Opioids and Addiction

Question 1

What parts of the brain control feelings of reward and desire?

Answer 1

VTA (Ventral Tegmental Area), Nucleus Accumbens, Amygdala, Hippocampus

Question 2

How does Opioid Addiction work in the brain?

Answer 2

Opiods cause inhibition of GABAergics and leads to increased Dopamine in the mesolimbic system.

Question 3

What is Dependence?

Answer 3

Dependence is the development of withdrawal syndrome following a dose reduction or administration of an antagonist.

Question 4

What is Tolerance?

Answer 4

Tolerance is a change in the dose-response relationship induced by exposure to the drug and manifests as the need for a higher dose to maintain an effect.

Question 5

What is Opioid Use Disorder?

Answer 5

OUD is the problematic pattern of opioid use leading to a clinically significant impairment or distress.

Question 6

What is Addiction?

Answer 6

Addiction is “compulsive use despite harm” and impaired control of drug use.

Question 7

What is Pseudo-Addiction?

Answer 7

Pseudo-addiction are behaviors that are reminiscent of addiction, but are driven by PAIN and disappear with more adequate analgesia.

Question 8

What are some signs of Pseudo-Addiction?

Answer 8

Clock watching, pain demonstration in presence of providers, “excessive” complaints

Question 9

What is the likelihood that a patient will develop OUD when taking opioids for pain?

Answer 9

<1%

Question 10

What are Risk Factors for Developing OUD?

Answer 10

Biological: family history of drug abuse, male

Social: poor social support, history of conviction related to drugs or driving while impaired

Psychological: personal history of substance abuse, history of sexual abuse, comorbid psychiatric disorder (major depression, bipolar disorder, personality disorder)

Question 11

How do you screen or monitor for OUD?

Answer 11

24 hour urine opiate screening test