Question

1. Discuss use of medications that treat opioid addiction, what are the most common methods, time frame, contraindications and timing of the treatment. Does a practitioner need special training?

Rubric:
Responding in detail to the main question citing references and at least 4 sentences. 20 points
Responding to TWO different students on two different days- 60 points
Responding by Day three of the week. 20 points
Total 100 points

Answer 1

#. Physiological factors that promote opiate addiction

Tolerance- repeated opiate use leads to diminished effects.

Cross-tolerance- repeated opiate use leads to diminished effects of other opiates.

Physical dependence- results from adaptions in the brain and periphery.

Opioid abstinence syndrom (withdrawal)- intensity can be influenced by drug use.

#. Methods of treatment :-

- Ultra-rapid (anesthis-assisted) detox

Patient is administered a high dose of opiate receptor antagonist such as naloxone or naltrexone while under general anesthesia for 2-3 hours.

- Stepped (opioid assisted) detox

Administration of opioid substitute such as burewnorphine followed by lower does of naloxone or naltrexone 2-3 days later in combination with other withdrawal management medications such as cloidine.

- Outpatient detox (maintenance therapy)

Prescription of less potent and longer lasting opiates like methadone, Suboxone, or other medications on an outpatient basis for weeks or months, followed eventually by tapering off the drug.

#. Treatment for opioid addiction

1. Motivation

2. Detox - Suboxone, Methadone,

3. Inpatient programs

4. 12 step

Medication-Assisted Treatment (MAT)

most effective evidence-based treatment

Buprenorphine/Naloxone - agonist/antagonist = Suboxone

- Receive outpatient

- structured program with urine screens and pill counts

- works best with ongoing group and/or individual therapy

Methadone maintenance - Methadone is an agonist

Best for those who fail Buprenorphine or have ongoing concurrent chronic pain

- daily outpatient visits to clinic

- includes counseling

- Must be 18 and addicted for a year

#. Inpatient addiction treatment

Usually 2-6 weeks

Not adequate by itself - 90% relapse rate on rehab alone *total abstinence (initially) has very poor prognosis

Often long waitlists, insurers reluctant to pay

Yes the practitioner should have special training in this field as many reactions occurs during the stages of treatment . To dealt with it you need a well versed person with experience .