opiods abuse
TRANSCRIPT
![Page 1: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/1.jpg)
OPIOID USE DISORDERS:
Assessment &Management
Jaison Joseph
![Page 2: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/2.jpg)
2
Opioids: Double-edged sword
![Page 3: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/3.jpg)
3
Dilemma and Challenge
![Page 4: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/4.jpg)
Opioids• Any drug that acts like opium in the human body
• Opium - prototype opioid which is derived from the poppy plant
![Page 5: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/5.jpg)
5
Opiates
Semi-synthetics
![Page 6: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/6.jpg)
6
Opioid Receptors
• µ (mu): – Activated by morphine: analgesia– Primary action site of all opioids– Distribution: CNS and GI– Linked to abuse/dependence
• κ (kappa): analgesia, endocrine changes and dysphoria
• δ (delta): for endogenous peptides
![Page 7: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/7.jpg)
7
Opioid Classification
Full agonists:•morphine•oxycodone
Partial agonist:•butorphanol
Antagonists:•naloxone•naltrexone
![Page 8: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/8.jpg)
© AMSP 8
Opioids
![Page 9: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/9.jpg)
Mechanism of Action : Opioids
![Page 10: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/10.jpg)
![Page 11: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/11.jpg)
![Page 12: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/12.jpg)
![Page 13: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/13.jpg)
![Page 14: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/14.jpg)
![Page 15: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/15.jpg)
An overview
![Page 16: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/16.jpg)
![Page 17: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/17.jpg)
![Page 18: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/18.jpg)
![Page 19: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/19.jpg)
![Page 20: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/20.jpg)
![Page 21: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/21.jpg)
![Page 22: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/22.jpg)
![Page 23: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/23.jpg)
![Page 24: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/24.jpg)
![Page 25: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/25.jpg)
Withdrawal state
![Page 26: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/26.jpg)
![Page 27: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/27.jpg)
Reward pathway
Pain pathway
![Page 28: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/28.jpg)
28
Pharmacodynamics: CNS
Undesirable:• EuphoriaRespiration• Sedation• Endocrine effects
Desirable:• Analgesia• Cough
suppression
![Page 29: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/29.jpg)
29
Pharmacodynamics: GI
Undesirable:• Nausea, vomiting • Constipation
Desirable:• Antidiarrheal• Inhibit peristalsis
![Page 30: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/30.jpg)
30
Pharmacokinetics
• Absorption: GI tract
• Distribution: protein binding
• Biotransformation: liver
• Excretion: kidney and GI (bile)
• Differs by age, gender
![Page 31: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/31.jpg)
Opioid Abuse
![Page 32: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/32.jpg)
Patterns of abuseHeroin - ‘smack’ or ‘Brown sugar’ – Most
dependence producing derivative
• may be smoked, chased (inhaled) or injected (intramuscular or intravenous)
• Chasing (inhaling the vapors emanating from a heated metallic foil) is the commonest mode of heroin use in India
![Page 33: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/33.jpg)
Opioid abuse : Medical Complications
![Page 34: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/34.jpg)
Investigation
• Naloxone challenge test
• Urinary opioid testing
![Page 35: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/35.jpg)
Acute Intoxication
• Apathy
• Brady cardia, hypotension, subnormal body temperature
• Pin point pupils
• Delayed reflexes, thready pulse, coma- overdose
![Page 36: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/36.jpg)
Acute Intoxication
Treatment
• Inj. Naloxone (I V) 2 mg repeated doses every 2 hours
• Supportive symptomatic management
![Page 37: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/37.jpg)
Withdrawal Syndrome
Occurs within 12- 24hrs
• Lacrimation, Rhinorrhoea, Pupillary dialation
• Nausea , vomitting, Sweating ,diarrhoea, yawning, Muscle cramps
• Tachy cardia, mild hypertension
• Severe anxiety
![Page 38: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/38.jpg)
Non-opioid agents
Clonidine 0.1mg (TDS/QID) ± ketorolac ± hypnotics ± antimotility agents
Opioids :(substitution)
- Methadone (10-20mg/d), (upto 40mg/d)
- Levomethadyl acetate (LAAM)
- Buprenorphine (2mg sublingual)
Relapse Prevention
Counselling: explain patient and family members - need for treatment, course, prognosis
etc.
Detoxification
![Page 39: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/39.jpg)
• Methadone - dose -80-120mg/d (20-60mg/d)Efficacy - 52% abstinence at 6 months
(>60mg/d)• Buprenorphine - dose - 8-12mg/d (sublingual
upto 16-32mg/d)comparable to methadone
• Levomethadyl Actate- Dosage range (25-140mg thrice weekly)- Efficacy - equivalent to methadone
Opioid Antagonists • Naltrexone - 100-150mg thrice weekly (50mg/d)
- 30-40% continued abstinence at 1 year follow up under family supervision.
Opioid Maintenance Therapy
![Page 40: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/40.jpg)
Nicotine use disorders
![Page 41: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/41.jpg)
Do you believe ?
![Page 42: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/42.jpg)
Nicotine
• Legal and popular substance the world• Main active chemical in Tobacco• Generally causes heightened alertness and improved
functioning in continuous repetitive tasks• Variety of ways including smoking, chewing, applying to
gums
![Page 43: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/43.jpg)
How it acts ???
• Inhaled smoke contains Nicotine and Tar • TAR – complex mixture of organic molecules• Nicotinic receptors are found on
dopaminergic cell bodies• Stimulation of nAChR leads to dopamine
release• DOPAMINE – reward neuro transmitter• As the smoking continues endorphin release
also increases
![Page 44: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/44.jpg)
Nicotine – How It Encourages Smoking ???
• It improves concentration and vigilance
• Improves working memory (through enhanced effect of glutamate, acetylcholine and serotonin)
• Moderate consumption of nicotine is associated with pleasure
![Page 45: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/45.jpg)
Nicotine withdrawal
![Page 46: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/46.jpg)
Health Impacts
![Page 47: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/47.jpg)
Health Impacts
![Page 48: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/48.jpg)
Screening
• FAGERSTROM TEST
• WHO ASSIST
![Page 49: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/49.jpg)
FAGERSTROM TEST
• How many cigarettes do you smoke each day/how many times do you smoke tobacco each day ?
» 10 or less cigs / 1 or 2 times ( 0 points)
» 11 – 20 cigs / 3 – 5 times ( 1 point)
» 21 – 30 cigs / 6 – 10 times ( 2 points)
» 31 or more cigs / more than 10 times ( 3 points)
3
![Page 50: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/50.jpg)
• How soon after you wake up do you smoke your first cigarette/beedi ?
» Within 5 mins ( 3 points)
» 5 – 30 mins ( 2 points)
» 31 – 60 mins ( 1 point)
» Aftre 60 mins ( 0 points)
3
FAGERSTROM TEST
![Page 51: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/51.jpg)
• Do you smoke or use tobacco product more frequently during the first hour after waking than during the rest of the day
» Yes ( 1 point)
» No ( 0 point)1
FAGERSTROM TEST
![Page 52: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/52.jpg)
• Which cigarette or tobacco use you hate the most to give up / which cigarette or tobacco use do you treasure the most ?
» First one in the morning ( 1 point)
» All others ( 0 point)
1
FAGERSTROM TEST
![Page 53: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/53.jpg)
• Do you find it difficult to refrain from smoking or use tobacco in places where it is forbidden?
(Eg: at the mosque, temple, school, bus ?)» Yes ( 1 point)
» No ( 0 point) 1
FAGERSTROM TEST
![Page 54: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/54.jpg)
• Do you still smoke or use smokeless tobacco products when you are so ill that you are in bed most of the day ?
» Yes ( 1 point)
» No ( 0 point)
1
FAGERSTROM TEST
![Page 55: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/55.jpg)
SCORING• 7 – 10 points = highly dependent
• 4 – 6 points = moderately dependent
• Less than 4 points = minimally dependent
FAGERSTROM TEST
![Page 56: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/56.jpg)
Pharmacological Treatment
• Nicotine replacement
• Bupropion HCl (bupron XL 150, 300mg)
• Varenicline (CHAMPIX)
![Page 57: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/57.jpg)
Nicotine replacement• NULIFE (elder pharma) – 1mg, 2mg, 4mg chewing gums• Reduces severity of nicotine withdrawal symptoms, urge to
smoke• Dose – smokers of more than 20 cigarettes per day 4mg
chewing gum to start with• Try to reduce to 2mg chewing gum• Chew slowly on parked on gum for 30 mins• Chew it when the urge comes.• Not more than 15 gums per day• Any strength 4 or 2mg• Use for 8 – 12 weeks. Continued beyond this if needed to
prevent a relapse
![Page 58: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/58.jpg)
BUPRON XL
• Significantly reduces the severity of nicotine withdrawal symptoms.
• Reduces the urge to smoke• Makes smoking less pleasurable and rewarding• Start 1- 2 weeks before than planned quit date in the
dose of - 150 mg XL * 6 days
- 300 mg XL from 7th day to 7-9 weeks
![Page 59: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/59.jpg)
VARENICLINE
• Partial agonist binding with high affinity to ß ʠ₄ ₂nAChR receptors
• It also reduces nicotine withdrawal symptoms.• Makes smoking less rewarding.• Dose – day 1-3 - 0.5mg HS. 4-7 - 0.5mg BD.
8 – end of 12 week - 1mg BD.• set a quit date between 8 and 14 days• After 12 week additional course of 12 week can be
considered for a successfully stopped smoker
![Page 60: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/60.jpg)
Nicotine use disorders treatment: Emerging trends
E - cigarette
![Page 61: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/61.jpg)
Substance use disorders treatment: Emerging trends
E cigarette• A battery-powered electronic nicotine delivery device
(ENDD) resembling a cigarette• Efficacy - Conflicting opinions ……(8 articles)
Not a proven nicotine replacement therapy;
No scientific evidence to confirm the product’s safety and efficacy’ (WHO,2008)
![Page 62: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/62.jpg)
Sedative- Hypnotic use disorders
![Page 63: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/63.jpg)
Benzodiazepines
![Page 64: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/64.jpg)
Intoxication & Withdrawal
![Page 65: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/65.jpg)
Pharmacological Treatment• Symptomatic• Gradual tapering• Mild to moderate dependence, an outpatient detoxification by
tapering of the drug, with weekly reduction in doses• Severe dependence, particularly with dependence on short acting
benzodiazepines, indoor detoxification is preferred & can be tapered off at a rate of 10% a day
• Risk of withdrawal seizures in patients dependent on short or intermediately acting benzodiazepine (oxazepam, alprazolam etc) can be dealt with detoxification with equivalent doses of long acting benzodiazepines & tapered off as usual.
• If only insomnia persists, non-benzodiazepine hypnotics like zopiclone alone or with relaxation exercises, should be tried
![Page 66: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/66.jpg)
Cannabis Use Disorders
![Page 67: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/67.jpg)
Cannabis
![Page 68: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/68.jpg)
How cannabis is used ??
![Page 69: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/69.jpg)
Intoxication & Withdrawal
![Page 70: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/70.jpg)
Pharmacological Treatment
• Symptomatic
• No medicine for craving
• Treatment of psychiatric disorders
![Page 71: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/71.jpg)
Volatile solvents use disorders
![Page 72: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/72.jpg)
Inhalants
![Page 73: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/73.jpg)
Mode of use
![Page 74: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/74.jpg)
Intoxication
Death can occur due to cardiac arrhythmias, respiratory depression or asphyxia
![Page 75: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/75.jpg)
Complications
![Page 76: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/76.jpg)
Pharmacological Treatment
• No specific treatment
• Symptomatic management
![Page 77: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/77.jpg)
A. Individual Psychotherapy
1. Brief psychotherapies
2. Cognitive & cognitive behavior therapies
(i) Cognitive therapy
- Reduction in drug used by identifying & modifying
maladaptive thinking patterns.
(ii) Relapse prevention model (Marlatt & Gordon)
- Cognitive behavioral approach to help patients develop
greater self control in order to avoid relapse.
Non-Pharmacological Management
![Page 78: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/78.jpg)
(iii) Motivational interviewing
- Motivating patient by cognitive approach to his
problem and its solutions.
(iv) Operant behaviour therapy
- Involve operant rewarding or punishing of patients
for desirable or undesirable behaviours.
(v) Contingency management
- A kind of operant behavioural therapy based on use
of predetermined positive and negative
consequences to reward abstinence or punish drug
related behaviours.
![Page 79: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/79.jpg)
(vi) Cue exposure treatment
- Based on Pavlovian extinction paradigm.
- Exposure to craving inducing cues and prevention of drugs use response leads to extinction of dependence.
B. Group therapies
C. Family therapy
Other Approach
- Self help approach - Narcotic Anonymous (NA)
- Social correctional approach
-Moralistic religious approach
![Page 80: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/80.jpg)
Substance Use Disorders
![Page 81: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/81.jpg)
Substance Use Disorders: Role of Nurse
Where are WE ????
• Substance abuse : Is it treatable ?????
• Is there any role of nurse ????????
![Page 82: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/82.jpg)
Goals & phases of Treatment
• Immediate goals (Initial phase) 2- 4 weeks
Completion of detoxification, psychosocial and medical crisis interventions
• Short-term goals (middle phase) 3- 6 months
management of medical and psychiatric co-morbidity and re-integration with family
![Page 83: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/83.jpg)
Goals & phases of Treatment
• Long-term goals (Late phase) > 6 months
Prevention of relapse
Re-integration into the society
Occupational rehabilitation
Improvement in overall quality of life
![Page 84: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/84.jpg)
Substance abuse disorders: Role of Nurse
Why to intervene ?
Where to intervene ?
What to intervene ?
![Page 85: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/85.jpg)
Nurses in Substance abuse disorders: Why to intervene?
![Page 86: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/86.jpg)
Nurses in Substance abuse disorders: Where to intervene?
![Page 87: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/87.jpg)
Nurses in Substance abuse disorders: What to intervene?
![Page 88: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/88.jpg)
The story of Mr. XYZ………Role of nurse : Why ? Where ? What?
• A 45 yr old/5th std/farmer/small town/wife & 3 children
Dependence
Abuse
Use
1992 1999 2010 2012 2013
1 ½ bottle /day 1 bottle / day
½ bottle /day
2-3 quarter /week
large peg / occasional or party
24 yrs *bottle- MC Dowells 245 rs
AbsenteeismquarrelsViolent
behaviors
Wife admitted in hospital due
to head injury
Role of Nurse ???
![Page 89: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/89.jpg)
• Feedback (scale assessment)
• Responsibility• Advice• Menu of options• Empathy• Self efficacy
The story of XYZ………Role of nurse : Why ? Where ? What?
Brief intervention or counseling
“ I am asking for a change in your 5- 8 years habit .…. Cut down your drinking habit first….am sure you can also do it because many people
have done it …..”
![Page 90: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/90.jpg)
Motivation Enhancement therapy(Stages of Treanstheoretical model of change ; Prochaska & DiClemente, 1983)
![Page 91: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/91.jpg)
The story of Venketesh…….Role of nurse : Why ? Where ? What?
• A 27 yr old, IT professional, Urban background, unmarried
• Diagnosis F 11.20 (Cap.Spasmoproxyvyn & Syp. Corex)• Treatment: T. Naltrexone 50 mg/day (Non compliant)• During follow up meets OPD nurse with bombarding
arguments ????
Why IV Naloxone to me now??
No effect at all ???
Am taking still capsules & syrup
![Page 92: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/92.jpg)
The story of Venketesh…….Role of nurse : Why ? Where ? What?
Client Education
Why IV Naloxone to me now??
• IV/ SC 0.4-0.8 mg (opiate free period)
No effect at all ??? Am taking still capsules & syrup !!!!
• Very high doses of opioids to overcome the blockade of receptors
First visit
Subsequent visit
Now am taking alcohol but stopped opioids…any problem??
• Naltrexone in F10.20 & “ High use alcohol Vs No effect” and dose regulation
How long I should take …..very costly !!!!
• No general rules; 6 months -1 year
![Page 93: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/93.jpg)
Nurses in substance abuse treatment:Emerging trends
VERY Less attention by nurses as independent practice
![Page 94: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/94.jpg)
Nurses in substance abuse treatment:Emerging trends
• Undergraduate nurses in Brazil are not adequately prepared in the care and management of substance misuse problems
• Specific support in teaching and research to nurse teachers…….
![Page 95: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/95.jpg)
Nurses in substance abuse treatment:Emerging trends
• Large body of research on brief intervention by nurses (Emergency unit, OPD clinics, OBG unit, workplace settings, primary care area)
• Strong recommendation by WHO (varied results & modest effect)
• Brief intervention @ PGIMER, Chandigarh experience….
SLNo:
Change in ASSIST scores n %
1 Reduced ASSIST Score 24 77 %
2 No change 05 16%
3 Increased ASSIST Score 02 7%
![Page 96: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/96.jpg)
Substance use disorders treatment: Current trends
NO FDA-approved medications to treat cocaine, marijuana, or methamphetamine SUDs.
![Page 97: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/97.jpg)
Treatment modalities
Treatment Modalities- 1Medicines (Agonist, Antagonist, Deterrents&
Others)
• Reversal of acute effects• overdose & toxicity• Detoxification• Decline of craving• Prevent relapse• Restoration of health damage
![Page 98: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/98.jpg)
Treatment modalities
Treatment Modalities- 2Psychological & Social Therapy
• Brief Counselling• Motivation enhancement therapy• Cognitive behavioural therapy• Relapse prevention counselling• Network therapy• Family and Marital Therapy • Therapeutic alliance
![Page 99: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/99.jpg)
Treatment decision tree
![Page 100: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/100.jpg)
ConclusionManagement of Substance Use Disorder
• Well-planned , comprehensive and co-ordinated strategy • The treatment goal could either be abstinence or harm
reduction• Chronic relapsing disorder: frequent relapse- up to 80%
within three months
• Therapist-patient relationship
• Improvement of treatment compliance by supervised and contractual pharmacotherapy
![Page 101: Opiods abuse](https://reader031.vdocuments.us/reader031/viewer/2022022415/5a6d2ddf7f8b9a10428b4e93/html5/thumbnails/101.jpg)
Thank You
For kind attention