Treating Opiate Addiction Why Patients Fail Counselor Toolbox Episode 127

A direct link to the CEU course is in the podcast show notes CEUs are available at a https 3A 2F 2Fwww allceus com 2Fmember 2Fcart 2Findex 2Fproduct 2Fid 2F680 2Fc 2F a AllCEUs provides counseloreducation and CEUs for LPCs LMHCs LMFTs and LCSWs as well as addiction counselor precertification training and continuing education Live Interactive Webinars 5 a https 3A 2F 2Fwww allceus com 2Flive-interactive-webinars 2F a Unlimited Counseling CEs for 59 a https 3A 2F 2Fwww allceus com 2F a AddictionCounselor and RecoveryCoach a https 3A 2F 2Fwww allceus com 2F a certificate-tracks Pinterest drsnipes Podcast a https 3A 2F 2Fwww allceus com 2F a counselortoolbox Pharmacology 5 Topics Receptors Function of opioids at receptors Consequences of repeated administration and withdrawal of opioids The affinity intrinsic activity and dissociation of opioids from receptors General characteristics of abused opioids Receptors Different types in the brain Mu receptor is most relevant to opioid treatment Activation of the mu receptor allows opioids to exert their analgesic euphorigenic and addictive effects Functions of Opioids at Receptors Full Agonists Activate receptors in the brain Bind to receptors and turn them on Increasing doses of full agonists produce increasing effects until the receptor is fully activated Opioids with the greatest abuse potential are full agonists Examples of full agonists are morphine heroin methadone oxycodone and hydromorphone Functions of Opioids at Receptors cont Antagonists Bind to opioid receptors but instead of activating receptors they effectively block them Prevent receptors from being activated by agonist compounds Like a key that fits in a lock but does not open it and prevents another key from being inserted Examples of opioid antagonists are naltrexone and naloxone Functions of Opioids at Receptors cont Partial Agonists Bind to receptors and activate them but not to the same degree as full agonists Increasing effects of partial agonists reach maximum levels and do not increase further even if doses continue to rise the ceiling effect As higher doses are reached partial agonists can act like antagonists by occupying receptors but not activating them and blocking full agonists from receptors Buprenorphine is an example of a mu opioid partial agonist Consequences of Repeated Administration and Withdrawal Repeated administration of a mu opioid agonist results in tolerance and dose-dependent physical dependence Spontaneous withdrawal begins 6 12 hours after the last dose peaks in intensity 36 72 lasts approximately 5 days Precipitated withdrawal occurs when an individual physically dependent on opioids is administered an opioid antagonist or partial agonist Characteristics of Abused Drugs Rate of onset of the pharmacological effects of a drug and its abuse potential is determined by the drug's route of administration its half-life Abuse Potential is related to ease of administration cost of the drug how fast the user experiences the desired results Naltrexone Antagonist Naltrexone may decrease the likelihood of relapse to drinking vivtrol Can precipitate an opioid withdrawal syndrome in buprenorphine-maintained patients Should not be prescribed for patients being treated with buprenorphine for opioid addiction Buprenorphine Because it is a partial agonist higher doses of have fewer adverse effects Slow dissociation rate long half life Abuse of buprenorphine primarily via diverting sublingual tablets to the injection route Buprenorphine's partial mu agonist properties make it mildly reinforcing thus encouraging patient compliance with regular administration

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