SUD/OUD/Addiction

important exception for DSM-V criteria for OUD

people that have a physical dependence/tolerance/withdrawal with opioids do not necessarily have OUD

DSM-V criteria for OUD

• loss of control: using more than intended/unable to cut back

• craving and preoccupation: strong urges to use/ spend significant time obtaining

• negative consequences: continued use despite problems with work, school, health, etc.

• physical dependence: developing tolerance/withdrawal (does not count if it occurs solely from taking prescribed opiates as directed)

MAT

medication for addiction treatment

Naltrexone

full antagonist (fully blocks from binding)

Buprenorphine

partial agonist, no antagonistic qualities; binds to opioid receptor with high affinity, doesn’t half occupy the receptor, but partially agonizes the receptors; theoretical ceiling effect, so respiration depression plateaus; relatively safe against overdose

Methadone

full agonist - activator; relatively long half life; you need to go to a center to receive treatment

do you give buprenorphine to someone who is fully using?

no! bc it is only a partial agonist, they’ll have precipitated withdrawal symptoms

MAT induction strategy

timing for introducing medication treatment to avoid withdrawal symptoms

COWS score

clinical opiate withdrawal scale; objective scale for withdrawal symptoms; should be greater than 8 for MAT start

MAT micro-induction strategy

slowly increasing dose of buprenorphine throughout first week to avoid withdrawal symptoms

What if someone needs pain relief if they’re already on buprenorphine or methadone?

Methadone- watch for resp. depression

Buprenorphine- need higher dose of painkiller

xylazine

sedative/tranquilizer; “Tranq”; lowers level of consciousness, blood pressure, respiration

xylazine effects-important

prolong the effects of fentanyl; does not respond to naloxone; fentanyl/xylazine combined overdose; skin wounds

tianeptine

“gas station heroin”; antidepressant; effects on opioid receptors; “ZaZa” and “Tianna Red”; can have prolonged withdrawal period; narcan given

ibogaine

naturally occurring substance with hallucinogenic/psychedelic properties; schedule 1 controlled substance (high potential for abuse); targets same receptors as opioids; more cost effective alternative to buprenorphine

nitazenes

synthetic opioids with high potency; several formulations; additional negative side effects (nausea, fever, diaphoresis); increased risk of overdose due to potency and no regulation; treat suspected overdose with naloxone

kratom

sold as a dietary supplement; acts on opioid, dopamine, and seratonin receptors; effects differ; stimulant as well as relaxation; likely develop dependance

medetomidine

usually sold as a dietary supplement; causes sedation, hypotension, hypoxia, hypothermia, diuresis; increased effects when combined w other CNS depressants; found containing fentanyl in NYS

harm reduction

practical strategies to reduce risks associated with health behavior, including drug use

chocolate chip cookie effect

street fentanyl is often found in highly concentrated doses (like chips in choc chip cookie); leading to unintentional overdoses

trend in erie county

more fatal overdoses from things like stimulants

signs and symptoms of an overdose

blue lips/nails; pinpoint pupils; dizziness and confusion; can’t be woken up; choking, gurgling, snoring sounds, drowsiness; slow breathing

naloxone

opioid agonist medication; reverses effects of an opioid overdose - knocks opioids off the receptors and binds with the receptor to reverse the effects