Opiate Misuse

Question 1

What are some psychosocial interventions in Opiate Misuse?

Answer 1

Keyworking
Therapeutic alliance
Self-help
Contingency management

Question 2

What are some medical interventions in Opiate Misuse?

Answer 2

Replacement prescribing: dosing, safe induction, increasing intensity of treatment & psychosocial interventions
Detox & relapse prevention: selected patients and risk management, relapse prevention packages and Rx
Benzodiazepines

Question 3

What are some detox options in opiate misuse?

Answer 3

Self-detoxification (with support)
Reducing prescribed opioids: use current drug OR consider alternative, gradual reduction; time limited process; psychosocial support; symptom Rx
Alpha 2 adrenergic agonists: lofexidine, initial test dose – then maximised dosage to overcome symptoms, tailor down dose
Adjunctive treatments – loperamide, hypnotic, NSAID

Question 4

What are some opioid substitution therapies (OST)?

Answer 4

Methadone or buprenorphine

Question 5

Describe Buprenorphine

Answer 5

Partial agonist
Combination-added naloxone
Equal efficacy with methadone
Potential public health benefits (less diversion deaths than methadone)