Opioid use disorder: Difference between revisions
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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 |
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*For reference, 1 point of street fentanyl is 100 mg, which is usually 4.4 mg of pure fentanyl |
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===Epidemiology=== |
===Epidemiology=== |
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*[[Methadone]] second-line |
*[[Methadone]] second-line |
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*Slow-release opioids such as [[Kadian]] third-line |
*Slow-release opioids such as [[Kadian]] third-line |
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==Prevention== |
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*Follow safe prescribing practices |
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*Risk assessment |
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**Consider their personal and family history of psychiatric illness and substance use disorder |
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**Consider their social history, including their living situation, safety of housing, personal safety, children or dependents, and social supports |
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**Can use tools such as the [[opioid risk tool]] or [[SOAPP-R]] as a more formal risk assessment |
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**Physical exam, looking for signs of substance use and its complications |
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**Bloodwork, including liver function tests, hemoglobin, and MCV |
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==Further Reading== |
==Further Reading== |
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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] |
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*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 |
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[[Category:Addiction medicine]] |
[[Category:Addiction medicine]] |
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Latest revision as of 18:59, 24 October 2021
Background
- 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
- The risk of OUD among patients treated with opioids for chronic pain is around 8 to 30%
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)
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
- Physical exam, looking for signs of substance use and its complications
- Bloodwork, including liver function tests, hemoglobin, and MCV
Further Reading
- Management of opioid use disorders: a national clinical practice guideline. CMAJ. 2018;190(9):e247-e257. doi: 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
