Opioid Addiction Flashcards
Is physical dependence/tolerance to opioids necessary/sufficient for diagnosis of opioid use disorder?
no
Criteria for Substance Use Disorder
- taking larger amounts or longer than intended
- attempt to quit or control use
- much time spent using or recovering
- cravings
- inability to meet responsibilities at home, school, employment
- interpersonal/relationship problems
- give up or cut back pleasurable activities to use
- place oneself in danger d/t use
- use resulting in physical or psychological illness/harm
- tolerance to effect of substance
- withdrawal sx when using or using less
Mild/Mod/Severe?
Mild 2-3
Mod 4-5
Severe 6+
What are 3 specific findings of opioid withdrawal?
Piloerection
Mydriasis
Yawning
What are other sx of opioid withdrawal?
- GI: cramps, diarrhea, N/V
- Flu-like: lacrimation, rhinorrhea, diaphoresis, shivering, piloerection, sneezing, myalgia, arthralgia, muscle cramps
- Sympathic/CNS arousal: mydriasis, HTN, tachycardia, anxiety, irritabiltiy, insomnia, agitation, restlessness, tremor, low grade fever
- Other: yawning, opioid craving
What does COWs stand for?
Chronic Opioid Withdrawal Scale
What is COWs used for?
- Severity tool
- NOT diagnostic tool
*Must have diagnosis of opioid withdrawal before using tool
Can methadone be administered in inpatient setting?
Yes, IF pt is admitted for a condition other than opioid use withdrawal
Inpatient Goal of mgmt of acute opioid withdrawal?
- focus on acute medical problem requiring hospitilization
- decrease leaving against medical advice
- facilitate open discussion about addiction
- improve pt/provider relationship
- help facilitate referral to substance us disorder tx after hospitlization
What are NOT the goal of inpatient mgmt of acute opioid withdrawal?
To cure addiction or eliminate cravings
Full agonist?
Morphine
Oxycodone
Methadone
Partial agonist?
Buprenorphine
Antagonist?
Naloxone
Naltrexone
Methadone (class, onset, duration, dosing)
Full opioid agonist
Full SYNTHETIC opioid
Onset: 30-60min
Duration: highly variable; tx pain before addiction
Dosing: 20-40mg
Buprenorphine
- PARTIAL AGONIST
- Mono therapy = safe in pregnancy
- Good SL and IV bioavailability
- HIGH AFFINITY for opioid receptor
- “ceiling effect”
What is the ceiling effect of Buprenorphine?
Effect of buprenorphine plateau and will ONLY provide withdrawal relief and pain relief
It will NOT provide euphoria, respiratory depression or death
What do you want to make sure before admin buprenorphine?
Pt is in withdrawal or has not been using opioids
*want to avoid going from full agonist –> partial agonist
What is suboxone?
- Buprenorphine + Naloxone
- Naloxone has good IV bioavailability
- burprenorphine doing affect
What is the purpose of combining nalaoxone w/ buprenorphine?
- Nalaxone is there so if a pt decides to melt, crush, mix suboxone, they will get the naloxone component when they inject it via IV
- reduces street value and misuse potential
What is naloxone?
- Full antagonist w/ strong affinity to receptor
- Reverses opioid OD by displacing opioid agonist (heroin) from receptor
- will induce withdrawal sx if opioid remain on receptor when given
- BLOCKS opioid receptor
What is naltrexone?
- Pure opioid antagonist
- comes PO and IM (Vivitrol)
Can pt be admin Vivitrol if they’re still taking opioids?
No. Must be opioid free for minimum 7-10days before tx
What are some “comfort meds” when treating opioid withdrawal?
- Clonidine (hyperadrenergic state)
- NSAIDs (muscle cramps/pain)
- Benzos (insomnia)
- Dicyclomine (abd cramps)
- Bismuth subsalicylate or other anti-diarrheals
Goals of maintenance therapy?
- alleviate withdrawal
- eliminate drug craving & opioid use
- opioid blockade
- normalize brain reward pathways & behavior
Need higher dose of methadone or buprenorphine to achieve 2->4
