Lecture 6

Question 1

when was the statement from 2 major professional societies about opioids and what was it about

Answer 1

1996
opioids should have a role in the treatment of chronic non cancer pain

Question 2

what was one of the reasons why opioids sales quadrupled between 1990and2010

Answer 2

-opioid marketing was aggressive
-specific opioids were marketed as less addictive

Question 3

which company was awarded a fine and why

Answer 3

-purdue
-misleading the public and prescribing physotians
-claimed that oxycontin was less addictive than other opioids

Question 4

what is the % that opioids work more than placebo

Answer 4

6%

Question 5

true or false rtcs were usually during less than 3months

Answer 5

true

Question 6

problems with opioids

Answer 6

-more er visits
-more deaths
-physical dependence
-opioid misuse
-opioid addiction

Question 7

what is the % of opiod related deaths in people

Answer 7

75% occured between men

Question 8

true or false: 50% opioid related deaths involved another substance

Answer 8

false it is 45%

Question 9

what is the main age category od opiod related deaths

Answer 9

90% occured among young and middle aged adults

Question 10

what is the main component of opioid related deaths: pharmateutical, both, non-pharmaceutical only or underdetermined

Answer 10

non pharmaceutical only aka illegaly bought

Question 11

what does opioid abuse mean

Answer 11

-opioids not prescribed to the user by a physician
-obtained from friends
-nonmedical
-to get high

Question 12

what does opioid misuse mean

Answer 12

• opioids prescribed by a physician
  -prescribed for a medical reason
  -they were prescribed for smth but used to get high

Question 13

past year nonmedical use of prescription opioids among adults

Answer 13

3-5%

Question 14

past year nonmedical use of prescription opioids among ado

Answer 14

5-10%

Question 15

why do ados use more prescription opioids

Answer 15

because they view prescription drugs aka opioids as safer than illegal drugs

Question 16

what are the main sources of prescription opioids for ados

Answer 16

-peers
-leftover medications

Question 17

what are the 2 prescription opioid misuse

Answer 17

-unsanctioned dose escalations
to improve sleep/mood
to experience the euphoric effects
-concurrent use of unsanctioned substances
alcohol/illicit drugs
prescription drugs

Question 18

prevalence of opioid misuse in primary and tertiary care settings

Answer 18

20-30%

Question 19

how do we know there is opioid misuse

Answer 19

-self reports
-clinical interviews
-medical records
-urine tox screens

Question 20

what is opioid dependence

Answer 20

characterized by somatic aka physical withdrawal symptoms following cessation of opioids or decreases in opioid blood levels

Question 21

true or false: opioid dependance is a normal/expected response resulting from prolonged opioid use

Answer 21

true

Question 22

individuals who have devloped opioid dependance necessariy have an opioid addiction problem

Answer 22

they do not

Question 23

how do we diagnose opioid addiction

Answer 23

-semi structered clinical interview
-dsm criteria

Question 24

prevalence of opioid use disorder in patients with chronic pain

Answer 24

10%

Question 25

what are the main categories for risk factors for opioid misuse and addiction

Answer 25

-demographic/backround variables -clinical/treatment variables -psychological/psychiatric variables

Question 26

what are the specifics of risk factors of opioid misuse and addiction; demographic/backround varibles

Answer 26

-sex -age -family histiry -personnal history

Question 27

what are the specifics of risk factors of opioid misuse and addiction; clinical/treatment variables

Answer 27

-opioid doses -pain intensity

Question 28

what are the specifics of risk factors of opioid misuse and addiction; psychological/psychiatric variables

Answer 28

-anxiety -depressive -psychiatric disorders -craving

Question 29

what is craving

Answer 29

-refers to the subjective desire to consume substances -long history in the broader substance use/addiction literature -extensive basic & clinical research on craving

Question 30

key recommendation domains for opioid prescription

Answer 30

-patient selection aka avoid high risk people -opioid dosing: prescription of <90 mg -opioid dose reduction: if it is higher then try to taper off

Question 31

what are the 2 roles of therapists in the management of patients with pain using opioids

Answer 31

-traditional roles aka coping skills, adjustment to pain -new/emerging role: prevent/reduce risks of opioid use problems

Question 32

interventions to preven/reduce opioid problems

Answer 32

-monitoring aka monitoring pain outcomes/misuse behavior -psychological interventions aka CBT and acceptance&mindfulness based interventions

Question 33

CBT

Answer 33

-education on opioid misuse and substance use problems -enhancing and maintaining motivation to be compliant -cignitive restructuring/help patients identify high risk situations -help patients cope with craving and urges to misuse opioids

Question 34

interventions based on acceptance&commitment therapy

Answer 34

-focus is not on changing negative cognitions or emotions -patients encouraged to accept unpleasant states -redefine personally meaningful values