Module 1: Fundamentals of Opioid use disorder Flashcards
Opioid toxidrome
Miosis (constricted pupils)
CNS Depression -> Decreased resp / LOC
Decreased GI motility -> Nausea, Constipation
Bradycardia
Important subtypes of opioid receptors in the brain
mu, delta and kappa (µ, d and K).
“Duck” -> d µ K
Which opioid receptor is associated with analgesia and euphoria effects of opioids?
Mu
In Canada, what is the predominant form of illegal opioid use: prescription misuse or street drugs (e.g. heroin, fentanyl)?
Prescription drug use.
“However, a 2001 study conducted in seven Canadian cities revealed the misuse of prescription opioids in various forms had become the predominant form of illegal drug (and specifically opioid) use (Fischer et al., 2005).”
In Canada, what drugs are most associated with opioid-related morbidity and mortality?
illicit fentanyl and fentanyl analogues
What is the acronym for characterizing a substance use disorder?
4 Cs:
- Continued use despite knowledge of harmful consequences
- Cravings
- Compulsion to seek and take the drug
- Loss of Control over use.
Addiction vs Dependence
Often used interchangeably.
Used when individual meets criteria for a substance use disorder.
What are some indications for concern in the habits of use of opioids of a person with chronic pain?
- repeatedly run out of their medication early
- give a dramatic or inconsistent history of how effective opioid analgesics have been for them
- demonstrate poor psychosocial functioning
- use a drug in an unintended manner (e.g., crushing or chewing controlled-release opioid products)
- are double-doctoring
- are dependent on other substances
- purchase additional opioids from the street or borrow from friends.
Which three areas of the brain are involved in substance use disorder?
And how are they each involved…
- basal ganglia – the “reward circuit”. Involved with binge/intoxication
- amygdala – “flight or fight” + stress/irritability/anxiety. Involved in withdrawal.
- prefrontal cortex – self-control/inhibition/planning/problem-solving. involved in urge to use substance.
What are the three phases of a substance use disorder?
- Phase 1: Binge/intoxication – A person uses a substance and experiences the rewarding effects.
- Phase 2: Withdrawal/negative effects – When the effects of the substances fade away, a person may experience negative physical and emotional feelings.
- Phase 3: Preoccupation/anticipation – A person seeks a substance in order to re-experience the rewarding effects.
Which neurotransmitter is involved with the binge/intoxication phase of substance use?
Dopamine.
In the Basal Ganglia (“reward circuit”)
What is the brain-based explanation for withdrawal/negative effects in substance use?
- Decreased dopamine in the basal ganglia
- Increased “action” in the extended amygdala (stress/anxiety centre)
What are features of an addictive substance?
The must reinforce use by:
1. Increase dopamine in the basal ganglia
2. rapid onset and short durationof action
3. cause euphoria
4. quickly lead to tolerance and withdrawal
What is tolerance?
“decline in the effect that a substance produces”
Explained by “down-regulation” of dopamine receptors with repeated use.
What is withdrawal?
” a cluster of distressing symptoms, often accompanied by directly observable physical signs, which represent an unmasking of the body’s adaptation to the drug’s presence”
