Fast Five Quiz: Do You Know Best Practices for Opioid Use and How to Confront Abuse?

Mary L. Windle, PharmD


September 21, 2016

Extended-release intramuscular naltrexone has been approved by the US Food and Drug Administration (FDA) for the prevention of relapse to opioid dependence. Buprenorphine has been combined with naloxone in a 4:1 ratio (Suboxone, Zubsolv) or a 6-7:1 ratio (Bunavail). A subdermal buprenorphine implant (Probuphine) has also been approved by the FDA for maintenance treatment of opioid dependence in patients who have achieved and sustained prolonged clinical stability on lower doses of buprenorphine-containing products. The implant is discreetly placed in the upper arm and lasts for 6 months before it needs to be replaced.

Opiate withdrawal is generally considered less likely to produce severe morbidity or mortality compared with barbiturates and benzodiazepines. Safe withdrawal from opioids is termed detoxification and can be performed as outpatient or inpatient therapy, depending upon the presence of comorbid medical and psychiatric problems, availability of social support, and polydrug abuse.

As more patients with opioid addiction receive treatment, physicians will encounter patients with acute pain syndromes. Acute pain must be adequately treated in these patients. Common misconceptions include the following:

  • Opioid agonist therapy provides analgesia. Maintenance methadone or buprenorphine does not provide sustained analgesia. Although methadone and buprenorphine are potent analgesics, the analgesic properties last only 4-8 hours, while the medications are dosed every 24-48 hours.

  • Use of opioid analgesia may cause addiction relapse. No evidence indicates that exposure to opioid analgesics during acute pain increases relapse rates. In fact, evidence suggests that the stress of unrelieved pain can trigger relapse.

  • The combination of opioid agonist therapy and other opioids may cause respiratory depression. This is a theoretical risk that is not supported by clinical or empirical experience. Tolerance to respiratory and CNS depressant effects occurs rapidly and reliably.

For more on the treatment of opioid abuse, read here.

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