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PSYT 301 > Lecture 7/8: opioids > Flashcards

Lecture 7/8: opioids Flashcards

1
Q

opioids is derived from what?

A

opium poppy plant

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2
Q

types of opioids

A
  1. natural opioids (opiates) – derived directly from the opium poppy without chemical modification
  2. semi-synthetic: chemically modified rom plant
  3. synthetic: fully synthesized in lab
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3
Q

3 main natural neuropeptides

A

b-endorphin, enkephalin, dynorphin

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4
Q

3 main receptors

A

mu, delta, kappa

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5
Q

ORs regulate what processes?

A

pain, mood, stress, pleasure

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6
Q

when if main considered chronic?

A

more than 3 months

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7
Q

why do we see opioid use in adolescences (recreationally)

A

misinformation that they think prescription opioids are safer than illicit sources

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8
Q

adolescents often get opioids from where?

A

a friend or leftover medication

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9
Q

what factors are associated with recreational use of opioids?

A
  • socio0demogrphic factors: young, low income, unstable housing
  • biological: genetics predisposition
  • psychological: adverse childhood experiences, personality predispositions, history of mental heath issues
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10
Q

factors increasing the risk of opioid-related deaths

A
  • mixing of drugs/substances (alcohol, BDZs, stimulants)
  • variation in opioid strength (illegally purchased vary in strength)
  • opioid tolerance shift (decreased tolerance shift from abstinence then going back to dose they took before)
  • administration route (injections)
  • using alone
  • physical health issues (person with acute/chronic illness)
  • contextual factors (e.g. covid-19)
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11
Q

factors contributing in pain perception

A

biological factors, psychological factors, socio/economical factors

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12
Q

how do we perceive pain (the pathway)

A

PNS sense pain through nociceptors which go up ascending pathways, which go up the CNS via the spinal cord, which is integrated/interpreted by the brain

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13
Q

what are common mental health disorder seen in pain patients?

A

depression, anxiety, trauma- and stress- related disorder, personality disorders, SUDs

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14
Q

factors leading to the rise in opioid prescriptions?

A
  • lack of education on pain/addiction in medical school
  • insurers/payers: no access to non-pharmacological treatment
  • pharmaceutical companies doing lots of marketing
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15
Q

side effects of opioids

A
  • sedation
  • cognitive issues
  • nausea/vomiting
  • constipation
    opioid-induced endocrinopathy
  • opioid-induced hyperalgesia
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16
Q

what are the behaviours seen in opioid-use disorder?

A
  1. Social problems
  2. Occupational problems
  3. Failure to fulfill life role obligations
  4. Risky use
  5. Taken in larger amounts than intended
  6. Psychological problems due to use
  7. Compulsive use
  8. Unsuccessful efforts to cut down
  9. Craving
    (not tolerance and withdrawal since seen in physical dependence)
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17
Q

what is craving?

A

subjective desire to consume substances

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18
Q

what is the main factor driving opioid misuse in patients with high negative affect?

A

craving

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19
Q

how well does craving associate with pain intensity?

A

moderately, when it should be the main driver

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20
Q

pain intensity is: static or fluctuating

A

fluctuate

21
Q

what is a harm reduction strategy?

A

Public health strategies aimed at minimizing the negative consequences (e.g. OD, infectious diseases) associated
with drug/opioid use.
also, to improve their well-being (physical, social, and mental) and to provided resources/treatment options.

22
Q

what are some harm reduction strategies?

A

safe opioid disposal locations, drug testing, syringe exchange programs
supervised consumption sites, safer opioid supply programs, naloxone distribution

23
Q

what are the treatment approaches for OUD?

A

opioid agonist treatment: act more slowly in the body and for longer periods of time (buprenorphine-naloxone, methadone, slow-release oral morphine)

24
Q

Buprenorphine - naloxone (suboxone) target

A
  • bu: partial opioid agonist for MOR and antagonist of KOR
  • nal: antagonist for ORs and will antagonize effect of bup if injected
    (sublingual)
25
Q

methadone target

A

full opioid agonist (liquid)

26
Q

advantage of buprenorphine

A
  • less side effects (lower risk of OD)
  • few interactions with other meds
  • lower risk of public safety harms if diverted
27
Q

approaches proposed to prevent opioid problem (prescription issue)

A
  • decision to initiate opioids for pain
  • selection of opioids, dosage, duration (short-acting, lowest effective dose)
  • evaluate risk (and taper when needed)
28
Q

what is the difference between opiates and opioids?

A

opiates restricted to natural opium products but opioids are the class of drugs that are found naturally in opium plant

29
Q

opioid use disorder (according to the new DSM-5) combines which two disorders that were previously described?

A

opioid dependence and opioid abuse

30
Q

what is InSite

A

the first supervised drug injection site, located in vancouver

31
Q

what is abstinence?

A

state of voluntary or involuntary non-engagement in a behaviour

32
Q

what are some therapy options for OUD?

A
  • 12-step program
  • cognitive-behavioural therapy
  • contingency management
  • family therapy
  • group counseling/ support groups
  • motivational interviewing
33
Q

what is the con of therapy as a trestment?

A

in some cases, it cannot be the sole form of treatment because it does not help with severe physical withdrawal symptoms from detoxing.

34
Q

when taken as prescribed, what do opioid agonist treatments do?

A

prevent opioid withdrawal symptoms for 24-36 hours and help eliminate opioid craving (compared to the 6-12 hour delay with stringer drugs such as heroin)

35
Q

benefits of methadone?

A

high bioavailability, long elimination, half-life is about 24 hours, and prevents withdrawal symptoms

36
Q

limitations of methadone

A
  • potential risk of overdose (no ceiling effect, initial doses lower than comfort zone during titration)
  • modalities - at the beginning of treatment,: dose obtained daily at pharmacy
  • has to be taken under supervision
  • training and license were required for physicians
37
Q

benefits of buprenophine

A
  • long elimination half-life, helps
    relieve withdrawal symptoms
  • lower risk of overdose (ceiling effect)
  • comes in many forms, less restrictive treatment modalities (for both patients and physicians)
38
Q

what are the limitations of buprenorphine?

A
  • needs to be combined with naloxone
    (to avoid misuse and diversion)
  • acceptability is elevated but the presence of naloxone is sometimes perceived as negative by people who use opioids
39
Q

what is the benefit of heroin as an opioid agonist treatment?

A

in theory, responds to the specific needs of patients who do not respond to available medication-assisted treatments

40
Q

what is the limitation of heroin as an opioid agonist treatment?

A
  • access to treatment is restricted
  • treatment modalities may present low acceptability for patients, as each injection must be obtained in a controlled medical space, following a
    planned schedule
41
Q

what are the different opioid antagonist treatments?

A
  • suboxone (buprenorphine and naloxone)
  • naltrexone
42
Q

what is the benefit of naltrexone as a treatment?

A
  • effectively antagonizes heroin
  • relatively long duration of action (4 hours) as compared to naloxone
  • works well for long-term treatment
43
Q

what are the limitations of naltrexone as a treatment?

A
  • can decrease, but doesn’t eliminate cravings
  • chronic exposure may result in upregulation of opioid receptors, thereby increasing their sensitivity
44
Q

what is the benefit of naloxone as a treatment?

A
  • appropriate for overdose intervention, can temporarily stop the effects of opioid use.
  • now available in nasal spray
  • easy to administer
45
Q

what is the limitation of using naloxone as a treatment?

A
  • cost of the nasal spray formula
  • requires legal and medical authorization (for manufacturing and distribution, collective prescription),
    pharmacists’ participation and implementation of staff and peer overdose prevention programs (and Take Home Naloxone) programs)
46
Q

what were the 4 phases leading to the overdose crisis?`

A
  1. over-reliance on opioid prescription
  2. increased diverted or illegally produced opioids
  3. unprecedented rise in synthetic opioids and analogues
  4. fentanyl dominance, widespread toxicity, and unpredictable supply
47
Q

what else can sometimes be found in fentanyl drug supply? what does this cause?

A

causes poly-dependence: xylazine, BDZ, levamisole

48
Q

what are some barriers and obstacles in trying to stop?

A
  • the wrong services
  • marginalization and discrimination
  • burnout and compassion fatigue
  • extensive waiting list
  • insufficient capacity

PSYT 301 (8 decks)

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