Opiate Abuse, MacIntyre Flashcards
how many people die everyday from opioid OD
44
which drug is on the rise in OD
heroin
leading cause injury death in 2013
drug OD
deadly combo of drugs
benzos and opioid painkillers
routes of opium
PO, IV, skin pop, snort, smoke
most popular Rx opioids
OxyContin:oxycodone
Vicodin: hydrocodone/acetaminophen
Percocet: oxycodone acetaminophen
Sx of Rx opioids
euphoria, sedation constricted pupils slurred speech impaired coordination dec BP HR and rspiratory depression
other names for heroin
horse, dope, H, junk, smack
how is heroin used
IV IM snorted skin popping
Sx heroin
euphoria, sedation, constricted pupils, impaired coordination, can cause dec BP HR, respiratory depression
IV use heroin inc risk for
HIV HCV HBV cellulitis sepsis bacterial endocarditis
Street heroin cut with
sometimes fentanyl, barbs, household powders… etc
intoxication Sx of heroin
pupillary constriciton flushing sedation slurred speech bradycardia hypotension resp depression hypothermia constipation
withdrawal Sx of heroin
pupillary dilation piloerection nausea vomiting diarrhea lacrimation rhinorrhea joint/muscle pain abdominal cramps yawning
withdrawal heroin peaks
3-4 days
can continue for weeks to months
if patient has co morbid respiratory conditions
avoid opiate use, at least reduce dose
naloxone
reverse opiate OD
shown in like epi pen format or intranasal
first step Tx for opioid abuse
detox
types of detox
cold turkey methadone and wean buprenorphine supportive meds for withdrawal Sx clonidine for mild withdrawal or as adjunct
after detox
need to transition to maintenance Tx else at high risk of relapse
synthetic opioid
methadone
pros methadone
safety
safe in pregnancy
intoxicating effects less euphoric
can take at home
cons to methadone
cant leave clinic vicinity for a day
prolong QT
multiple DDI
use restricted
What is LAAM
levo alpha acetylmethadol
similar to methadone but less dosing
