Counseling Points - September 2007 - (Page 9)

detoxification (URD) regimen is expensive. Conducted under anesthesia, this treatment is dangerous enough to require a large staff of skilled professionals to provide the service in intensive care units. Anesthesia is necessary to administer URD, because it is designed to displace all opioids from the body’s receptor sites in such a rapid manner that it could not be tolerated consciously. URD is associated with a high mortality rate, and does nothing to treat the profound cravings that inevitably follow and lead to relapse. Other detoxification programs use a variety of medications to treat the symptoms of withdrawal for whatever period of time insurance policies will pay or patients can afford. Many medical withdrawal programs now use buprenorphine to provide the patient with a more comfortable detoxification. Since buprenorphine has a prolonged half-life of 37 hours, the patient may leave the program feeling comfortable, but cravings and withdrawal symptoms will typically recur unless maintenance medication is provided. the criteria for a concomitant alcohol or sedative dependency. Once eligibility and readiness have been documented, the assessor should look for individual factors that may make one medication a better choice over the other.There are indications that permit buprenorphine treatment to be considered for someone with less than a year of dependency. Also, individuals who have difficulty making time for frequent, regular attendance (a daily dosing schedule) may choose buprenorphine over methadone. Other factors that may be taken into consideration are drug interactions, medical problems, and co-occurring mental health disorders. The Physiology of Intoxication and the Withdrawal Syndrome Intoxication is defined as occurring when the direct physiologic effect of a substance on the central nervous system (CNS) causes clinically significant maladaptive behavioral or psychological changes, causing belligerence, mood lability, cognitive impairment, impaired judgment, and impaired social or occupational functioning. The physiologic effects of opioids result from the stimulation of opioid receptors found not only in the CNS, but also throughout the body. Distinct opioid receptors have been identified, mostly notably the mu, kappa, delta, and epsilon receptors. Stimulation of the mu receptor results in analgesia, euphoria, miosis, reduced gastric motility, sedation, and respiratory depression (the most common cause of fatality in overdose situations). Stimulation of the kappa receptor produces similar results, but to a lesser degree; it also causes dysphoria. Opioid withdrawal is clinically associated with neurophysiologic rebound in the organ systems upon which opioids have their primary actions.Thus, generalized CNS suppression is replaced by increased CNS activity. The symptoms of withdrawal present as a very bad case of the flu, and include autonomic variability Choosing Between Methadone and Buprenorphine Treatment Any individual considering participation in a medication-assisted treatment program should be referred to an appropriate treatment facility that has the expertise to conduct the extensive assessment needed to identify eligibility and readiness for this therapy. The available medications, methadone and buprenorphine, are considered to have similar levels of effectiveness. Both are viewed as appropriate for initial use in medication-assisted treatment. Several types of individuals, however, may not be candidates for opioid pharmacotherapy with these agents, including individuals abusing opioids who do not meet the criteria for dependency, those who are unable to attend treatment regularly, those who have had allergic reactions to methadone or buprenorphine, or those who meet SEPTEMBER 2007 9

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Welcome Office-Based Medication-Assisted Treatment of Opioid Dependence Summary Continuing Education Posttest Postest Answer and Program Evaluation Form

Counseling Points - September 2007

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