Task Solutions of Pharmacotherapy Opioid Agonist Treatment– CNA549

CNA549
Approaches to
Intervention
School of Nursing
College of Health and Medicine
Editor: Ravina Raidu
1
Phar macotherapy
Opioid Agonist Treatm …

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CNA549
Approaches to
Intervention
School of Nursing
College of Health and Medicine
Editor: Ravina Raidu
1
Phar macotherapy
Opioid Agonist Treatment (OAT)
School of Nursing
College of Health and Medicine
2
Overview
What is Opioid Agonist Treatment (OAT)
Opioid Withdrawal
OAT Formulations
OAT Service Options
Advantages of OAT
Limitations of OAT
Safety Issues Regarding OAT
Opioid Intoxication & Overdose
OAT & Engagement with Clients
Important Note
Summary
References
3School of Nursing, College of Health & Medicine, UTAS
What is Opioid Agonist Treatment (OAT)
Safe and effective treatment approach in addressing opioid
dependency
Long-term approach
Consists of regular administration of long-acting opioid
medication to opioid dependent clients
In conjunction with case management, regular monitoring and
psychosocial intervention support
Can lead to improved control over substance use
Psychological stability
One component of Opioid Treatment Program (OTP)
School of Nursing, College of Health & Medicine, UTAS4
NSW Clinical Guidelines: Treatment of Opioid Dependence, 2018
Opioid Withdrawal
Drake et al, 2019
School of Nursing, College of Health & Medicine, UTAS5
OAT Formulations
Consist of long-acting opioid medication including:
Oral methadone or biodonetaken daily
Sublingual buprenorphine -dosing regimen from a daily to once
every two or three day dose
Sublingual buprenorphine-naloxone (suboxone)
Subcutaneous long-acting injected depot buprenorphine (depot
BPN) issued weekly or monthly (Buvidal) and/or Sublocade(monthly)
Schedule 8 drug
Lintzeriset al. 2019; NSW Clinical Guidelines: Treatment of Opioid Dependence, 2018
School of Nursing, College of Health & Medicine, UTAS6
OAT Formulations cont.
Methadone and/or Biodonefull agonist
Buprenorphine partial antagonist
Buprenorphine/Naloxone partial antagonist
Naltrexone -antagonist
School of Nursing, College of Health & Medicine, UTAS7
OAT Service Options
Specialist AOD services can be provided by public and private
providers, including the provision of OAT through:
Public OTP services
Private OTP clinics (clients have to pay for the medical review
and their opioid treatment)
Primary Healthcare services (GPs will prescribe for clients)
Community Pharmacy (clients pay for their medication,
dispensing and prep fees)
School of Nursing, College of Health & Medicine, UTAS8
Advantages of OAT
Improves wellbeing by preventing physical withdrawal and
reducing cravings
Stabilises the lives of people and reduces harm associated with
substance use
Maintenance keeps the person stable while they make positive
changes
Health problems related to injecting such as BBV, skin infections,
vein problems are reduced
Legally prescribed and cheaper than heroin
School of Nursing, College of Health & Medicine, UTAS9
Limitations of OAT
Expense to clients (dispensing fees charged outside of public
clinics)
Side effects of medications (methadone constipation, poor
dental hygiene; BPN & methadone -impact on sex hormones,
sleep apnoea)
Restrictions of supervised dosing (e.g. lifestyle, travel options)
Prolonged withdrawal when trying to reduce
NSW Clinical Guidelines: Treatment of Opioid Dependence, 2018
School of Nursing, College of Health & Medicine, UTAS10
Safety Issues Regarding OAT
Drug-drug interactions: Combination of oral buprenorphine or methadone
and sedative drugs (opioids, alcohol, benzodiazepines, tricyclic
antidepressants, major tranquillisers and sedating antihistamines) can be
dangerous e.g. overdose
Intoxicated presentations: particularly clients on methadone with benzo or
alcohol use
Pregnancy and breastfeeding: consider risk benefit assessment
Pain Management: consult with pain team/GP as required
Managing adverse events: injection site/harm minimisation/referral to
medical, surgical or GP as required
Liver disease: avoid depot BPN with hepatic failure as may have impaired
BPN metabolism
Driving: warn patients they may experience sedation in first few days of
starting OAT; avoid driving whilst stabilising on their dose
School of Nursing, College of Health & Medicine, UTAS11
Opioid Intoxication and Overdose
Signs & Symptoms
NSW Clinical Guidelines Treatment of Opioid Dependence, 2018
OAT & Engagement with Clients
Opioid treatment services need to be flexible and diverse to factor in:
The chronic relapsing nature of opioid dependence
Differences in individuals personal circumstances
The needs of clients (e.g. their severity of dependence, motivation
and response to interventions)
Progression through the different stages of behavioural change
clients need changes with treatment progression
Patient-centred approach
NSW Clinical Guidelines: Treatment of Opioid Dependence, 2018
School of Nursing, College of Health & Medicine, UTAS13
Important to Note:
Specific clinical management for opioid maintenance treatment is outlined in
State or Territory policy and procedure guidelines
Please review the opioid maintenance clinical guidelines for your State or
Territory and other resources in relation to methadone, buprenorphine,
buprenorphine/naloxone and depo BPN maintenance
Protocol for stabilization on opioid treatment will be defined in your State or
Territory clinical protocols
Health professionals must keep in mind that guidelines are not intended to
replace clinical judgement in individual cases
For a health professional to go outside of clinical guidelines a discussion with
the multidisciplinary team is advised and course of action and rationale
documented in the clinical file
School of Nursing, College of Health & Medicine, UTAS14
Summary
What is Opioid Agonist Treatment (OAT)
Opioid Withdrawal
OAT Formulations
OAT Service Options
Advantages & Limitations of OAT
Safety Issues Regarding OAT
Opioid Intoxication & Overdose
OAT & Engagement with Clients
Important Note
School of Nursing, College of Health & Medicine, UTAS15
References
Darke, S, Lappin, J & Farrell, M 2019, The Clinicians Guide To Illicit Drugs And Health,
Silverback Publishing, UK.
NSW Clinical Guidelines: treatment of opioid dependence 2018, NSW Ministry of
Health, North Sydney.
Lintzeris, N, Dunlop & Masters, D 2019, Guidelines for use of depot buprenorphine
treatment (Buvidaland Sublocade) in the treatment of opioid dependence, NSW
Ministry of Health,
www.health.nsw.gov.au/aod/Pages/depot-bupe-guidelines.aspx.
School of Nursing, College of Health & Medicine, UTAS16
Thank you

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