Opioid Use Disorder Flashcards
Differentiate opiates and opioids.
opiates: derived from poppy
-heroin, codeine, morphine, opium
opioids: opiates + synthetics
-Vicodin, oxycodone, fentanyl, Percocet
What is an opioid?
class of drugs (prescribed or illicit)
depressants
may be used to:
-reduce pain
-manage opioid dependance
-produce temporary euphoria
Differentiate the main opioid receptors.
mu:
-responsible for most of the opioid analgesic effect
-respiratory depression
-reduced GI motility
-sedation
-euphoria
-physical dependence
delta:
-analgesia
-euphoria
-physical dependence
kappa:
-analgesia
-sedation
-?mood
-does NOT contribute to physical dependence
What is opioid use disorder?
primary chronic disease of brain reward, motivation, memory, and related circuitry with a dysfunction in these circuits being reflected in an individual pathologically pursuing reward and/or relief of withdrawal symptoms by substance use and other behaviors
What can happen to people with OUD without treatment or engagement in recovery activities?
addiction is progressive and can result in disability and premature death
How was OUD previously classified?
formerly classified as opioid “dependence”, “addiction”, “misuse”, “abuse”
-the DSM-5 has now included all of the above scenarios in the diagnosis of OUD
Describe the diagnosis of OUD.
presence of at least 2 of these symptoms (except 10/11)
1. opioids taken in larger amounts or longer than intended
2. persistent desire/lack of success in cutting down
3. great deal of time spent to obtain opioid or recover
4. craving a strong desire to use opioid
5. recurrent opioid use resulting in failure to fulfill obligations
6. continued use despite social/personal problems
7. important activities given up because of opioid
8. recurrent opioid use in situations it is physically hazardous
9. continued use despite knowledge of problem
10. tolerance
11. withdrawal
What kind of disease is OUD?
a long-lasting chronic brain disease
is similar to other chronic diseases such as T2DM and HTN in that it cannot be cured but can be treated and managed
What kind of management does OUD require and why?
long-term chronic disease management because it is a relapsing condition
True or false: OUD ends when the drug is removed from the body or when acute post-drug taking illness dissipates
false
-it is a chronic condition
What is OUD associated with?
increased morbidity and mortality
-opioid overdose and trauma is leading cause of death
-increased rates of HIV, hepatitis, STDs
Describe the cycle of OUD.
binge/intoxication:
-individual consumes an intoxicating substance and experiences its rewarding or pleasurable effects
withdrawal/negative affect:
-individual experiences a negative emotional state in the absence of the substance
preoccupation/anticipation:
-individual seeks substance again after a period of abstinence
Do individuals experience the cycle of OUD the same?
there may be variation in how people progress through the cycle and the intensity with which they experience each of the stages
a person may go through this 3 stage cycle over the course of weeks or months or progress through it several times in a day
What tends to occur over time with the OUD cycle?
tends to intensify over time, leading to greater physical and psychological harm
How are the 3 stages of the OUD cycle linked?
the 3 stages are linked and feed on each other, but they also involve different brain regions, circuits, and NTs and result in specific kinds of changes in the brain
Describe the neurobiology of opioid tolerance.
when an opioid attaches to the mu receptor it triggers the mesolimbic reward system in the VTA
-VTA responsible for release of DA in the NAc in the basal ganglia
-release of DA in the NAc = pleasure
when taken repeatedly opioids trigger the brains reward system driving a compulsion to take the drug again and again
feedback to the prefrontal cortex to the VTA regulates the driver to obtain pleasure
over time, with repeated opioid use, this feedback pathway becomes dysregulated, impairing decision making
additionally, opioid receptors in the VTA become less sensitivity to opioid stimulation
-DA production is reduced and the experience of pleasure/opioid effect is diminished
higher and higher doses to achieve same pleasure reward
Describe the neurobiology of intoxication.
OUD results from changes in the LC
neurons in the LC produced noradrenaline and distribute it to other parts of the brain where it stimulates wakefulness, breathing, blood pressure, alertness, etc. (fight or flight)
when opioids bind to mu receptor in LC they suppress release of noradrenaline
-drowsiness, slowed respiration, low BP –> opioid intoxication
What is the MOA of naloxone?
binds the same sites as opioids in the brain (more tightly)
-displaces the opioid
-antagonist at receptor
What is the effect of naloxone on breathing?
restores breathing within 2-5 minutes when it has been dangerously slowed or stopped due to opioid use
What are the routes of admin for naloxone?
IM: can be given through clothing into muscle of upper arm/leg
IN: sprayed into nostrils ($$$)
What can naloxone precipitate in those with opioid dependence?
opioid withdrawal
How long do the effects of naloxone last?
30-90 min, so overdose may return
-especially if taking long-acting opioid
-repeated doses q2-3 mins may be required
What is one of the most promising and tangible pharmacist activities to decreased opioid related risks?
distribute naloxone
-several studies show that naloxone distribution programs decrease overdose risk
-NNT 10
Are take home naloxone kits covered under the Sask Formulary?
no
-patients must pay $40/kit or $120/nasal spray kit
-however, can refer patients to THN Site for free kit
