Week 3 - G - Opioid misuse - Detox and Opioid replacement therapy

Question 1

LETS TALK ABOUT OPIATE ADDICTION AND THE MEDICAL TREATMENT
Need to know which drugs can help with the long term management of abstinence from opiates ie which can be used for relapse prevention, which can be given to prevent overdose of opiates and which can be used to prevent withdrawal

What are the three options for treating a patients opiate abuse?

Answer 1

This would be:

* Detoxification

* Opiate blockade

* Replacement prescribing - opiate substitution therapies

Options range from longer term (ORT) to shorter term (detox/blockade) for medical treatment

Question 2

What patients is detoxification used in?

Answer 2

Patient with a shorter history of addiction and an uncomplicated history who are relatively stable

Question 3

What are the different detoxification options?

Answer 3

1. Self detoxification (with support)
2. Reducing prescribed opiates
3. Giving non-addictive alternatives eg lofexidine
4. Adjunctive treatments

Question 4

Opiate blockade is usually only used acutely to treat an overdose

What are the options to treat an overdose?

How does this work?

Answer 4

Can give nalaxone
Naloxone - this an opioid antagonist - this works by inhibiting the mu (MOP), kappa (KOP) and delta (DOP) receptors which are the opioid receptors - it mainly exerts its effect by inhibiting the MOP receptor however

By giving these it reverse the effects of opioids

Question 5

Replacement prescribing, usually given to those who have been on opiates longer term and therefore need gradual withdrawing

What are the two main Opioid substitution therapies (OST) ?

Answer 5

Methadone and buprenorphine

Question 6

Methadone is partial MOP (mu opioid) receptor agonist
Buprenorphine is an opioid-receptor partial agonist (it has opioid agonist and antagonist properties).

What is an example of a non addictive treatment to patients who are trying to withdraw from opioid addiction? How does this drug work?

Answer 6

This would be lofexidine - this is an alpha 2 adrenergic receptor agonist and can be used to help alleviate the symptoms of opiate withdrawal

Question 7

What is useful to give to former addicts after a suitable opiate free period? (same as the drug given in acute treatment of an overdose)

Answer 7

This would be naloxone

Question 8

Is any other support given other than medical treatment for patients who take opioids?

Answer 8

This would be psychological support - CBT