Opiate_Misuse_QA

Question 1

What investigations are performed for opiate misuse?

Answer 1

Physical examination, urine drugs screen, U&Es, FBC, LFTs, blood borne infections (RPR, hepatitis serology, HIV test).

Question 2

What is the general management approach for opiate misuse?

Answer 2

Assessing and minimising risk rather than insisting on abstinence, offering information on improving safety of drug use.

Question 3

What harm reduction strategies are recommended?

Answer 3

Needle exchanges for IV drug users, vaccination and testing for blood-borne viruses for sex-workers and IVDU.

Question 4

What general recommendations should be provided to patients?

Answer 4

Counsel on aspects of a healthy lifestyle, provide information about self-help groups, offer assessment for family members and carers.

Question 5

When should opioid withdrawal treatment not be routinely offered?

Answer 5

Concurrent medical problem requiring urgent treatment, in police custody, presenting in acute or emergency settings, pregnant women.

Question 6

What is the first line medication for detoxification?

Answer 6

Methadone (liquid) or buprenorphine (sublingual).

Question 7

What is the second line medication for detoxification?

Answer 7

Consider lofexidine (alpha-2 agonist) if above options are unacceptable, mild dependence or keen to detoxify over a short period of time.

Question 8

How long does inpatient detoxification typically last?

Answer 8

Up to 4 weeks.

Question 9

How long does community detoxification typically last?

Answer 9

Up to 12 weeks.

Question 10

How are withdrawal symptoms managed during detoxification?

Answer 10

Clonidine and Lofexidine (alpha-2 adrenergic agonists), anti-diarrhoeals, anti-emetics, pain killers.

Question 11

What are the different types of detoxification methods?

Answer 11

Ultra-rapid, rapid, and accelerated detoxification.

Question 12

What is the approach for ultra-rapid detoxification?

Answer 12

24 hours under general anaesthesia or heavy sedation.

Question 13

What is the approach for rapid detoxification?

Answer 13

1-5 days with moderate sedation.

Question 14

What is the approach for accelerated detoxification?

Answer 14

No sedation.

Question 15

What are the goals of stabilisation and maintenance?

Answer 15

Promote abstinence from illicit drugs, prevent relapse, reduce HIV and hepatitis C risk, reduce mortality, and decrease criminality.

Question 16

What treatments are essential for the majority of patients with opioid use disorder?

Answer 16

Medication-assisted treatment.

Question 17

What medications are used for long-acting opioid agonist and antagonist therapy?

Answer 17

Methadone, buprenorphine, and injectable extended-release naltrexone.

Question 18

What is contingency management?

Answer 18

Offer incentives for every drug-negative test, frequent screening, urinalysis is the preferred method of screening.

Question 19

What follow-up care should be provided after detoxification?

Answer 19

Refer to Drugs and Alcohol Service for at least 6 months, offer talking therapy, appoint a key worker.

Question 20

What should be explained to patients regarding blood-borne diseases?

Answer 20

Explain tests for blood-borne diseases and offer vaccinations.

Question 21

What are the features of opioid withdrawal?

Answer 21

Restlessness, anxiety, sweating, yawning, diarrhoea, abdominal cramps, nausea and vomiting, palpitations.

Question 22

What should be explained about the detoxification regime?

Answer 22

Explain giving a substitute to lessen withdrawal symptoms.

Question 23

What symptomatic treatments will be given during detoxification?

Answer 23

Nausea, diarrhoea, and autonomic symptoms management.

Question 24

What is the role of psychological therapies in preventing relapse?

Answer 24

Preventing relapse.

Question 25

What is the role of the key worker?

Answer 25

Supports the patient through detoxification.

Question 26

What support groups can be recommended?

Answer 26

Narcotic Anonymous, SMART Recovery.