Substance and Non Substance Related Addiction Disorders: Diagnosis and Treatment

Opioid Use and Addictive Disorder

Author(s): Teri Gabel, Imad Alsakaf and James Meyer

Pp: 144-167 (24)

DOI: 10.2174/9781681083438117010017

* (Excluding Mailing and Handling)

Abstract

This chapter discusses epidemiologic, pathophysiology and diagnostic issues associated with opioid use disorders. Differentiation of the recreational user and the user who was prescribed narcotics for a diagnosed pain issue is an important variable in the approach to management. Absolute sobriety from opiates/opioids is difficult to achieve and a multifaceted approach is a necessity. This chapter also describes nondrug therapies used in the management of opioid use disorders, including narcotics anonymous, cognitive behavioral therapies and others. For many patients, substitution therapy may be necessary for the short or long term to prevent further issues with opioid use and a better outcome. Buprenorphine substitution therapy requires special provider training while methadone must be dispensed by a licensed opiate treatment program. Withdrawal from opioids is not life threatening but is subjectively very distressing. Management of opioid withdrawal can include treatment with buprenorphine or methadone resulting in relief of withdrawal symptoms and then slowly tapering off the medication. Alternatively non-opiate agents such as clonidine and other medications for symptom relief are used to ameliorate withdrawal. The chapter includes key points and a case vignette to assist the learner. A patient education sheet and further resources are included.


Keywords: Buprenorphine, Clonidine, Methadone, Naloxone, Naltrexone, Suboxone, Substitution therapy, Subutex.

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      • 13. app/Models/UserAccess/UserAccess.php:1266
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      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873443466 and j.to_ip >=873443466 )) and ((j.from_date <= 1739835026 and j.to_date >= 1739835026 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 9906) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873443466 and j.to_ip >=873443466 )) and ((j.from_date <= 1739835026 and j.to_date >= 1739835026 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 9906) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873443466 and j.to_ip >=873443466 )) and ((j.from_date <= 1739835026 and j.to_date >= 1739835026 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 9906)
      1.07msalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1945 and `b`.`banner_from_date` <= 1739835026 and `b`.`banner_to_date` >= 1739835026 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.45msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1945
      • 3: 1739835026
      • 4: 1739835026
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='52d1fc73d8b73e9adc329ade1557beef'
      260μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    8Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        tFP8Fvx8Vnwum5EHKQuKCntkEWTXck3zxgCvWOCL
        uc_cart_id
        52d1fc73d8b73e9adc329ade1557beef
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/9906" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/9906
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6IkV1RTlhTUk1Q2RqaHBiRzBQejl1Vnc9PSIsInZhbHVlIjoiUjZTUmxqQjNKMWFsbGhHTGkzdWFJM0pQQzdMQmhzOVVMY0IvRXROdGY0cz0iLCJtYWMiOiIxYjZjYThhNTgxODllMTNhNGYwOWRlZGQ4NDZkMzRhOGMzNDg2MmY2NGE0YTc1MWUyYzNhM2E1ZWYyY2M5NzRmIiwidGFnIjoiIn0%3D; XSRF-TOKEN=eyJpdiI6InF4bVUzYTZ0akR3Vkw1aWl2YjVPRWc9PSIsInZhbHVlIjoiaHBpdWNkK2R2T3NMZEZndTZYd3ZBL0s3TzFxYk5yNko4TS9vL2pCeTZ6Ym9PUDllR25OQjlCbmZWYUFGMDVxdDY2L1BLUUp3TnZOTVp4a2grZ1Mvcm9WUEJmZTN2ZWptZS8yL08rak9iblpzeEQwdmlFdEh5WDVrNzNIYmJUdUoiLCJtYWMiOiJkODZkZTk5OWE5N2FlNDdiOTc4NWExZTM2NGY2MGY4YjRjNmQzYjExOTJjNTE4ZTdkODk3Nzk1NmViYjVkMDY2IiwidGFnIjoiIn0%3D; alphaeurekaselectnet_session=eyJpdiI6IlZqaDNSaTl6TkxYazV4Z0V2cER6RlE9PSIsInZhbHVlIjoiY3NBaUZBNUUvaUx1bUNURDY5VTJibmg3Q1doWk93cXJVaDBZQit4OEtJUnFUWFpMS2NMOGxBT2dCQ3l6L0RtcmdUTnNzWEtWeTJGdFV0QnFxcUs2OEVZdDJTTWNFbExldHhGTlgxUmdIaG1kRkVjMmNPR2NybG9TemVNNTJMVmwiLCJtYWMiOiI2YzUxNmU5N2Q3MmIwZGM2NGJmZTU0MDE0YWMzZjI5ZDQ3ZmRhYmEwMTgzNmMyZGJmNzJjZjNjZTVlMDZhNTE2IiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6IkV1RTlhTUk1Q2RqaHBiRzBQejl1Vnc9PSIsInZhbHVlIjoiUjZTUmxqQjNKMWFsbGhHTGkzdWFJM0pQQzdMQmhzOVVMY0IvRXROdGY0cz0iLCJtYWMiOiIxYjZjYThhNTgxODll" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
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        response_headers
        0 of 0
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        session_attributes
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        array:5 [ "_token" => "tFP8Fvx8Vnwum5EHKQuKCntkEWTXck3zxgCvWOCL" "uc_cart_id" => "52d1fc73d8b73e9adc329ade1557beef" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/9906" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-17 23:30:26GET/chapter/99061121910