opioid maintenance therapy
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Indications
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
More general terms
Additional terms
References
- ↑ 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20978062 <Internet> http://www.bmj.com/content/341/bmj.c5475.full
- ↑ 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26978227 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2503503
Lee TH Zero Pain Is Not the Goal. JAMA. Published online March 15, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26978460 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2503504 - ↑ 3.0 3.1 3.2 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
- ↑ 4.0 4.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28446428 <Internet> 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: https://www.ncbi.nlm.nih.gov/pubmed/28446438 - ↑ 5.0 5.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28655025 <Internet> http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2632987