Opioid Use Disorder Treatment

what percentage of hemp is THC

0.3%

THC with NO psychoactive effects

cannabidiol

THC

produces the high

what kind of receptors have to do with marijuana?

CB1 and CB2

id medical cannabis federally illegal? state?

yes, no

what should cannabis be used for?

non-cancer chronic pain

chemo induced N/V

MS spasticity

short term sleep problems from MS, CP, etc

contraindications for cannabis use

substance abuse

psych d/o

pregnancy

dronobinol

• synthetic THC agonist CB1 and CB2

• AIDS induced anorexia, chemo N/V

• max dose 40 mg qd

• 5mg 2x/day → 10 mg every 2-3 days until max reached

• ab pain, dizzy, somnolence, euphoria, N/V, paranoia

• interactions with other sedatives

• monitor LFTs

• appetite stimulant, no driving!

cannabidiol

98% pure plant, CB1, CB2

max 20 mg qd

2.5 mg/kg 2x/day

somnolence, DECREASE appetite, fatigue, sleep disorder, infections

interactions with sedatives

raises caffeine levels and anti seizure meds

monitor LFTs

d/c IF transaminase is 3x over limit and bilirubin is 2x

give it 4 weeks to work

tolerance

needing more of the drug for the same effect

is tolerance the same as addiction?

NO

pts with OUD have a ___________ tolerance for meds but a ____________ tolerance for pain

higher, lower

how do you find out if a pt is addicted?

• screening

• conversations with fam

• data review

• toxicology

• clinical records

is opioid withdrawal life threatening?

no

how many symptoms do you need for the following OOUD categories?

mild, moderate, severe

2-3

4-5

6 or more

heroin - time till withdrawal symptoms and how long they last

8-24 hrs, 4-10 days

methadone - time till withdrawal symptoms and how long they last

12-24 hrs, 10-20 days

what symptoms happen first during withdrawal, and what comes after?

physical then psychological

how do you treat mild withdrawal?

fluids

2-3 L water

vit B and C

how do you treat moderate withdrawal?

symptomatic

methadone, buprinorphine

how do you treat severe withdrawal?

opioids

symptomatic

lofexidine

only FDA approved non-opiod for use in withdrawal

less hypotensive

SUPER expensive

QT interval

clonidine

same action as lofexidine

wayyyy cheaper

HYPOTENSIVE

promethozine

given to withdrawal pts

25 mg Q 6 H PRN

for nausea

tizanidine

given to OUD withdrawal pts

2-4 mg q 8H

for muscle spasms