap heroin from Mexico
3) 2020s - fentanyl-tainted illicit drugs

Question 25

go review slide 538

Answer 25

weeeeee

Question 26

a talk-based psychosocial intervention administered by a licensed psychologist; aims to develop non-drug coping strategies to triggers

Answer 26

cognitive behavioural therapy

Question 27

individuals are rewarded (money) for evidence of positive behavioural change

Answer 27

contigency management interventions/ motivational incentives

Question 28

involves organizations such as Alcoholics Anonymous and Narcotics Anonymous

Answer 28

counseling/therapeutic communities

Question 29

- connects people seeking treatment to a community of non-users - de-stigmatizes drug use - can connect users with medical interventions - free these are all positive aspects of:

Answer 29

Narcotics Anonymous/Alcoholics Anonymous

Question 30

- no medical interventions - religious undertones can be off-putting for some - abstinence only these are all negative aspects of:

Answer 30

Narcotics Anonymous/Alcoholics Anonymous

Question 31

a comprehensive treatment approach including maintenance on an opioid agonist and cognitive behavioural therapy

Answer 31

agonist replacement therapy

Question 32

agonist therapy blunts the symptoms of:

Answer 32

opioid withdrawl

Question 33

since replacement agonists have longer half-lives, you avoid the:

Answer 33

repeated high/crash cycle

Question 34

- reduced drug cravings - better participation in addiction treatment since withdrawl symptoms aren't a distraction - improved social function - reduction in infectious disease/death associated with illicit drug use these are all postivie aspects of:

Answer 34

agonist replacement therapy

Question 35

a drug which acts as a partial agonist at the mu opioid receptor, and an antagonist at the kappa and delta opioid receptor

Answer 35

buprenorphine

Question 36

how does buprenorphine affect mood?

Answer 36

antagonist at kappa receptor improves mood

Question 37

buprenorphine is marketed as:

Answer 37

suboxone (buprenorphine + naloxone)

Question 38

interventions or services that are offered to minimize the harms of illicit drug use

Answer 38

harm reduction

Question 39

what are some examples of harm reduction?

Answer 39

needle exchange, naloxone kits, safe consumption sites, and safe supply

Question 40

provide a safe place to take drugs to reduce harm or poisonings (overdoses)

Answer 40

supervised consumption sites (SCS)

Question 41

do clients have to bring their own drugs to supervised consumption sites (SCS)?

Answer 41

yes (they are provided clean needles and medical supervision)

Question 42

do you need a referral to access supervised consumption sites (SCS)?

Answer 42

no, anyone can access them and can remain anonymous

Question 43

refers to a legal and regulated supply of drugs that have traditionally been acceptable through the illicit drug market

Answer 43

safe supply

Question 44

drugs in "safe supply" include:

Answer 44

opioids, cocaine, methamphetamine, MDMA, and LSD

Question 45

- strong evidence that these interventions reduce morbidity and mortality associated with opioid use - provide access to information and resources for additional treatment these are all positive aspects of:

Answer 45

harm reduction (SCS/iOAT - injectable opioid agonist therapy)

Question 46

- normalizes risky drug use - moral argument for providing drugs to people with addiction (are they getting better?) - "not in my backyard" (NIMBY) related to the location of SCS/iOAT clinics (need to be found across communities in order to be effective) these are all negative aspects of:

Answer 46

harm reduction (SCS/iOAT)

Question 47

a non-selective competitive opioid receptor antagonist which is available to the public as an intramuscular injection or nasal spray, works within minutes and lasts about half an hour

Answer 47

acute intoxication treatment

Question 48

what is an example of acute intoxication treatment?

Answer 48

naloxone