Opioid use disorder - Revision history

Aidan at 18:59, 24 October 2021

2021-10-24T18:59:07Z

← Older revision		Revision as of 18:59, 24 October 2021
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	*A [[substance use disorder]] involving heroin, fentanyl, or other opioid medications		*A [[substance use disorder]] involving heroin, fentanyl, or other opioid medications
			*For reference, 1 point of street fentanyl is 100 mg, which is usually 4.4 mg of pure fentanyl

	===Epidemiology===		===Epidemiology===

Aidan: /* Further Reading */

2021-05-22T14:59:16Z

Aidan: /* Prevention */

2020-07-09T19:40:12Z

Prevention

← Older revision		Revision as of 19:40, 9 July 2020
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	*Slow-release opioids such as [[Kadian]] third-line		*Slow-release opioids such as [[Kadian]] third-line

	== Prevention ==		==Prevention==

	* Follow safe prescribing practices		*Follow safe prescribing practices
	* Risk assessment		*Risk assessment
	** Consider their personal and family history of psychiatric illness and substance use disorder		**Consider their personal and family history of psychiatric illness and substance use disorder
	** Consider their social history, including their living situation, safety of housing, personal safety, children or dependents, and social supports		**Consider their social history, including their living situation, safety of housing, personal safety, children or dependents, and social supports
	** Can use tools such as the [[opioid risk tool]] or [[SOAPP-R]] as a more formal risk assessment		**Can use tools such as the [[opioid risk tool]] or [[SOAPP-R]] as a more formal risk assessment
			**Physical exam, looking for signs of substance use and its complications
			**Bloodwork, including liver function tests, hemoglobin, and MCV

	==Further Reading==		==Further Reading==

Aidan: /* Management */ added prevention section

2020-07-09T19:24:03Z

Management: added prevention section

← Older revision		Revision as of 19:24, 9 July 2020
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	*[[Methadone]] second-line		*[[Methadone]] second-line
	*Slow-release opioids such as [[Kadian]] third-line		*Slow-release opioids such as [[Kadian]] third-line

			== Prevention ==

			* Follow safe prescribing practices
			* Risk assessment
			** Consider their personal and family history of psychiatric illness and substance use disorder
			** Consider their social history, including their living situation, safety of housing, personal safety, children or dependents, and social supports
			** Can use tools such as the [[opioid risk tool]] or [[SOAPP-R]] as a more formal risk assessment

	==Further Reading==		==Further Reading==

Aidan: /* Further Reading */ fixed citation

2020-07-09T19:10:32Z

Aidan at 19:08, 9 July 2020

2020-07-09T19:08:16Z

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-== Management ==
+===Epidemiology===
 [[Category:Addiction medicine]]

Aidan at 14:31, 9 July 2020

2020-07-09T14:31:38Z

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	* [http://www.cmaj.ca/content/190/9/E247 Canadian Guidelines]		* [http://www.cmaj.ca/content/190/9/E247 Canadian Guidelines]

	[[Category:~~Addictions~~ medicine]]		[[Category:Addiction medicine]]

Aidan: moved Suboxone to own page

2020-07-04T01:26:59Z

moved Suboxone to own page

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	== ~~Epidemiology~~ ==		== Background ==
			* A [[substance use disorder]] involving heroin, fentanyl, or other opioid medications

			=== Epidemiology ===
	* Risk of addiction ~= 10% ~~for~~ non-cancer ([https://doi.org/10.1097/01.j.pain.0000460357.01998.f1 Vowles et al in Pain])		* Risk of addiction ~= 10% in the treatment of non-cancer pain ([https://doi.org/10.1097/01.j.pain.0000460357.01998.f1 Vowles et al in Pain])

	== Management ==		== Management ==
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	=== Opioid Substitution Therapy (OST) ===		=== Opioid Substitution Therapy (OST) ===

	* Recommend Suboxone first-line		* Recommend [[Suboxone]] first-line
	* Methadone second-line		* [[Methadone]] second-line
	* Slow-release opioids third-line		* Slow-release opioids such as [[Kadian]] third-line

	==== Suboxone (buprenorphine/naloxone) ====

	* Recommended as first-line
	* Buprenorphine is partial mu-opioid receptor agonist
	* Theoretical ceiling effect
	* Strong receptor affinity, displaces other opioids

	===== Full Start =====

	* Precipitates withdrawal, so wait 12-24h for short-acting, 18-36h for long-acting, or after tapering methadone
	* Ensure COWS ≥12, then give 4mg, wait a few hours, give another 4mg
	* Day 2: 12mg; Day 3: 16mg; discharge and refer to Addictions clinic

	==== Methadone ====

	* Recommended as second-line by Canadian guidelines

	== Further Reading ==		== Further Reading ==

Maintenance script: Imported from text file

2020-07-04T01:17:48Z

Imported from text file

New page

== Epidemiology ==

* Risk of addiction ~= 10% for non-cancer ([https://doi.org/10.1097/01.j.pain.0000460357.01998.f1 Vowles et al in Pain])

== Management ==

* Precipitated withdrawal more dangerous than natural withdrawal

=== Acute Overdose ===

* First give boluses of naloxone 0.04mg to 0.08mg IV to improve respiratory depression escalated quickly q2-3 minutes up to 0.4, 2, 4, 10, 15mg (start low and go fast)
* Then start infusion of 2/3 the effective dose per hour
* QRS and QT lengthening by blocking Na and K channels
** May need repeated defibrillation, overdrive pacing, or ECMO

=== Opioid Substitution Therapy (OST) ===

* Recommend Suboxone first-line
* Methadone second-line
* Slow-release opioids third-line

==== Suboxone (buprenorphine/naloxone) ====

* Recommended as first-line
* Buprenorphine is partial mu-opioid receptor agonist
* Theoretical ceiling effect
* Strong receptor affinity, displaces other opioids

===== Full Start =====

* Precipitates withdrawal, so wait 12-24h for short-acting, 18-36h for long-acting, or after tapering methadone
* Ensure COWS ≥12, then give 4mg, wait a few hours, give another 4mg
* Day 2: 12mg; Day 3: 16mg; discharge and refer to Addictions clinic

==== Methadone ====

* Recommended as second-line by Canadian guidelines

== Further Reading ==

* [http://www.cmaj.ca/content/190/9/E247 Canadian Guidelines]

[[Category:Addictions medicine]]

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	*Management of opioid use disorders: a national clinical practice guideline. ''CMAJ''. 2018;190(9):e247-e257. doi: [https://doi.org/10.1503/cmaj.170958 10.1503/cmaj.170958]		*Management of opioid use disorders: a national clinical practice guideline. ''CMAJ''. 2018;190(9):e247-e257. doi: [https://doi.org/10.1503/cmaj.170958 10.1503/cmaj.170958]
			*Opioid Agonist Therapy:A Synthesis of Canadian Guidelines for Treating Opioid Use Disorder. 2021. Available at: https://www.camh.ca/-/media/files/professionals/canadian-opioid-use-disorder-guideline2021-pdf.pdf

	[[Category:Addiction medicine]]		[[Category:Addiction medicine]]

← Older revision		Revision as of 19:10, 9 July 2020
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	==Further Reading==		==Further Reading==

			*Management of opioid use disorders: a national clinical practice guideline. ''CMAJ''. 2018;190(9):e247-e257. doi: [https://doi.org/10.1503/cmaj.170958 10.1503/cmaj.170958]
	*[http://www.cmaj.ca/content/190/9/E247 Canadian Guidelines]

	[[Category:Addiction medicine]]		[[Category:Addiction medicine]]