Medications - Addiction: Alcohol & Opioids

Buprenorphine

What it does:

• Partial opioids agonist / antagonist

Desired Outcome

• ↓ Withdrawal symptoms

• ↓ Negative effects of withdrawal

Hold / Contraindicated

• Severe respiratory depression

• Asthma

• Patient must be opioid free for 12 to 24 hours and is in mild to moderate withdrawal ---- if not HOLD – patient can be thrown into severe withdrawal

Monitor

• Urinary retention

• Kidney function

• Liver function

Patient Education

• Educate to recognize respiratory depression and when to call provider

• Do not stop abruptly

• Take as prescribed

Disulfiram

Treats 

• Alcohol dependence

Desired Outcome 

• Abstinence from alcohol

Hold / Contraindications 

• Metronidazole / alcohol containing products

Monitoring 

• Liver function at baseline & periodically during therapy / CBC

Patient Education 

• Avoid alcohol / alcohol containing products

Side Effects 

• Flushing / nausea / vomiting / headache when alcohol is consumed

Methadone

What it does

• Opioid agonist

• Used for opioid dependence / withdrawal

Desired outcome

• Reduction of opioid withdrawal symptoms

Hold / Contraindications

• Significant respiratory depression

• Severe asthma

Monitoring

• Respiratory status

• Overdose / toxicity – naloxone

Patient Education

• Report respiratory depression / overdose

• Change position slowly – orthostatic hypotension

Naloxone

Treats

• Opioid antagonist – reversal agent for opioid overdose

Desired Outcome

• Reversal of opioid overdose / effects

Hold  Contraindications

• n/a

Monitoring

• Respiratory rate

• Anticipate pain management after reversal

• Manage withdrawal symptoms

Patient Education

• May become combative / disoriented

• Safety risk

• Reversal may be painful 

• Effect of drug lasts about 30 minutes

Naltrexone

Treats

• Opioid & alcohol use 

• For opioids blocks opioid receptors

Desired Outcome

• ↓ Alcohol cravings

• Prevents positive effects of opioids

Hold / Contraindications

• Severe liver disease

• Those using opioids for chronic pain – detox from opioids first before using for alcohol

Monitoring

• Liver function

• Hepatotoxicity 

Patient Education

• Can trigger withdrawal symptoms if detox is not completed

Vitamins

Treats

• Water-soluble – B1, B2, B3, B6, B9 & C

• Deficiency from diuretic effect of alcohol

• Impaired absorption from damaged digestive tract

• Fat-soluble – A, D, E, K

• Deficiency from ↓ dietary fat intake and absorption

• Folic acid / thiamine (B1) / multivitamins

• Essential with chronic alcohol use

Desired Outcome

• Replace / prevent vitamin deficiencies

Hold / Contraindications

• n/a

Monitoring

• Monitor vitamin supplementation due to impaired absorption

• High doses of folic acid → heart attack risk

Patient Education / Side Effects

• Water-soluble vitamin overdose – nausea / vomiting / diarrhea