Opoid Dependence and Treatment (DONE)

Question 1

What three main factors are involved in addiction?

Answer 1

Biological e.g. genetic predisposition
Psychological e.g. anxiety
Social e.g. drug use by friends or family

Question 2

Give examples of drugs that can be abused

Answer 2

Caffeine
Alcohol
Tobacco
OTC- codeine, dextromethorphan, antihistamines, decongestants, laxatives
Prescribed- opioids, benzodiazepines

Question 3

What are the three classes of controlled substances? Give examples of each

Answer 3

Class A- heroin, cocaine, ecstasy
Class B- amphetamine, ketamine, cannabis
Class C- benzodiazepines, anabolic steroids

Question 4

What is acute intoxication?

Answer 4

Recreational or experimental use- euphoria, anxiolysis, sedation, slurred speech, miosis
Overdose- decreased level of consciousness, pinpoint pupils, respiratory depression

Question 5

Harmful use definition

Answer 5

Pattern of psychoactive substance use that is causing damage to physical or mental health

Question 6

What is opioid dependence syndrome?

Answer 6

Three or more of the following need to be present:
Evidence of tolerance
Strong desire to take the substance
Difficulties in controlling substance-taking behaviour
Neglect of alternative pleasures or interests
Persisting despite clear evidence of harmful consequences
Physiological withdrawal state

Question 7

Symptoms of opioid withdrawal

Answer 7

GI distress- abdominal cramps, diarrhoea, nausea, vomiting
Flu like symptoms
Sympathetic nerve and central nervous system arousal
Other- yawning, sneezing, anorexia, dizziness, myalgias, leg cramps

Question 8

What interventions are needed for managing opioid dependence?

Answer 8

Pharmacological- maintenance, detoxification, abstinence
Psychosocial- contingency management, peer support and self help, residential rehabilitation
Needle exchange

Question 9

What are the aims of maintenance, substitution and harm reduction?

Answer 9

To provide stability by reducing craving and preventing withdrawal
Eliminating the hazards of injecting
Freeing the person from preoccupation with obtaining illicit opioids, and to enhance overall function

Question 10

What are the characteristics of methadone?

Answer 10

Synthetic opioid receptor mu agonist
Usual maintenance dose 60-120 mg daily
Orally administered with a long elimination half life for once daily dosing schedule
Extensive liver metabolism so care in liver impairment
Risk of respiratory depression
Can prolong QT and cause arrhythmia

Question 11

What are the characteristics of buprenorphine?

Answer 11

Partial opioid agonist/antagonist
Maintenance dose 12-24 mg daily
High affinity for opioid receptors and may elicit symptoms of withdrawal but prevents other drugs from occupying the receptor
Relatively good safety profile and abuse potential

Question 12

What happens in detoxification?

Answer 12

Should be available for people who wish to become abstinent
Inpatient detoxification only for people who need a high level of medical and or nursing support e.g. severe mental health problems
Naltrexone can be used to help maintain abstinence

Question 13

Detoxification medication

Answer 13

Started with the same medication used for maintenance treatment
Severity of the withdrawal syndrome reduced using Lofexadine and other symptomatic pharmacological interventions
Rapid detox- naloxone induced withdrawal (1-5 days)

Question 14

What are the characteristics of lofexadine?

Answer 14

Alpha-2 adrenergic agonists
Relieve the autonomic symptoms of withdrawal
Reduces blood pressure which needs to be monitored
Can prolong Qt interval
Needs to be withdrawn over 2-4 days

Question 15

What are the characteristics of naloxone?

Answer 15

Potent opioid antagonist used to treat opioid overdose
Can be given via IV, IM or SC
Plasma half life of one to two hours

Question 16

What are the characteristics of naltrexone?

Answer 16

Orally active long acting opioid antagonist once daily dosing of 50mg PO OD
High affinity for mu opioid receptor
Metabolised via first pass to active metabolite with half life of 13 hours
Licensed for use as part of a comprehensive programme of treatment against alcoholism
Used to help maintain abstinence and prevent relapse in opioid addiction, long acting naloxone implant (3-6 months)

Question 17

Psychological interventions to help manage opioid dependence

Answer 17

Self help groups
Peer support
Narcotics anonymous
Contingency management
Behavioural couples therapy
Community reinforcement approach
Social behaviour network therapy
Cognitive behavioural relapse prevention based therapy
Psychodynamic therapy

Question 18

What happens in rehabilitation?

Answer 18

Life skills e.g. time management, budgeting
Employment services
Education
Reintegration into family life and society