Opioid Physical Dependence: Substantial for opioids. Abstinence syndrome extremely unpleasant but rarely dangerous. Protracted withdrawal may persist for months and characterized by insomnia, irritability and fatigue. OUD Maintenance Therapy Opioid Overdose Reversal Drug Class Pure Opioid Agonist Partial Mu Agonist, Kappa Antagonist Pure Opioid Antagonist Pure Opioid Antagonist Prototype Methadone Buprenorphine Naltrexone Naloxone MOA Replaces/substitutesthe misused opioid Replaces/substitutesthe misused opioid Discourages opioid use by blocking euphoria/effects Reversesrespiratory and CNS depression Therapeutic Uses OUD withdrawal/detox, OUD maintenance/suppressive therapy, pain management OUD withdrawal/detox, OUD maintenance/suppressive therapy, pain management AUD, OUD (after detox) Reversal agent for overdose, post-op effects, neonate resp. depression AEs Standard opioid AEs; QT prolongation; respiratory depression; hepatic injury HA; GI upset; anxiety; sleep disturbances; LE edema;sweating GI; HA, sedation, anxiety; injection-site rxns; liver toxicity Reversal of pain control, withdrawal if physically dependent on opioids Nursing Implications CII Controlled Substance Baseline ECG, routine thereafter for cardiac hx; report sx of liver injury; monitor VS and dose sufficiency to suppress withdrawal Greater risk of death if relapse after discontinuation � effectiveness with counseling CIII Controlled Substance Administer tablets and film sublingually Greater risk of death if relapse after discontinuation � effectiveness with counseling MUST be opioid-free (- urine) Manufacturer provided needles in gluteal muscle Greater risk of death if relapse after discontinuation � effectiveness with counseling Titrate carefully to prevent withdrawal/loss of pain control Monitor for 4+hrs after overdose Teach proper admin technique based on product prescribed Other PK: LONG half-life and duration of action, crosstolerance to other opioids IV: PMH/FH of QT prolongation. May be used in pregnancy DDIs: CNS depressants, QT-prolonging drugs, CYP3A4 inhibitors Safety: Accumulation/respiratory depression with repeat dosing, only prescribed for OUD through opioid tx program (exception for 72hrs of IP use) IV: PMH/FH of QT prolongation. PREFERRED in pregnancy alone. DDIs: Strong inducer/inhibitors of CYP3A4, CNS depressants Safety: Ceiling effect: lower abuse/respiratory depression (� with concomitant CNS depressants) IV: contraindicated in acute hepatitis/liver failure; NOT used in pregnancy DF: Monthly IM injection. Preferred in OUD DDIs: Opioids (no others) Pain management may be difficult given drug properties Can precipitate withdrawal PK: SHORT half-life, onset 2- 5mins, duration; hours, STRONG mu binding, NOT PO (1st pass) DF: SubQ/IM/IV, IN DDIs: opioids Can precipitate withdrawal Opioid Overdose Risk Factors*