OPIOID USE DISORDER
OPIOID USE DISORDER
Our Experience
Our experience with opioid use disorder (OUD) is that the prevalence of OUD has always been a significant problem in the US. Over the last 15 years, the use of fentanyl and more concentrated opiates has made it more of a public health care crisis as well. This is due to the overwhelming number of overdoses and the causing of untimely deaths in the younger population.
WHAT IS OPIOID USE DISORDER (OUD)?
Opioid use disorder, previously known as Opioid Abuse or Opioid Dependence, is a condition characterized by a problematic pattern of opioid use that leads to clinically significant impairment or distress. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines criteria for this condition, which include the following:
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Taking opioids in larger amounts or over a longer period than intended
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Having a persistent desire or unsuccessful attempts to reduce or control opioid use
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Spending excess time obtaining, using, or recovering from opioids
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Craving opioids
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Continued opioid use causing an inability to fulfill work, home, or school responsibilities
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Continuing opioid use despite persistent social or interpersonal problems
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Lack of involvement in social, occupational, or recreational activities
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Using opioids in physically hazardous situations
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Continuing opioid use despite awareness of persistent physical or psychological problems
Additionally, exhibiting tolerance symptoms, which can be defined by either of the following:
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A need for markedly increased amounts of opioids to achieve intoxication or desired effect
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Markedly diminished effect with continued use of the same amount of an opioid
Withdrawal symptoms may also be exhibited, as manifested by either of the following:
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The characteristic opioid withdrawal syndrome
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Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms
TREATMENT FOR OPIOID USE DISORDER
Medication treatment plays a crucial role in addressing Opioid Use Disorder (OUD). Here are the FDA-approved medications for treating OUD:
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Methadone: A full opioid agonist, methadone helps reduce cravings and withdrawal symptoms. It is typically dispensed by federally licensed opioid treatment programs (OTPs) and administered under supervision. Methadone has been used for over 50 years in OUD treatment and has shown benefits in reducing opioid use, improving treatment retention, and decreasing mortality
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Buprenorphine: This medication acts as a partial opioid agonist. It also reduces cravings and withdrawal symptoms. Buprenorphine is available in various forms, including sublingual tablets, films, and extended-release injections. Qualified clinicians can prescribe buprenorphine, and patients may eventually receive take-home doses
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Naltrexone: An opioid antagonist, naltrexone blocks the effects of opioids in the body. It is available as a daily pill or extended-release intramuscular injection. Clinicians can prescribe naltrexone, and it is not associated with the risk of misuse or diversion
When considering which medication to recommend, clinicians take into account factors such as patient preference, practical access to care, prior treatment experience, and individual risk-benefit assessments. Offering evidence-based medications is essential, especially for patients with moderate or severe OUD. For clinicians unable to provide treatment directly, arranging care through specialized providers or certified opioid treatment programs is crucial for effective management
DIFFERENT TYPES OF TREATMENT
Buprenorphine:
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Type: A partial mu-opioid receptor agonist.
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Mechanism: It suppresses and reduces cravings for opioids.
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Prescription: Clinicians with a current, standard DEA registration with Schedule III authority can prescribe buprenorphine in any clinical setting
Methadone:
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Type: A full mu-opioid receptor agonist.
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Mechanism: It reduces opioid cravings and withdrawal symptoms, and it can blunt or block the effects of opioids.
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Prescription: Methadone can only be provided for OUD through a SAMHSA-certified opioid treatment program (OTP)
Naltrexone:
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Type: An opioid receptor antagonist.
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Mechanism: It blocks the euphoric and sedative effects of opioids, preventing feelings of euphoria.
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Timing: Naltrexone should be started after a minimum of 7 to 10 days free of opioids to avoid precipitating severe opioid withdrawal.
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Prescription: Any clinician with an active license to prescribe medications can prescribe naltrexone
Remember that individual patient factors, preferences, and risk assessments play a crucial role in determining the most suitable medication. Offering evidence-based treatments is essential for effective management of OUD .
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