Opioid use disorder: Difference between revisions

Revision as of 19:08, 9 July 2020

Background

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

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)

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

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-* A [[substance use disorder]] involving heroin, fentanyl, or other opioid medications
+*A [[substance use disorder]] involving heroin, fentanyl, or other opioid medications
-=== Epidemiology ===
-* 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 ==
+===Epidemiology===
+*The risk of OUD among patients treated with opioids for chronic pain is around 8 to 30%
-* Precipitated withdrawal more dangerous than natural withdrawal
+==Management==
-=== Acute Overdose ===
+*Precipitated withdrawal more dangerous than natural withdrawal
-* 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
+===Acute Overdose===
-=== Opioid Substitution Therapy (OST) ===
+*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)
-* Recommend [[Suboxone]] first-line
+*Then start infusion of 2/3 the effective dose per hour
-* [[Methadone]] second-line
+*QRS and QT lengthening by blocking Na and K channels
-* Slow-release opioids such as [[Kadian]] third-line
+**May need repeated defibrillation, overdrive pacing, or ECMO
+===Opioid Substitution Therapy (OST)===
-== Further Reading ==
+*Recommend [[Suboxone]] first-line
-* [http://www.cmaj.ca/content/190/9/E247 Canadian Guidelines]
+*[[Methadone]] second-line
+*Slow-release opioids such as [[Kadian]] third-line
+==Further Reading==
+*[http://www.cmaj.ca/content/190/9/E247 Canadian Guidelines]
 [[Category:Addiction medicine]]