Opioids and Pain Management

What were the results of a study that observed death during and after hospitalization of Opioid Use Disorder?

Found that patients may use substances during the stay or leave the hospital to find substances. Deaths that occur after being discharged was due to losing tolerance for illegal drugs

What are some of the criteria to be diagnosed with Opioid Use Disorder under the DSM-5?

Taking more or longer than intended

Not being able to cut down

Cravings

Interfering with personal life

What is the Standard of Care provided for those with Opioid Use Disorder?

They should have access to Opioid Agonist Treatment (OAT), psychosocial support, safe use education, safe supplies, and take home naloxone kits

What is buprenorphine?

High affinity, partial agonist for mu-opioid receptor (same receptor for morphine and fentanyl)

What is the Ceiling effect of buprenorphine?

Its opioid effect like respiratory depression hits a maximum threshold so higher concentrations does not mean more opioid effect

Why is naloxone in suboxone?

Does not allow the misuse of buprenorphine

What is the classic induction if suboxone?

Give 2mg every up to 16mg on first day

What is the micro-induction of suboxone?

Start with 0.5mg over multiple times in the time then increase over the days

What is the macro-induction of suboxone?

Give 8-16mg once then repeat in an hour

Which induction type should be used when patients are already in withdrawl?

Classic and macro induction method

Why is classic/macro used when patients are already in withdrawl?

Since suboxone is only a partial agonist, the high dose compared to micro will be enough to alleviate the withdrawl symptoms

What is sublocade?

Buprenorphine extended release injection

Why is sublocade used?

Subcutaneous injection for patients stabilized on 8-24mg of suboxone for at least 7 days

What is methadone?

Full agonist for mu-opioid receptor

When do the plasma levels peak for methadone?

2.5-4 hours after ingestion

What is the standard titration for methadone?

Start at 30mg then increase by 10mg every 3 days until stablizatio

What is rapid titration of suboxone?

Start at 40mg then increase by 15mg every 3 days

Why is there an increased risk of death during the first few weeks of titration?

Withdrawal symptoms felt so patient may try to seek out other substances but they now have a lower tolerance

What is kadian?

Full agonist opioid used to treat OUD

What is unique about kadian prescrptions?

Patients with OUD must have the ingestion witnessed by a pharmacist

What is injectable opioid agonist treatment?

High intensity treatment option for patients with severe OUD and have tried other methods

What is one step that needs to happen before patient can start injectable opioid agonist treatment?

They need to be assessed and accepted by a Narcotic Transition Service clinic before starting

What is Recovery Orientated System of Care?

Providing counselling, peer support, collaborative approach to create a wholistic pathway

What can help with patient’s safety planning?

Take home naloxone kit, safer use education, supervised consumption service

What is self stigma?

Internalizing new messages (using drugs) leading to low self esteem and shame which can cause someone to avoid support because of the fear of judegement

What is social stigma?

Negative attitudes about something (drug use) leading to shame for those people

What is structural stigma?

Policies or social services that have barriers to prevent access to care

What is drug checking?

Paper spray MS to provide on site testing and get results of what is in the drug