Patients With Substance Use Disorder (SUD)

Question 1

Expected physiological state in which abrupt cessation or administration of an antagonist results in drug class specific withdrawal

Answer 1

Physical dependence

Question 2

Physiological state characterized by a decrease in the effects or side effects of a drug over time

Answer 2

Tolerance

Question 3

A situation created by under-treatment of pain. Behaviors may mimic those of addiction but cease with effective pain control

Answer 3

***Pseudo-addiction (not a diagnosis)

Question 4

-Primary chronic disease of brain reward, motivation, memory and circuitry
-leads to characteristic biological, psychological, social and spiritual manifestations.
-reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors despite harm to self or others

Answer 4

Addiction

Question 5

**Characteristics of Addiction

Answer 5

• inability to consistently ABSTAIN
• impairment in Behavioral control
• CRAVING or increased hunger for drugs or rewarding experiences
• diminished recognizing of significant problems with one’s behaviors and interpersonal relationships
• a dysfunctional Emotional response

Question 6

Pain care in presence of SUD

Answer 6

• avoid stigmatizing the patient
• define and treat pain syndrome
• identify current or history of substance abuse
• maximize non-opioid therapies
• use oral pure opioid agonists whenever possible
  
  • adequate doses-may need higher than usual doses
  • use appropriate intervals
• establish parameters for adherence - frequent visits, pill counts, UDS, more frequent prescriptions, opioid agreements

Question 7

Pain care in presence of SUD

Answer 7

Discuss consequences of non adherence to treatment
Recognize specific abuse behaviors (not weaning as instructed, “lost medication bottles”)

Question 8

When to refer to addiction specialist

Answer 8

1. Reluctance to negotiate agreement
2. Violation of agreement
3. Resistance to changing treatments with adverse effects
4. Does not follow agreed upon lines of communication
5. Concurrent use of alcohol or illicit drugs
6. Selling, forging, losing prescriptions, stealing or borrowing drugs
7. Injecting/snorting oral formulations

Question 9

• fear of worsening the addiction leads to withholding or reducing meds
• relapse may be a consequence of under treatment
  -*** person may “self medicate” if pain is not adequately managed
• with substance use disorder, larger doses of medication may be required
• multidisciplinary approach is needed

Answer 9

Under treatment : consequences for people with SUD and pain