Opioid Dependence Treatment and Guidelines

Nicholls, Lance; Bragaw, Lisa; Ruetsch, Charles

doi:10.18553/jmcp.2010.16.s1-b.14

Cited by 61 publications

(49 citation statements)

References 14 publications

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“…Th erapeutic requirements and goals, defi ned by the recommendations for the treatment of opioid dependence, have become less rigid [9]. Th e ultimate goal of the treatment does not have to be a "drug free" patient, but a longer stay in treatment, better health and social functioning, reducing the use of illegal drugs, reducing mortality associated with drug abuse, controlling the risk of transmittable diseases -HIV infection, hepatitis B and C, tuberculosis, crime prevention, cost reduction caused by the problem of dependence in society.…”

Section: Discussionmentioning

confidence: 99%

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Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

Crnic¹,

Todorovic²

2017

Hosp Pharm Int Multi J

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SUMMARYIntroduction: Opiate dependence is a serious, chronic and recurrent psychiatric disorder, whose prevalence reach epidemic proportions. This also contributes to a signifi cant increase in mortality, associated with overdose with opiates, as well as the rise in other health and social problems of the society. The methods and availability of treatment do not correspond to increased treatment needs, and treatment success is limited by the characteristics of the disorder, or numerous risk factors, which contribute to a high percentage of recidivism. Good clinical practice guidelines have defi ned treatment recommendations that include high and low-demanding programs. The personalized and integrative approaches are emphasized. Case report: The patient aged 41 years, intravenous-use opiate addict from his adolescences, with numerous psychological, health and social complications of addiction, is a participant in institutional treatment, following a court order as a measure of obligatory treatment, due to criminal off enses related to addiction. The history of the disease refers to numerous unsuccessful attempts to heal and short-term abstinence in the past, mainly in penal institutions. The patient meets all the criteria defi ned by the guidelines for inclusion in the buprenorphine maintenance program started in the year 2013. During the four-year treatment, the doses of the drug were adapted as needed; two heroin relapses and many in-risk situations for relapse were registered. The treatment continuated with close monitoring of the patient's condition and, with appropriate psychosocial interventions, contribute to keeping the patient in treatment and preventing the development of new complications of addiction, as well an improving the quality of his life. Discussion: Pharmacological treatment of opioid dependence relies on agents belonging to groups of antagonists, agonists and partial agonists of opiate receptors. The earlier programs with abstinence as a treatment goal have signifi cantly allocated the place to "harm reduction" programs, where the therapeutic goals are less demanding and defi ned as the harm-reduction of opiate dependence on the individual and the society. Treatment guidelines defi ne the principles and types of treatment regimens with agonists and partial agonists of opiate receptors and most commonly used are methadone and buprenorphine. The high risk of relapses despite treatment is defi ned and a comprehensive approaches and inclusion of Cognitive Behavior Therapy /CBT/, family and social therapy are needed.

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Section: Discussionmentioning

confidence: 99%

“…Nowadays diff erent therapeutic options for treatment of opiate dependence are defi ned [9,10]. Depending on the therapeutic goals, treatment programs can be divided into highly demanding, which means complete and long-lasting abstinence and low demanding, "harm-reduction programs", that involve prolonged substitution therapy.…”

Section: Introductionmentioning

confidence: 99%

Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

Crnic¹,

Todorovic²

2017

Hosp Pharm Int Multi J

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“…Drogas de prescripción médica o ilícitas que el paciente ha estado consumiendo por largos periodos; 2. Sedantes u opiáceos administrados como parte del tratamiento en (1,22) una unidad de cuidados intensivos; o 3. Alcohol .…”

Section: Delirium Secundario a Abstinencia A Drogas O Alcoholunclassified

Delirium: an update for internists and psychiatrists

Torales

Barrios

Armoa

2017

Rev. virtual Soc. Parag. Med. Int

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RESUMENA lo largo del tiempo, al delirium se lo ha conocido por diversos nombres: falla cerebral aguda, síndrome cerebral orgánico agudo, síndrome confusional o psicosis postquirúrgica. No obstante, el término preferido en la actualidad es delirium (de latín delirare, que significa "arar fuera del surco"). El delirium, como síndrome, es un conjunto de signos y síntomas de inicio agudo caracterizado por deterioro cognitivo fluctuante, con enturbiamiento de la conciencia y capacidad disminuida de mantener y cambiar la atención de un punto a otro.Numerosos estudios han demostrado que los pacientes que desarrollan delirium tienen un riesgo aumentado de resultados adversos tanto durante la hospitalización como tras el alta. Este riesgo es independiente de cualquier comorbilidad existente, de la severidad de la enfermedad, la edad u otras variables asociadas. Asimismo, el delirium está asociado a un incremento en la mortalidad, aumento del tiempo de hospitalización y desarrollo de disfunciones cognitivas posteriores al alta.Este artículo de revisión presenta una actualización acerca de la fisiopatología del delirium, de las herramientas de reconocimiento del cuadro y de su tratamiento. Todas estas informaciones resultan útiles en el manejo diario de este tipo de pacientes, tanto por médicos internistas como por médicos psiquiatras. Palabras claves:ABSTRACT Over time, delirium has been known by several names: acute brain failure, acute organic brain syndrome, confusional syndrome, or post-surgical psychosis. However, the currently preferred term is delirium (from the Latin term delirare, which means "to go out of the furrow"). Delirium, as a syndrome, is a set of signs and symptoms of acute onset characterized by fluctuating cognitive impairment, clouding of consciousness and diminished ability to maintain and shift attention from one point to another. Numerous studies have shown that patients who develop delirium have an increased risk of adverse outcomes both during hospitalization and after discharge. This risk is independent of any existing comorbidity, severity of disease, age or other associated variables. Likewise, delirium is associated with an increase in mortality, delirio, trastornos neurocognitivos, síndrome confusional, delirio -fisiopatología, delirio -tratamiento farmacológico

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“…Although drug-drug interactions are common, methadone metabolites are inactive. Methadone metabolites and unchanged methadone are both excreted in the bile and in the urine [11]. Hemodialysis with methadone is safe and well tolerated.…”

Section: Methadone Pharmacokineticsmentioning

confidence: 99%

“…The NMDA antagonist effect involves modulation of the glutamatergic system, which is thought to mediate the development of tolerance [11].…”

Section: Methadone Pharmacokineticsmentioning

confidence: 99%

Pharmacotherapy of Opioid Addiction: “Putting a Real Face on a False Demon”

Salsitz

Wiegand

2015

J. Med. Toxicol.

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Methadone maintenance therapy (MMT), a pharmacological treatment for opioid use disorder for the past 50 years, continues to remain controversial. Despite consistent and overwhelming evidence confirming the effectiveness and safety of MMT, misconceptions and myths persist regarding its legitimacy as a treatment for opioid addiction. This often results in the underutilization and limited availability of this treatment modality. Despite successful outcomes, the controversial nature of MMT, and the stigma experienced by the patients on methadone, has been a particularly difficult obstacle to overcome. We present the history of MMT, review the evidence for its efficacy in the treatment of opioid dependence, and explore the origins of the stigma and misconceptions related to MMT.

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Opioid Dependence Treatment and Guidelines

Abstract: BackGrOunD: In response to the growing incidence of opioid dependence, guidelines have been created, and new treatments are being developed to assist physicians in treating dependence and withdrawal of opioids.

Cited by 61 publications

References 14 publications

Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

Recidivism with opiate addicted patients on buprenorphine substitution treatment: Case report

Delirium: an update for internists and psychiatrists

Pharmacotherapy of Opioid Addiction: “Putting a Real Face on a False Demon”

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