Opioid use disorder: Difference between revisions

Revision as of 01:26, 4 July 2020

A substance use disorder involving heroin, fentanyl, or other opioid medications

Risk of addiction ~= 10% in the treatment of non-cancer pain (Vowles et al in Pain)

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

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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 ==
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 === 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 ==