Opiod dependence

Question 1

What features might suggest a patient is opioid dependent?

Answer 1

Behaviour - early getting scripts, requesting increasing dosages, illicit drug use.
Opioid withdrawal behaviour - restless, agitation, rhinorrhoea, lacrimation, nausea, vomit, abdominal pain, myalgias, arthralgias.
Signs of withdrawal may start 6-12 hours after short acting opioids. 24-48 hours after methadone dose.

Question 2

What examination findings may suggest opioid withdrawal?

Answer 2

myiadrisis, tachycardia, hypertension, yawning, increased bowel sounds.

Question 3

Is it legal to prescribe a opioid drug to a patient deemed is drug dependent?

Answer 3

It is illegal

Question 4

Can you prescribe S8 drugs to drug dependent persons?

Answer 4

Need approval from pharmaceutical services.

Question 5

In ACT, how long can you prescribe S8 drugs to non drug dependent persons?

Answer 5

If greater than 2 months, then need CHO approval.

Question 6

What strategies can you use to help control the patients use of opiods who may be at risk of dependence?

Answer 6

Outline at the first consultation, how much and how frequent you can prescribe it.
Will only given scripts Monthly, if you come early and signs there may be dependence make the patient collect drugs fortnightly, weekly, every 2nd day, daily.

Question 7

What drugs can be used to for opioid maintenance program?

Answer 7

Methadone

Buprenorphine Suboxone tablet and film - contains naloxone in it as well. Subutex (no naloxone)

Question 8

Outline the action of methadone and why it is useful in opiod maintenance?

Answer 8

Opioid full agonist
Long acting 24 hours
Maintain opioid tolerance
Reduce withdrawal side effects
Withdrawal may take more than 24 hours to come on.
Less criminality
Reduce drug risk beahviour ie HIV transmission lower.

Question 9

Outline the adverse effects of methadone?

Answer 9

Risk of induction death 7.1 per 10,000 cases

Hyperalgesia, prolonged QT

Question 10

Outline the typical starting and maintenance doses of methadone and suboxone?

Answer 10

Methadone 30mg daily, titrate slowly up. 80 mg maintenance is usual.
Suboxone - 4/1mg daily, the up to 16mg/4mg maintenance.

Question 11

Outline the side effects of suboxone?

Answer 11

Headaches, nausea, sedation, constipation, insomnia.

Question 12

What options do you have for treatment if a patient on methadone continues to use opiods?

Answer 12

Consider opioid antagonist - naltrexone