User:Sintegral/Opioid use disorder

From Wikipedia, the free encyclopedia

Excerpt from article: Opioid use disorder

Opioid use disorder[edit]

Excerpt Begin[edit]

Medications[edit]

See also: Heroin-assisted treatment

Opioid replacement therapy (ORT) involves replacing an opioid, such as heroin, with a longer acting but less euphoric opioid.[1][2] Commonly used drugs for ORT are methadone or buprenorphine which are taken under medical supervision.[2] As of 2018, buprenorphine/naloxone is preferentially recommended, as the addition of the opioid antagonist naloxone is believed to reduce the risk of abuse via injection or insufflation without causing impairment.[3][4]

The driving principle behind ORT is the program's capacity to facilitate a resumption of stability in the user's life, while the patient experiences reduced symptoms of drug withdrawal and less intense drug cravings; a strong euphoric effect is not experienced as a result of the treatment drug.[2] In some countries (not the US, or Australia),[2] regulations enforce a limited time for people on ORT programs that conclude when a stable economic and psychosocial situation is achieved. (People with HIV/AIDS or hepatitis C are usually excluded from this requirement.) In practice, 40–65% of patients maintain abstinence from additional opioids while receiving opioid replacement therapy and 70–95% can reduce their use significantly.[2] Along with this is a concurrent elimination or reduction in medical (improper diluents, non-sterile injecting equipment), psychosocial (mental health, relationships), and legal (arrest and imprisonment) issues that can arise from the use of illegal opioids.[2] Clonidine or lofexidine can help treat the symptoms of withdrawal.[5]

Participation in methadone and buprenorphine treatment reduces the risk of mortality due to overdose.[6] The starting of methadone and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies.[6] ORT has proven to be the most effective treatment for improving the health and living condition of people experiencing illegal opiate use or dependence, including mortality reduction[2][7][6] and overall societal costs, such as the economic loss from drug-related crime and healthcare expenditure.[2] ORT is endorsed by the World Health Organization, United Nations Office on Drugs and Crime and UNAIDS as being effective at reducing injection, lowering risk for HIV/AIDS, and promoting adherence to antiretroviral therapy.[6]

Buprenorphine and methadone work by reducing opioid cravings, easing withdrawal symptoms, and blocking the euphoric effects of opioids via cross-tolerance,[8] and in the case of buprenorphine, a high-affinity partial agonist, also due to opioid receptor saturation.[9] It is this property of buprenorphine that can induce acute withdrawal when administered before other opioids have left the body. Naltrexone, a μ-opioid receptor antagonist, also blocks the euphoric effects of opioids by occupying the opioid receptor, but it does not activate it, so it does not produce sedation, analgesia, or euphoria, and thus it has no potential for abuse or diversion.[10][11]

In the United States, since March 2020 as a result of the COVID-19 pandemic, buprenorphine may be dispensed via telemedicine.[12]

Methadone[edit]

Receptor binding affinities of isomers of methadone[13][14]
Compound Affinities (KiTooltip Inhibitor constant, in nM) Ratios
MORTooltip μ-Opioid receptor DORTooltip δ-Opioid receptor KORTooltip κ-Opioid receptor SERTTooltip Serotonin transporter NETTooltip Norepinephrine transporter NMDARTooltip N-Methyl-D-aspartate receptor M:D:K SERT:NET
Racemic methadone 1.7 435 405 1,400 259 2,500–8,300 1:256:238 1:5
Dextromethadone 19.7 960 1,370 992 12,700 2,600–7,400 1:49:70 1:13
Levomethadone 0.945 371 1,860 14.1 702 2,800–3,400 1:393:1968 1:50
Main article: Methadone maintenance

Methadone maintenance treatment (MMT), a form of opioid replacement therapy, reduces and/or eliminates the use of illegal opiates, the criminality associated with opiate use, and allows patients to improve their health and social productivity.[15][16] Methadone is a μ-opioid receptor agonist. If initial doses during the beginning of treatment are too high or are concurrent with illicit opioid use, this may present an increased risk of death from overdose.[6] In addition, enrollment in methadone maintenance has the potential to reduce the transmission of infectious diseases associated with opiate injection, such as hepatitis and HIV.[15] The principal effects of methadone maintenance are to relieve narcotic craving, suppress the abstinence syndrome, and block the euphoric effects associated with opiates. Methadone maintenance is medically safe and non-sedating.[15] It is also indicated for pregnant women addicted to opiates.[15] For individuals who wish to completely move away from drugs, they can start a methadone reduction program. A methadone reduction program is where an individual is prescribed an amount of methadone which is increased until withdrawal symptoms subside, after a period of stability, the dose will then be gradually reduced until the individual is either free of the need for methadone or is at a level which allows a switch to a different opiate with an easier withdrawal profile, such as suboxone. Methadone toxicity has been shown to be associated with specific phenotypes of CYP2B6.[17]

Some impairment in cognition has been demonstrated in those using methadone.[18][19] Currently, 55 countries worldwide use methadone replacement therapy, while some countries such as Russia do not.[20]

Buprenorphine[edit]

Buprenorphine/naloxone tablet

Buprenorphine is a partial opioid receptor agonist. Unlike methadone and other full opioid receptor agonists, buprenorphine is less likely to cause respiratory depression due to its ceiling effect.[10] Treatment with buprenorphine may be associated with reduced mortality.[6] Buprenorphine under the tongue is often used to manage opioid dependence. Preparations were approved for this use in the United States in 2002.[21] Some formulations of buprenorphine incorporate the opiate antagonist naloxone during the production of the pill form to prevent people from crushing the tablets and injecting them, instead of using the sublingual (under the tongue) route of administration.[2]

[SINTEGRAL EDIT] In order to reduce the harm associated with buprenorphine injection, it is available in a sublingual formulation that combines buprenorphine with the opioid receptor antagonist naloxone in a 4:1 ratio (ie. 8 mg/2 mg).This sublingual formulation is commonly administered as a flat, orange film with a grainy texture that is rectangular with dimensions of approximately 2.1 cm. length by 1.2 cm width.

One generic 8mg Suboxone (Buprenorphine/Naloxone) sublingual film package.

As a partial agonist with high receptor affinity and modest efficacy, buprenorphine has a ceiling effect after afer dosage levels around 16 mg, although doses of up to 32 mg are prescribed in some cases[22]. While it may induce euphoria similar to methadone in addicts that have not accumulated tolerance, attempts to increase euphoria or achieve intoxication through dose escalation beyond 32 mg are generally ineffective.[22][SINTEGRAL EDIT]


Other opioids[edit]

See also: Heroin maintenance

Evidence of effects of heroin maintenance compared to methadone are unclear as of 2010.[23] A Cochrane review found some evidence in opioid users who had not improved with other treatments.[24] In Switzerland, Germany, the Netherlands, and the United Kingdom, long-term injecting drug users who do not benefit from methadone and other medication options may be treated with injectable heroin that is administered under the supervision of medical staff.[25] Other countries where it is available include Spain, Denmark, Belgium, Canada, and Luxembourg.[26]

Dihydrocodeine in both extended-release and immediate-release form are also sometimes used for maintenance treatment as an alternative to methadone or buprenorphine in some European countries.[27] Dihydrocodeine is an opioid agonist.[28] It may be used as a second line treatment.[29] A 2020 systematic review found low quality evidence that dihydrocodeine may be no more effective than other routinely used medication interventions in reducing illicit opiate use.[30]An extended-release morphine confers a possible reduction of opioid use and with fewer depressive symptoms but overall more adverse effects when compared to other forms of long-acting opioids. Retention in treatment was not found to be significantly different.[31] It is used in Switzerland and more recently in Canada.[32]

Naltrexone[edit]

Naltrexone is an opioid receptor antagonist used for the treatment of opioid addiction.[33][34] Naltrexone is not as widely used as buprenorphine or methadone for OUD due to low rates of patient acceptance, non-adherence due to daily dosing, and difficulty achieving abstinence from opioids before beginning treatment. Additionally, dosing naltrexone after recent opioid use could lead to precipitated withdrawal. Conversely, naltrexone antagonism at the opioid receptor can be overcome with higher doses of opioids.[35] Naltrexone monthly IM injections received FDA approval in 2010, for the treatment of opioid dependence in abstinent opioid users.[33][36]

Excerpt End[edit]

  1. ^ "Opioid substitution therapy or treatment (OST)". MIGRATION AND HOME AFFAIRS. European Commission. 14 March 2017.
  2. ^ a b c d e f g h i Richard P. Mattick et al.: National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD): Report of Results and Recommendation
  3. ^ Rees, John, Garcia, Gabriel. Clinic Payment Options as a Barrier to Accessing Medication-assisted Treatment for Opioid Use in Albuquerque, New Mexico. ADDICT DISORD THEIR TREAT. 2019;18(4):246-248. doi:10.1097/ADT.0000000000000175.
  4. ^ Bruneau J, Ahamad K, Goyer MÈ, Poulin G, Selby P, Fischer B, Wild TC, Wood E (March 2018). "Management of opioid use disorders: a national clinical practice guideline". CMAJ. 190 (9): E247–E257. doi:10.1503/cmaj.170958. PMC 5837873. PMID 29507156.
  5. ^ Gowing L, Farrell M, Ali R, White JM (May 2016). "Alpha₂-adrenergic agonists for the management of opioid withdrawal". The Cochrane Database of Systematic Reviews (5): CD002024. doi:10.1002/14651858.CD002024.pub5. PMC 7081129. PMID 27140827.
  6. ^ a b c d e f Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, Ferri M, Pastor-Barriuso R (April 2017). "Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies". BMJ. 357: j1550. doi:10.1136/bmj.j1550. PMC 5421454. PMID 28446428.
  7. ^ Michel et al.: Substitution treatment for opioid addicts in Germany, Harm Reduct J. 2007; 4: 5.
  8. ^ Bonhomme J, Shim RS, Gooden R, Tyus D, Rust G (July 2012). "Opioid addiction and abuse in primary care practice: a comparison of methadone and buprenorphine as treatment options". Journal of the National Medical Association. 104 (7–8): 342–50. doi:10.1016/S0027-9684(15)30175-9. PMC 4039205. PMID 23092049.
  9. ^ Orman JS, Keating GM (2009). "Buprenorphine/naloxone: a review of its use in the treatment of opioid dependence". Drugs. 69 (5): 577–607. doi:10.2165/00003495-200969050-00006. PMID 19368419. S2CID 209147406.
  10. ^ a b "Medications for Opioid Use Disorder - Treatment Improvement Protocol 63". Substance Abuse and Mental Health Services Administration. Retrieved 20 November 2018.
  11. ^ Gastfriend DR (January 2011). "Intramuscular extended-release naltrexone: current evidence". Annals of the New York Academy of Sciences. 1216 (1): 144–66. Bibcode:2011NYASA1216..144G. doi:10.1111/j.1749-6632.2010.05900.x. PMID 21272018. S2CID 45133931.
  12. ^ "Letter by the DEA regarding buprenorphine" (PDF). DEA.
  13. ^ Codd EE, Shank RP, Schupsky JJ, Raffa RB (1995). "Serotonin and norepinephrine uptake inhibiting activity of centrally acting analgesics: structural determinants and role in antinociception". J. Pharmacol. Exp. Ther. 274 (3): 1263–70. PMID 7562497.
  14. ^ Gorman AL, Elliott KJ, Inturrisi CE (February 1997). "The d- and l-isomers of methadone bind to the non-competitive site on the N-methyl-D-aspartate (NMDA) receptor in rat forebrain and spinal cord". Neurosci. Lett. 223 (1): 5–8. doi:10.1016/S0304-3940(97)13391-2. PMID 9058409.
  15. ^ a b c d Joseph H, Stancliff S, Langrod J (2000). "Methadone maintenance treatment (MMT): a review of historical and clinical issues". The Mount Sinai Journal of Medicine, New York. 67 (5–6): 347–64. PMID 11064485.
  16. ^ Connock M, Juarez-Garcia A, Jowett S, Frew E, Liu Z, Taylor RJ, Fry-Smith A, Day E, Lintzeris N, Roberts T, Burls A, Taylor RS (March 2007). "Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation". Health Technology Assessment. 11 (9): 1–171, iii–iv. doi:10.3310/hta11090. PMID 17313907.
  17. ^ Bunten H, Liang WJ, Pounder DJ, Seneviratne C, Osselton D (September 2010). "OPRM1 and CYP2B6 gene variants as risk factors in methadone-related deaths". Clinical Pharmacology and Therapeutics. 88 (3): 383–9. doi:10.1038/clpt.2010.127. PMID 20668445. S2CID 28983025.
  18. ^ Ieong HF, Yuan Z (1 January 2017). "Resting-State Neuroimaging and Neuropsychological Findings in Opioid Use Disorder during Abstinence: A Review". Frontiers in Human Neuroscience. 11: 169. doi:10.3389/fnhum.2017.00169. PMC 5382168. PMID 28428748.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  19. ^ Darke S, Sims J, McDonald S, Wickes W (May 2000). "Cognitive impairment among methadone maintenance patients". Addiction. 95 (5): 687–95. doi:10.1046/j.1360-0443.2000.9556874.x. PMID 10885043.
  20. ^ Schwartz M (22 July 2008). "Russia Scorns Methadone for Heroin Addiction". The New York Times. Retrieved 5 April 2014.
  21. ^ "Subutex and Suboxone Approved to Treat Opiate Dependence". U.S. Food and Drug Administration (FDA). 8 October 2002. Retrieved 1 November 2014.
  22. ^ a b Bart, Gavin (2012-07). "Maintenance Medication for Opiate Addiction: The Foundation of Recovery". Journal of Addictive Diseases. 31 (3): 207–225. doi:10.1080/10550887.2012.694598. ISSN 1055-0887. PMC 3411273. PMID 22873183. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  23. ^ Dalsbø, T. K.; Steiro, A. K.; Hammerstrøm, K. T.; Smedslund, G. (June 2010). "Heroin Maintenance for Persons with Chronic Heroin Dependence". PMID 29320074. {{cite journal}}: Cite journal requires |journal= (help)
  24. ^ Ferri M, Davoli M, Perucci CA (December 2011). "Heroin maintenance for chronic heroin-dependent individuals". The Cochrane Database of Systematic Reviews (12): CD003410. doi:10.1002/14651858.CD003410.pub4. PMC 7017638. PMID 22161378. S2CID 6772720.
  25. ^ Rehm J, Gschwend P, Steffen T, Gutzwiller F, Dobler-Mikola A, Uchtenhagen A (October 2001). "Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: a follow-up study". Lancet. 358 (9291): 1417–23. doi:10.1016/S0140-6736(01)06529-1. PMID 11705488. S2CID 24542893.
  26. ^ "Heroin Assisted Treatment | Drug Policy Alliance". Retrieved 4 March 2016.
  27. ^ Robertson JR, Raab GM, Bruce M, McKenzie JS, Storkey HR, Salter A (December 2006). "Addressing the efficacy of dihydrocodeine versus methadone as an alternative maintenance treatment for opiate dependence: A randomized controlled trial". Addiction. 101 (12): 1752–9. doi:10.1111/j.1360-0443.2006.01603.x. PMID 17156174.
  28. ^ "Dihydrocodeine". Pubchem.
  29. ^ "Login". online.lexi.com. Retrieved 2018-11-02.
  30. ^ Carney, Tara; Van Hout, Marie Claire; Norman, Ian; Dada, Siphokazi; Siegfried, Nandi; Parry, Charles Dh (18 February 2020). "Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders". The Cochrane Database of Systematic Reviews. 2: CD012254. doi:10.1002/14651858.CD012254.pub2. ISSN 1469-493X. PMC 7027221. PMID 32068247.
  31. ^ Ferri M, Minozzi S, Bo A, Amato L (June 2013). "Slow-release oral morphine as maintenance therapy for opioid dependence". The Cochrane Database of Systematic Reviews (6): CD009879. doi:10.1002/14651858.CD009879.pub2. PMID 23740540.
  32. ^ "Bundesamt für Gesundheit – Substitutionsgestützte Behandlung mit Diacetylmorphin (Heroin)". Archived from the original on 13 March 2016.
  33. ^ a b "Vivitrol Prescribing Information" (PDF). Alkermes Inc. July 2013. Retrieved 2 November 2017.
  34. ^ Skolnick P (January 2018). "The Opioid Epidemic: Crisis and Solutions". Annual Review of Pharmacology and Toxicology. 58 (1): 143–159. doi:10.1146/annurev-pharmtox-010617-052534. PMID 28968188.
  35. ^ Sullivan MA, Garawi F, Bisaga A, Comer SD, Carpenter K, Raby WN, Anen SJ, Brooks AC, Jiang H, Akerele E, Nunes EV (December 2007). "Management of relapse in naltrexone maintenance for heroin dependence". Drug and Alcohol Dependence. 91 (2–3): 289–92. doi:10.1016/j.drugalcdep.2007.06.013. PMC 4153601. PMID 17681716.
  36. ^ Center for Substance Abuse Treatment (2009). Chapter 4—Oral Naltrexone. Substance Abuse and Mental Health Services Administration (US).
Retrieved from "https://en.wikipedia.org/w/index.php?title=User:Sintegral/Opioid_use_disorder&oldid=1022514147"