Opioid therapy : managing risks of abuse, addiction and diversion

Question 1

Tolerance

Answer 1

• need for increasing doses of a medication to facilitate an effect

Question 2

Substance dependence vs Physical dependence

Answer 2

Substance dependence:

• maladaptive substance use with drug seeking behaviour and physical indicators such as withdrawal and tolerance

Physical dependence:

• withdrawal only

Question 3

Aberrant drug related behaviour definitions

Answer 3

Mildly Aberrent

• requests for specific medications
• aggressive complaints about need for meds
• using friend or family’s drugs
• frequent rx losses
• hoarding drugs

Highly Aberrant

• forging prescriptions
• obtaining drugs from non medical source
• selling Rx drugs
• crushing SR drugs for snorting or injecting

Question 4

Clinical Assessment Guidelines

Answer 4

• multidisciplinary team
• graduated interview beginning with broad questions about substances, become more specific
• identify and treat comorbid psychiatric disorders
• Pre screening
  
  • Opioid risk tool
  • SOAPP tool

Question 5

4 As of ongoing monitoring for patients with chronic pain on opioids

Answer 5

• Analgesia
  
  • how much relief it takes for a patient to feel like their life is meaningfully changed
• Activities of daily living
• Adverse effects
• Aberrant behaviours

Question 6

List general principles of treatment for patients with aberrent drug use

Answer 6

• goal is harm reduction
• Empathetic listening
• Use behavioural, non opioid interventions as part of management
• Choose medications and dosing based on prior hx of aberrancy
  
  • slower onset
  • longer duration
• frequent reassessment

Question 7

Outpatient management

Answer 7

• limit amount of drug dispensed per prescription
• make refills contingent on clinic attendance
• consider urine tox screen
• involve family in treatment plan

Question 8

Inpatient management

Answer 8

• private room near nursing station
• daily urine collection
• monitor for withdrawal