Contents

Search

opioid maintenance therapy

Indication: - substance abuse, opioid abuse Complications: - increased mortality during the 1st 4 weeks after starting opioid maintenance therapy (HR: 2-3) & in the 1st 4 weeks after after stopping opioid maintenance therapy (HR: 8-9)* * opioid maintenance therapy reduces overall mortality [4] Management: - long-acting opioid receptor agonist - methadone - buprenorphine - a weekly injectable depot formulation of buprenorphine may be effective [5] - methadone or buprnorphine should not be withheld in patients also taking benzodiazepines or other CNS depressants [3] - educate patients about the potential risks (overdose, death) of combining benzodiazepines or other CNS depressants with methadone or buprenorphine [3] - attempt to taper patients off of benzodiazepines or CNS depressants - consider treatments other than benzodiazepines or CNS depressants for anxiety or insomnia - monitor for illicit drug use regularly - patients may need medication treatment of addiction indefinitely * Qualified physicians (addiction specialists or physicians who complete 8 hours of approved training) may now prescribe buprenorphine & buprenorphine-naloxone (Suboxone) for office- based maintenance or detoxification

Related

opioid receptor agonist (narcotic)

General

pharmaceutical agent

References

  1. Cornish R et al Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database BMJ 2010; 341:c5475 PMID: 20978062 http://www.bmj.com/content/341/bmj.c5475.full
  2. Dowell D, Haegerich TM, Chou R CDC Guideline for Prescribing Opioids for Chronic Pain. United States, 2016 http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1er.htm - Olsen Y The CDC Guideline on Opioid Prescribing. Rising to the Challenge. JAMA. Published online March 15, 2016 PMID: 26978227 http://jama.jamanetwork.com/article.aspx?articleid=2503503 - Lee TH Zero Pain Is Not the Goal. JAMA. Published online March 15, 2016 PMID: 26978460 http://jama.jamanetwork.com/article.aspx?articleid=2503504
  3. FDA Safety Watch. Sept. 20, 2017 Opioid Addiction Medications in Patients Taking Benzodiazepines or CNS Depressants: Drug Safety Communication - Careful Medication Management Can Reduce Risks. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm576755.htm
  4. Sordo L, Barrio G, Bravo MJ et al Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ 2017;357:j1550 PMID: 28446428 http://www.bmj.com/content/357/bmj.j1550 - Manhapra A, Rosenheck R, Fiellin DA. Opioid substitution treatment is linked to reduced risk of death in opioid use disorder. BMJ. 2017 Apr 26;357:j1947. PMID: 28446438
  5. Walsh SL, Comer SD, Lofwall MR et al Effect of Buprenorphine Weekly Depot (CAM2038) and Hydromorphone Blockade in Individuals With Opioid Use Disorder. A Randomized Clinical Trial. JAMA Psychiatry. Published online June 22, 2017 PMID: 28655025 http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2632987