Jackson the recommended treatment for acute pain in patients receiving medication-assisted treatment for OUD and reassured her that her clinicians would work together to manage her pain.
Jackson continued receiving her home dose of buprenorphine-naloxone after admission, and throughout her transplant procedure and hospital stay. She was able to attend step meetings held weekly in the hospital and was visited by community volunteers from a local OUD treatment program. When she developed mucositis and could no longer take buprenorphine by mouth, the buprenorphine-naloxone was discontinued, and she started receiving hydromorphone by patient-controlled analgesia PCA with doses adjusted to treat her pain.
She had significant pain the first day after buprenorphine discontinuation because the drug was still in her system where it prevented other opioids from binding to the mu opioid receptors. By the third day, however, her pain was well controlled with hydromorphone by PCA. When the mucositis resolved, she discontinued the PCA hydromorphone; 16 hours later, after she experienced mild opioid withdrawal, her buprenorphine-naloxone was restarted. Jackson's treatment plan included ongoing assessment using the COWS to assess the symptoms that occurred during the transition from hydromorphone to buprenorphine-naloxone.
Buprenorphine-naloxone was restarted at a dose recommended by her prescribing clinician. The care team managed her withdrawal symptoms as follows: nausea with prochlorperazine, diarrhea with loperamide and intravenous fluids, and anxiety with lorazepam. As nurses, we encounter people with OUD in the hospital setting.
CE: Acute Pain Management for People with Opioid Use Disorder
Patients with serious illnesses and comorbid OUD face additional stressors: concerns about receiving adequate pain management and the fear of relapse into drug use. Nurses can best care for this patient population by learning about OUD and its treatment. We can help patients cope during hospitalization by accessing such resources as local step programs and support groups or reaching out to community volunteers, who may be willing to visit during hospitalization.
Nurses can educate other clinicians on the care of people with OUD. We play a key role in advocating appropriate pain management in this patient population while providing compassionate, nonjudgmental care. Sordo L, et al Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies BMJ j [Context Link]. Alford DP, et al Acute pain management for patients receiving maintenance methadone or buprenorphine therapy Ann Intern Med 2 [Context Link].
Braeburn Pharmaceuticals Prescribing information: Probuphine buprenorphine implant for subdermal administration. Princeton, NJ; May. Bryson EO The perioperative management of patients maintained on medications used to manage opioid addiction Curr Opin Anaesthesiol 27 3 [Context Link].
Indivior, Inc. Prescribing information: Sublocade buprenorphine extended-release injection, for subcutaneous use CIII. North Chesterfield, VA; Mallinckrodt, Inc. Methadose oral concentrate methadone hydrochloride oral concentrate USP and Methadose sugar-free oral concentrate methadone hydrochloride oral concentrate USP dye-free, sugar-free, unflavored [prescribing information].
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- Methadone and Buprenorphine A Guide for Law Enforcement | HuffPost Life.
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Pharmacotherapy for opioid use disorder. Rockville, MD. HHS Publication No. BioDelivery Sciences International, Inc. Raleigh, NC; Jun. Prescribing information: Suboxone buprenorphine and naloxone sublingual film, for sublingual or buccal use CIII. North Chesterfield, VA; Feb. Data on substance abuse treatment facilities.
Rockville, MD; SMA Centers for Disease Control and Prevention. Opioid overdose.http://yuzu-washoku.com/components/2020-11-01/2557.php
Methadone vs. Buprenorphine: How Do OTPs and Patients Make the Choice? – Addiction Treatment Forum
Carmichael AN, et al Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review Subst Abuse Rehabil 7 [Context Link]. Ma JD, et al A single-center, retrospective analysis evaluating the utilization of the opioid risk tool in opioid-treated cancer patients J Pain Palliat Care Pharmacother 28 1 [Context Link]. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM Some cases of bronchospasm, angioneurotic edema, and anaphylactic shock have also been reported.
In patients with moderate hepatic impairment, SUBOXONE Film is not recommended for initiation of treatment, but may be used with caution and careful monitoring for maintenance treatment in patients who have initiated treatment on a buprenorphine product without naloxone. Caution patients about driving or operating hazardous machinery until they are reasonably certain that SUBOXONE Film does not adversely affect their ability to engage in such activities.
Elevation of Cerebrospinal Fluid Pressure: Buprenorphine may elevate cerebrospinal fluid pressure and should be used with caution in patients with head injury, intracranial lesions, and other circumstances when cerebrospinal pressure may be increased. Buprenorphine can produce miosis and changes in the level of consciousness that may interfere with patient evaluation. Elevation of Intracholedochal Pressure: Buprenorphine has been shown to increase intracholedochal pressure, as do other opioids, and thus should be administered with caution to patients with dysfunction of the biliary tract.
Effects in Acute Abdominal Conditions: Buprenorphine may obscure the diagnosis or clinical course of patients with acute abdominal conditions.
Risk of Respiratory Depression and Concomitant Use of Benzodiazepines or Other CNS Depressants with Buprenorphine: Buprenorphine has been associated with life-threatening respiratory depression, overdose, and death, particularly when misused by self-injection or with concomitant use of benzodiazepines or other CNS depressants, including alcohol. Use with caution in patients with compromised respiratory function e. Unintentional Pediatric Exposure: Buprenorphine can cause severe, possibly fatal, respiratory depression in children who are accidentally exposed to it.
Neonatal Opioid Withdrawal Syndrome: Neonatal opioid withdrawal syndrome NOWS is an expected and treatable outcome of prolonged use of opioids during pregnancy.
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