Medical Treatment of Opiate Misuse Flashcards
(18 cards)
Define recovery?
Process of recovery from problematic substance use is characterised by VOLUNTARILY-SUSTAINED control over substance use, which maximises health and well-being and participation in the rights, role and responsibilities of society
Define harm reduction, in the context of substance misuse?
Attempts to reduce the adverse consequences of drug use among persons who continue to use drugs, i.e: ameliorate adverse consequences of drug use while, at least in the short-term, drug use continues
Principle feature is the acceptance of the fact that some drug users cannot be expected to cease their drug use at the present time
Adverse consequences of substance misuse?
OD
HIV and AIDs
Infectious diseases
Principles of recovery from substance misuse?
Build progress on identified strengths, i.e: it is a strength-based approach
It is aspirational, is led by needs of the patient and is a holistic approach
NOTE - it is risky as it may be destabilising
Principles of harm reduction?
Reduce the risk assoc. with negative attributes or behaviours; this is imposed on the inidividual and has a narrow-focus (use the ORT, opioid risk tool)
NOTE - low risk, as it maintains stability
Medical treatment for opiate misuse?
Replacement prescribing
Detoxification and relapse prevention
Benzodiazepines
When is detoxification used for opiate misuse?
When the patient has a shorter Hx of opiate misuse and this is uncomplicated
Patient is relatively stable socially (recovery is capital)
Options for opiate detoxification?1
- Self-detoxification (with support)
- Reducing prescribing opiods - use current drug or consider an alternative; gradually reduce the dose (time-limited process) and. The patient also requires psychosocial support and symptomatic relief
- α2-adrenergic agonists, e.g: Lofexidine - use an initial testing dose and then maximise the dosage to overcome the patient’s symptoms, before tailoring the dose down
- Adjunctive treatments, e.g:
• Loperamide
• Hypnotic
• NSAID
Examples of Opioid Substitution Therapies (OST)?
Methadone
Buprenorphine
Diamorphine
Issues assoc. with OST?
Risky to patients due to poly-drug use and drug death
Risk to others (diversion)
Use of methadone?
AKA dolophine - a synthetic opioid used to help patients with tapering down opioid ude
What is Buprenorphine?
AKA Subutex / Suboxone
Partial agonist that can be used for replacement prescribing
It has equal efficacy to methadone but there are issues assoc. with supervision, as the drug is sublingual and takes 15 mins to disolve
What is Heroine Assisted Treatment (HAT)?
A supervised treatment option for those who have failed on ORT; it is mainly for those who are at risk of harm (PWIDs) and who are also failing on traditional treatments
What type of intervention is HAT?
Harm reduction intervention
Benefits of OST?
Improved retention
Reduced illicit opioid use/heroine use (inc. abstinence)
Reduced injection-related risk behaviours
Patient factors that affect the effectiveness of OST?
Levels of pre-treatment use
Previous treatments / outcomes
Alcohol use
Mental health Hx
Employment
Treatment duration and completion
Psychological interventions for opiate misuse?
For opiate users - any psychological treatment is better than none
For tranquiliser users - CBT
For stimulant users - any psychological treatment is better than none but most evidence is for CBT
For cannabis users, MI, CBT and family therapies are most effective
For alcohol users, CBT, 12-step and family therapy
NOTE - also helpful for comorbid psychiatric conditions
What is contingency management?
Uses stimulus control and +ve reinforcement to change behaviour
Among the more effective approached to promoting abstinence during treatment of substance use disorders
