Medical treatment of opiate misuse

Question 1

What is harm reduction?

Answer 1

aims to reduce the adverse consequences of drug use among persons who continue to use drugs- practical goals.

Question 2

Medical interventions

-what 3 areas need to be addressed?

Answer 2

Benzos- detoxification

Alcohol- address and asses- treat

Opiates- detoxification, opiate blockade & replacement prescribing

Question 3

Opiates

• what patients would benefit from detoxification?
• from opiate blockade?
• additional?
• what are the options or detoxification? () risks?

Answer 3

• uncomplicated, shorter hx, socially stable
• only in impulsive relapsers
• psychosocial interventions

-More common:
Opioid substitution therapies (OST)
METHADONE or buprenorphine (takes longer to take), diamorphine
risks: polydrug use and death
Less common:
Self-detoxification (with support)
reducing prescribed opiates (use current drug or alternative, gradual reduction)
Alpha 2 adrenergic agonists
(e.g. lofexidine, maximise dose to overcome symptoms)
Adjuvant Tx: loperamide, NSAIDs

Question 4

Psychological interventions

-what are you trying to achieve?

Answer 4

-behavioural change:
retention
harm reduction
recovery