Opioid use disorder

Background

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

Epidemiology

• Risk of addiction ~= 10% in the treatment of non-cancer pain (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 such as Kadian third-line

Further Reading

• Canadian Guidelines