The rewarding effects of drugs occur through dopamine stimulation in the mesolimbic system of the brain. 153 When a drug stimulates the brain’s mu opioid receptors, cells in the ventral tegmental area release dopamine into the nucleus accumbens, causing pleasurable feelings. 153 The pharmacokinetics and lipophilicity of the drug and its route of administration influence the speed and amount of dopamine released and thus the degree of reward experienced by the individual. Intravenous and inhalational use speeds onset more than oral ingestion. However, ER/LA opioids can be altered by the individual to produce a rapid onset of action by crushing, chewing, or dissolving in liquids, for example. 69 Repeated ingestion stimulates the brain’s reward system. At the same time, the brain creates conditioned associations and lasting memories that associate reward with environmental cues of drug use. Normally, inhibitory feedback from the prefrontal Conclusion All HCPs who treat pain with the use of opioids need up-to-date competencies to manage potential opioid- related harms. This includes a familiarity with the full complement of nonpharmacologic and pharmacologic options to create an individualized treatment plan, reserving opioids for when other strategies are not effective. An optimal multimodal approach to pain management consists of using treatments from one or more clinical disciplines incorporated into comprehensive plan. 3 For select patients who benefit from opioids long term, HCPs should reduce risk and optimize benefits by patient education, screening of high-risk patients for OUD, continuous monitoring, combining treatments with nonopioid options when indicated, referral and co-management of comorbid conditions, and an exit strategy to ensure careful tapering when
cortex helps most individuals overcome drives to obtain pleasure through unsafe actions. 153 However, prefrontal cortex inhibitory cues are compromised in people with addictions, and drug use behaviors are driven by a complex combination of both positive and negative reinforcements. Positive reinforcements include the individual’s pleasure from using the substance and negative reinforcements include the desire to prevent withdrawal. As tolerance and dependence develop, more drug is necessary to obtain the same reward and prevent withdrawal. The locus coeruleus area of the brain plays an important role in the production or suppression of withdrawal symptoms. When an OUD is present, the compulsion to use opioids repeatedly goes beyond the reward drive. As changes in the brain develop, the person’s experience of pleasure diminishes and they engage in the compulsive drug use despite adverse consequences that characterizes OUD. 153 indicated. It is important for patient outcomes and for regulatory and legal requirements to document every aspect of opioid therapy within the medical record and to follow all federal, state, and local regulations regarding opioid therapy. HCPs should know the signs and symptoms of OUD and be prepared to treat or refer for treatment with the understanding that medications for OUD are essential to save lives.
WORKS CITED https://qr2.mobi/BP2e
APPENDIX A: COLORADO GUIDELINES FOR THE SAFE PRESCRIBING AND DISPENSING OF OPIOIDS - REVISED: 3/14/2019 EXECUTIVE SUMMARY
Prescribers and dispensers have an obligation to effectively manage pain and improve function while reducing opioid-related adverse outcomes. To assist healthcare professionals in discharging this duty, the Boards have adopted this Policy to ensure consistent, evidence-based guidance for all Colorado prescribers and dispensers in their treatment of patients 18 years of age and older suffering from acute, subacute or Overview of Recommendations Prior to Prescribing or Dispensing Opioids ● Develop and Maintain Competence
chronic, non-cancer pain. For the purpose of this Policy, the terms “chronic pain” or “chronic non- cancer pain” refer to pain that lasts longer than 90 days or beyond the time of normal tissue healing and is non-terminal. It does not include conditions such as cancer, scleroderma, multiple sclerosis, muscular dystrophy, rheumatoid arthritis or other conditions that may require palliative or end-of-life care. When Prescribing or Dispensing Opioids ● Verify a patient–provider relationship ● Prescribing Safeguards ○ Dosage - When prescribing a dosage above 50 mme/day, STOP: 1) Ensure the patient’s condition warrants the higher dose; 2) Ensure the benefits of a higher dose outweigh the risks; and, 3) Ensure additional risk mitigation strategies are in place.
● Diagnose and Evaluate Patient ● Consider Alternatives to Opioids ● Collaborate with the Healthcare Team ● Patient Education ● Develop an Exit Strategy
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Book Code: MDCO1025
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