Opioid Dependence Flashcards
What are the two main treatment strategies for substance dependence?
Detoxification or substitute prescribing for maintenance
What symptoms can benzodiazepine withdrawal cause?
Confusion, convulsions, and toxic psychosis.
What is the recommended approach for benzodiazepine withdrawal?
Gradual dose reduction to avoid abrupt withdrawal.
When are benzodiazepines used in alcohol dependence treatment?
Chlordiazepoxide is used for acute alcohol withdrawal, alongside acamprosate and disulfiram for long-term abstinence.
What type of drug is buprenorphine, and what is its mechanism?
A semi-synthetic opioid, acting as a partial agonist at opioid receptors. It can block other opioids while also providing opioid-like effects.
How long does buprenorphine last?
Low dose: Up to 12 hours
High dose: 48–72 hours
What is Subutex, and how is it administered?
Sublingual buprenorphine tablets with poor oral bioavailability.
What is Suboxone, and why is it used?
A combination of buprenorphine + naloxone to prevent abuse (naloxone induces withdrawal if injected).
Why must patients be supervised while taking buprenorphine?
To prevent diversion and misuse (patients selling or injecting the drug)
What is methadone, and how does it work?
A synthetic opioid agonist that acts like heroin but with a longer duration of action.
What are the benefits of methadone?
✅ Good cross-tolerance with opioids → helps with withdrawal
✅ Long half-life (24–36 hrs) → taken once daily
✅ Orally absorbed → no need for injection
✅ Does not damage major organs
What is naloxone used for?
A short-acting opioid antagonist used as an antidote for opioid overdose
Why is naloxone a short-term measure?
It wears off quickly, so an ambulance must still be called.
What formulations is naloxone available in?
Prefilled syringes, ampoules, IV, and IM injections.
What is naltrexone, and when is it used?
An opioid antagonist used for relapse prevention in detoxified opioid users.
What must patients be aware of before starting naltrexone?
⚠️ Must be opioid-free for 7–10 days
⚠️ Risk of acute withdrawal if opioids are in the system
⚠️ Risk of overdose if trying to override receptor blockade
⚠️ High overdose risk if relapsing, especially with injected opioids
What is required before starting methadone or buprenorphine?
Urine drug test to confirm opioid use.
How are starting doses managed?
Methadone doses slowly increase to avoid overdose.
Buprenorphine doses can be titrated within a week but require caution.
What is precipitated withdrawal, and when does it occur?
A sudden withdrawal reaction caused by buprenorphine if opioids are still in circulation.
Onset: 1–3 hours after first dose
Peak: Within 6 hours
Why is supervised consumption important for methadone and buprenorphine?
Prevents diversion (methadone being spit out and sold).
How long should buprenorphine patients be supervised?
Up to 10 minutes while the tablet dissolves.
What happens if a patient misses 3+ doses?
Pharmacist informs the Drug & Alcohol Team.
Risk of overdose due to loss of tolerance.
Assessment of illicit drug use before restarting treatment.
For buprenorphine, extra caution needed due to risk of precipitated withdrawal.
What is lofexidine, and how does it work?
An α2-adrenoreceptor agonist that may alleviate physical symptoms of opioid withdrawal by reducing adrenergic activity.
How does buprenorphine act at opioid receptors?
It is a partial agonist, meaning it works similarly to full agonists like heroin or methadone, but with a ceiling effect that reduces overdose risk.
How does buprenorphine block other opioids?
It also acts as an antagonist, meaning it can block the effects of other opioids taken simultaneously, reducing their impact.
