treatment of opiates

Question 1

what is the typical path for recovering addicts?

Answer 1

• Revolving door scenario: enter and complete treatment and are released only to relapse and return to treatment and do that over and over
• relapse is the most predictable outcome among treated opiate addicts (80% of treated and released opiate addicts had used at least once within the first 6m and most use during the first week of release)

Question 2

what therapy approaches are used for opiate drug treatment?

Answer 2

• psychotherapy approaches like ones that are used in other drugs therapies

Question 3

Harm Reduction Philosophy

Answer 3

• suggests that the goal of treatment should be to minimize any harmful effects of continued drug use

Question 4

methadone maintenance

Answer 4

• addicts are given methadone in place of their typically used opiate
• methadone is petroleum-based synthetic analgesic and is a full opiate agonist, equal in potency to morphine as an analgesic but not in euphoric effects
• involves using the controlled use of methadone rather than the uncontrolled use of the other opiate
• first used in Canada in the early 60s
• long-term duration and effective of taken orally (2 characteristics which make it useful as a substitute for heroin)
• Methadone is done on an “outpatient basis” and only considered for patients that are physically dependent and who have been using for a long time (ie. at least 2yrs of regular use)
• the dose must be large enough to present withdrawal but not so large as to produce euphoria
• “carrying privileges”: can take their dose at home
• life-long procedure and about 20% of patients are able to completely stop all opiate use

Question 5

Buprenorphine

Answer 5

• Subutex (Buprenorphine alone)
• Suboxone (Buprenorphine + naloxone) - more commonly used
• partial opiate agonist and produces less of an opiate effect than methadone (ie. less of a risk of an overdose than with methadone)
• generally less potent than methadone - for individuals whoa re less physically dependant
• longer half-life than methadone (up to 2 days or so) and is available in a form that makes abuse less likely than with methadone

Question 6

Heroin substitution program in Canada

Answer 6

• heroin is injected in these sites

- used in other countries (Britain, Switzerland, Poland, The Netherlands and Australia)

Question 7

Needle Exchange programs (harm reduction)

Answer 7

• aim to reduce the harm associated with drug use, particularly iv use, by providing clean and sterile supplies
• reduce the incidence of needles being discarded in public places

Question 8

Supervised Consumption Sites (harm reduction)

Answer 8

• drug users can consume their own drugs with medical personnel being present in case of adverse effects
• these sites don’t provide the drugs nor do they test for purity or adulterants
• “chill rooms” are available but not necessary to be in