Opioid Addiction

Question 1

categorization of opioids

Answer 1

natural
semi-synthetic
synthetic

Question 2

opioid MOA

Answer 2

agonists of mu opioid receptors (MOP-r)

• extensive distribution thru CNS
• analgesic/reward effects
• G-protein receptor coupled
• regulates release of DA. NE. GABA, glutamate, substance P

Question 3

opioid routes of administration

Answer 3

oral
IN
IV
smoking
subcutaneous
intramuscular
trans mucosal
transdermal
intravenous

Question 4

opioid w/d sx

Answer 4

Dysphoria
Anxiety 
Cravings
Insomnia
Nausea
Abdominal Cramps
Muscle and Joint Aches
Muscle twitches
Chills/sweats
Yawning
Runny nose
Eyes tearing

Question 5

opioid w/d signs

Answer 5

Restlessness
Tachycardia
Mydriasis
Vomiting and Diarrhea
Myoclonic jerks
Low grade temperature
Diaphoresis
Piloerection
Yawning
Rhinorrhea
Lacrimation

Question 6

opioids (examples)

Answer 6

heroin (diacetylmorphine)
morphine
codeine
hydrocodone
oxycodone
oxymorphone
hydromorphone
methadone
fentanyl

Question 7

In opioid related deaths, there was an estimated _________ in the number of opioid-related overdose deaths in 2017 compared with 2016, followed by another __ estimated decrease in 2018 compared with 2017.

Answer 7

In opioid related deaths, there was an estimated [2% DECREASE] in the number of opioid-related overdose deaths in 2017 compared with 2016, followed by another [4%] estimated decrease in 2018 compared with 2017.

Question 8

What percentage of opioid-related ODs tested + for fentanyl?

Answer 8

89%

Question 9

features of the Baker-Polito 2017 plan

Answer 9

Inc access to acute/chronic tx

• expand residential facilities
• add recovery coaches
• ER req for OD pts

Improve education and prevention

• schedule II electronic rx mandate
• COMMISION TO REVIEW APPROPRIATE RX PRACTICES/EXPLORE OPTIONS LIKE BLISTER PACKS

Petition the federal gov to provide specific mechanisms on

• naloxone OTC
• pt limits for buprenorphine prescribers

Question 10

Most sensitive urine drug test for opioid detection

Answer 10

liquid chromatography-mass spectrometry

Question 11

physical and imaging evidence of IV drug use

Answer 11

track marks
non-healing ulcer used as injection site
osteomyelitis of ulna
LE petechia (S. aureus endocarditis)

Question 12

IV drug use co-morbidities

Answer 12

Abscess 
Cellulitis
Thrombophlebitis
Deep Vein Thrombosis
Venous ulcer
Necrotizing fasciitis                                        	
Pyomyositis

Septic emboli
Bacterial endocarditis, Staph aureus
Osteomyelitis
Septic arthritis
Brain abscess
Pulmonary abscess, granulomas
Fungal infections
Hepatitis B and C
HIV

Question 13

IV drug use and HIV statistics

Answer 13

2017: for all HIV infections reported, IV drug users represented 14% of total

Over past 5-10 years, IV drug users represented 4-8% of total reported newly diagnosed HIV infections

Question 14

Variables effecting opioid w/d experience

Answer 14

Short vs. long-acting (intense/brief w/d vs. less intense/prolonged w/d)

duration of use

dose

individual

Question 15

medical management of opioid w/d via substitution of agonist w/ taper

Answer 15

methadone

buprenorphine

Question 16

medical management of opioid w/d via sx attenuation

Answer 16

clonidine (alpha-2-adrenergic agonist, suppresses NE release)

Question 17

medical management of opioid w/d via antagonist precipitation of w/d

Answer 17

naltrexone

Question 18

medical management of opioid w/d via sx modulation

Answer 18

• Benzodiazepines
• NSAIDs
• anti-diarrheals
• Antispasmodics
• Stimulation device NSS-2 Bridge

Question 19

methadone

Answer 19

Schedule II full agonist opioid

Opioid Treatment Program (OTP) federally licensed clinics; does not show up on PMP

Drug delivery system: Daily oral outpatient dosing (liquid preparation) and monitoring

On-site behavioral health therapy

Question 20

buprenorphine

Answer 20

Schedule III partial agonist opioid; allows for 30 day prescription with refills x5
Office based
MD (NP/PA) prescribers c DEA waiver

delivery:
transmucosal
buccal film
subdermal implant
subQ injection

Question 21

naltrexone

Answer 21

Schedule VI
Office based
Delivery: oral or monthly IM
Higher tx dropout rates

Question 22

PMP (prescription drug monitoring database) requirements in MA

Answer 22

MD’s are required to access MassPAT before EVERY schedule II and III prescription and before the first benzodiazepine prescription.

Question 23

Controlled substances scheduling system

Answer 23

Schedule I – high potential for abuse; no accepted medical use (eg, heroin)

Schedule II – high potential for abuse; currently accepted medical use (eg, morphine, methadone)

Schedule III-V
Lesser potential for abuse (buprenorphine)

Schedule VI
All other prescription drugs (naltrexone)

Question 24

signs of opioid OD

Answer 24

stupor --> coma
respiratory depression --> arrest
bradycardia
miosis
pale skin --> dusky lips and fingers

Question 25

opioid OD tx

Answer 25

naloxone:
- opioid antagonist
- intravenous IV, intranasal IN, intramuscular IM

supportive:

• ventilation
• fluids

Question 26

Supervised Injection Facilities (SIF) are currently being piloted in Massachusetts, T or F?

Answer 26

NO.

US Attorney for Massachusetts issued statement against their implementation in 2018.

Question 27

Effects of opioids within brain

Answer 27

The Mesolimbic Pathway: projections VTA of the midbrain to NA.

VTA neurons synthesize Dopamine (DA).

Drug (opioid)-Receptor (MOR) interaction causes inhibition of GABAergic neurons and activates DA release from neurons extending into NA –> pleasurable feeling

Question 28

Why is methadone therapeutically useful for w/d?

Answer 28

Methadone takes much longer than other opiate medications to peak and reach its endpoint –> provides relief from cravings and w/d

Question 29

clonidine

Answer 29

alpha-2 agonist used to tx opioid w/d
suppresses NE release
mediates hyper autonomic signs