Office-Based Buprenorphine Treatment of Opioid Use Disorder (Online)-Module 2: Additional Resource (Slide Handout)

Module 2: Additional Resource (Slide Handout)
Pdf Summary
The document provides an in-depth overview of the pharmacology, efficacy, and safety of medications used in the treatment of opioid use disorder (OUD), focusing primarily on buprenorphine, methadone, and naloxone. It discusses their mechanisms of action, administration, interactions, and withdrawal management.<br /><br />**Buprenorphine:**<br />- **Function:** Buprenorphine is a partial mu opioid receptor agonist, offering a safer profile by reducing respiratory depression and the potential for physical dependence compared to full agonists.<br />- **Administration:** Typically available in sublingual tablets or films (e.g., Suboxone, Zubsolv). It's also available as a subdermal implant (Probuphine) for long-term treatment.<br />- **Withdrawal:** The risk of precipitated withdrawal exists if administered too soon after full agonists. The severity of withdrawal is influenced by the level of dependence, timing, and dose of buprenorphine.<br />- **Side Effects:** Common side effects include nausea, constipation, decreased libido, and less severe withdrawal symptoms compared to full opioid agonists. Buprenorphine carries a lower risk of misuse and overdose but should be used cautiously with benzodiazepines and other CNS depressants.<br />  <br />**Methadone:**<br />- **Function:** A full opioid receptor agonist, methadone is effective in stabilizing lifestyle, improving overall health, and reducing criminal behavior and injection drug use.<br />- **Administration:** Methadone's half-life varies widely among individuals, necessitating careful dose adjustments. It's metabolized by CYP3A4.<br />- **Induction:** Dosing begins with a cautious titration to avoid withdrawal or excessive sedation, with a target dose of 80-100 mg daily.<br />- **Side Effects:** Side effects include sedation, constipation, appetite changes, and potential prolongation of the QT interval. Regular ECG monitoring is recommended.<br /><br />**Naltrexone:**<br />- **Function:** Naltrexone is a long-acting opioid receptor antagonist, used mainly for relapse prevention after withdrawal. Extended-release (XR) naltrexone formulations, like Vivitrol, provide better retention and lower opioid use in treated patients.<br />- **Administration:** Initiating treatment requires the patient to be opioid-free for 7-10 days to avoid precipitated withdrawal.<br />- **Side Effects:** Include injection site reactions, nausea, and possible hepatic toxicity when used orally. XR formulations reduce issues related to poor adherence seen with oral naltrexone.<br /><br />**Naloxone:**<br />- **Function:** A full opioid antagonist used to reverse opioid overdoses. It acts quickly to displace opioids from receptors, reversing life-threatening effects such as respiratory depression.<br />- **Administration:** Available as an injectable or intranasal spray, with multiple doses possibly required in cases of potent opioid (fentanyl) overdoses.<br />- **Challenges:** Naloxone's effects are short-lived, and patients might return to an overdose state once it wears off. Counselors should engage overdose survivors in addiction treatment.<br /><br />The document consolidates current understanding and borderlines the complexities surrounding the treatment of OUD, emphasizing the benefits and strategic considerations pertinent to medication-assisted treatment (MAT).
Keywords
opioid use disorder
buprenorphine
methadone
naloxone
naltrexone
medication-assisted treatment
withdrawal management
mechanisms of action
side effects
administration