Opiate_Misuse_QA Flashcards
What investigations are performed for opiate misuse?
Physical examination, urine drugs screen, U&Es, FBC, LFTs, blood borne infections (RPR, hepatitis serology, HIV test).
What is the general management approach for opiate misuse?
Assessing and minimising risk rather than insisting on abstinence, offering information on improving safety of drug use.
What harm reduction strategies are recommended?
Needle exchanges for IV drug users, vaccination and testing for blood-borne viruses for sex-workers and IVDU.
What general recommendations should be provided to patients?
Counsel on aspects of a healthy lifestyle, provide information about self-help groups, offer assessment for family members and carers.
When should opioid withdrawal treatment not be routinely offered?
Concurrent medical problem requiring urgent treatment, in police custody, presenting in acute or emergency settings, pregnant women.
What is the first line medication for detoxification?
Methadone (liquid) or buprenorphine (sublingual).
What is the second line medication for detoxification?
Consider lofexidine (alpha-2 agonist) if above options are unacceptable, mild dependence or keen to detoxify over a short period of time.
How long does inpatient detoxification typically last?
Up to 4 weeks.
How long does community detoxification typically last?
Up to 12 weeks.
How are withdrawal symptoms managed during detoxification?
Clonidine and Lofexidine (alpha-2 adrenergic agonists), anti-diarrhoeals, anti-emetics, pain killers.
What are the different types of detoxification methods?
Ultra-rapid, rapid, and accelerated detoxification.
What is the approach for ultra-rapid detoxification?
24 hours under general anaesthesia or heavy sedation.
What is the approach for rapid detoxification?
1-5 days with moderate sedation.
What is the approach for accelerated detoxification?
No sedation.
What are the goals of stabilisation and maintenance?
Promote abstinence from illicit drugs, prevent relapse, reduce HIV and hepatitis C risk, reduce mortality, and decrease criminality.
What treatments are essential for the majority of patients with opioid use disorder?
Medication-assisted treatment.
What medications are used for long-acting opioid agonist and antagonist therapy?
Methadone, buprenorphine, and injectable extended-release naltrexone.
What is contingency management?
Offer incentives for every drug-negative test, frequent screening, urinalysis is the preferred method of screening.
What follow-up care should be provided after detoxification?
Refer to Drugs and Alcohol Service for at least 6 months, offer talking therapy, appoint a key worker.
What should be explained to patients regarding blood-borne diseases?
Explain tests for blood-borne diseases and offer vaccinations.
What are the features of opioid withdrawal?
Restlessness, anxiety, sweating, yawning, diarrhoea, abdominal cramps, nausea and vomiting, palpitations.
What should be explained about the detoxification regime?
Explain giving a substitute to lessen withdrawal symptoms.
What symptomatic treatments will be given during detoxification?
Nausea, diarrhoea, and autonomic symptoms management.
What is the role of psychological therapies in preventing relapse?
Preventing relapse.
What is the role of the key worker?
Supports the patient through detoxification.
What support groups can be recommended?
Narcotic Anonymous, SMART Recovery.
