Opioid use disorder: Difference between revisions
From IDWiki
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| − | == |
+ | == Background == |
| + | * A [[substance use disorder]] involving heroin, fentanyl, or other opioid medications |
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| + | === Epidemiology === |
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| − | * Risk of addiction ~= 10% |
+ | * 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) === |
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| − | * 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 |
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| − | ==== Suboxone (buprenorphine/naloxone) ==== |
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| − | * Recommended as first-line |
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| − | * Buprenorphine is partial mu-opioid receptor agonist |
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| − | * Theoretical ceiling effect |
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| − | * Strong receptor affinity, displaces other opioids |
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| − | |||
| − | ===== Full Start ===== |
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| − | * Precipitates withdrawal, so wait 12-24h for short-acting, 18-36h for long-acting, or after tapering methadone |
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| − | * Ensure COWS ≥12, then give 4mg, wait a few hours, give another 4mg |
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| − | * Day 2: 12mg; Day 3: 16mg; discharge and refer to Addictions clinic |
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| − | ==== Methadone ==== |
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| − | * Recommended as second-line by Canadian guidelines |
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== Further Reading == |
== Further Reading == |
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Revision as of 21:26, 3 July 2020
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
