Opioid Dependence

Question 1

What is the optimal treatment for opioid dependence?

Answer 1

Opioid substitution therapy with long-acting oral opioid agonists, with daily supervised administration.

Question 2

What are two examples of long-acting oral opioid agonists?

Answer 2

Methadone and buprenorphine

Question 3

At what dose is Methadone usually initiated?

Answer 3

20-30 mg daily and titrated upward until withdrawal symptoms and cravings are suppressed.

Question 4

How is Buprenorphine treatment initiated?

Answer 4

Commenced at 4-8 mg daily and titrated to a maximum of 32 mg daily until withdrawal symptoms and cravings are suppressed.

Question 5

What is the goal of opioid substitution therapy?

Answer 5

To minimise potentially harmful illicit, prescription or OTC medication misuse.

Question 6

Proton pump inhibitor examples

Answer 6

Omeprazole
Esompeprazole
Pantoprazole
Rabeprazole
Lansoprazole

Question 7

How can Buprenorphine cause precipitated withdrawal if dosed soon after a full opioid agonist in a dependent patient?

Answer 7

Because it has high affinity at the mu opioid receptor. Buprenorphine may displace the full agonist from the receptor, and with only partial efficacy, the net effect is withdrawal.