Management of Opiate Misuse Flashcards
What medical intervention is used to combat addiction?
- Replacement prescribing.
- Detoxification and relapse prevention.
- Benzodiazepines.
What psychosocial intervention may be used to combat addiction?
- Keyworking.
- Therapeutic alliance.
- Self-alliance.
- Self-help.
- Contingency management (paying people to stop).
When is detox suitable?
If history of opiate misuse is shorter and uncomplicated
What type of person is detox suitable in?
Someone who is stable socially
When only does detox work?
Person is detoxing TO (not FROM) something
What is used only in impulsive relapsers?
Opiate blockage
Give an example of an opiate blocker.
Naltrexone
What 4 detox options are available?
- Self-detoxification (with support).
- Reducing prescribed opioids.
- Alpha-2-adrenergic agonists.
- Adjunctive treatments.
Outline how reducing prescribed opiates is done.
- Use current drug OR consider alternative.
* Gradual reduction; time-limited process; psychosocial support; symptom Rx.
Give an example of an alpha-2-adrenergic agonist.
Lofexidine
What does Lofexidine do?
Reduces physical symptoms
Describe the dosing of Lofexidine.
Initial test done, then maximise dosage to overcome sx.
Later, tailor dose down
Give examples of adjunctive treatments.
Loperamide.
Hypnosis.
NSAID.
OST
Opiate Substitute Therapies
Give 2 examples of opiate substitute therapies.
Methadone
OR
Buprenorphine
What is the risk for patients on OST?
Poly drug use (plus alcohol) and drug death
In terms of mode of action, what type of drug is Buprenophine?
A partial antagonist
What is the main issue with Buprenorphine?
Issue of supervision – it is a sublingual tablet which takes 15mins to dissolve, so prescribing pharmacist needs to be with each pt for this length of TIME
What can Buprenorphine be used in combination with?
Naloxone
What can be done (that isn’t usually done in the UK) if OST fails?
Heroin assisted treatment (HAT)
Who is HAT usually used for?
Those at risk of harm (PWIDs) who are failing on traditional treatments
What are higher doses of OST-M better for?
Retaining patients and reducing opiate and cocaine use
