Opioids

Question 1

T or F. Many people die from opioid use even though they didn’t mean to take it

Answer 1

T! Contaminated with meth

Question 2

diagnosis of opioid use disorder

Answer 2

taking more or for longer than intended
not being able to cut down or sto
lots of time spent obtaining
craving
role failure
persistent use despite probs in life
important activities given up
recurrent use in hazardous situations
persistent use despite physical/psych problems
tolerance to effects of substance
withdrawal symptoms when not using or using less

mile = 2-3
moderate = 4-5
severe = >=6

Question 3

standard of care for opioids

Answer 3

• OAT (agonist) = Buprenorphine, methadone, slow release oral morphine
• psychosocial supports
• safer use education
• safer use supplies
• take home naloxone kits
• access to supervised consumption sevrices

Question 4

how to administer Buprenorphine/naloxone

Answer 4

classic induction
- moderate withdrawal then 2mg SL q1h prn up to 16 mg SL on D1

micro induction
- start with 1/4 tablet bid to q3h and then titrate

macro induction
- 16mg SL then 8mg Sl q30mins x 2

extended-release injection (Sublocade)
- once monthly subcut injection for pts stabilized on 8-24 mg of SL buprenorphine/naloxone for a min of 7 days

Question 5

what is methadone?

Answer 5

• full agonist opioid, with activity predominantly at the mu-opioid receptor
• some antagonist activity at NDMA receptor
• peak plasma levels at 2.5-4hrs after ingestinon
• variable elimination half-life (22-48 hrs) and thus time to reach steady state = GREAT! ppl only need to take once a day

Question 6

cautions for methadone

Answer 6

multiple drug interactions
QTc proloncation
increased risk of death during intiaition and titration (first 2-4 wks)
narrow ther index
long elim half life

Question 7

slow release oral morphine

Answer 7

Kadian
- full agonist opioid
- extensive but variable first-pass metab
- about 40% administered dose = central compartment
- mean peak plasma morphine conctn occurs between 8.5 and 10 hrs = steady state achieved in ~2days

Question 8

types of stigma

Answer 8

self
social and structural

Question 9

why do people leave te hospital early? (4)

Answer 9

undertreated withdrawal and ongoing cravings
uncontrolled pain
stigma and discrimination
hospital restrictions

Question 10

trauma informed care

Answer 10

1. safety
2. trustworthiness and transparency
3. peer support
4. collaboration and mutuality
5. empowerment and choice
6. cultural, historical, and gender issues