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Questions:
1.
How do Opioid Overdoses occur?
2.
What are the signs of Opioid Overdose?
3.
What could the therapist say to a patient/client who expresses fears about opioid tapering?
4.
Can first responders develop toxicity from just entering the room where someone has fentanyl overdosed?
5.
What is Street Fentanyl?
6.
How should the initiation of Opioid therapy be presented to a patient?
7.
What are the exit strategies that should be included as part of the Treatment Plan when indicated by the risk assessment?
8.
What Select Population might be at higher risk than other patients for opioid use disorder?
9.
What type of pain are Opioids most effective in treating?
10.
Why should women of childbearing age be queried regarding methods of contraception?
11.
What drug class presents an extremely high risk for adverse drug reaction involving overdose and/or death during the induction process?
12.
What treatment should Pregnant women who are physically dependent on opioids receive?
13.
Why are the words "Opioid use" a better way to talk about OUD than "Opioid misuse or abuse?"
14.
A provider should talk to a woman with OUD about what’s involved in sharing her information. What language can a provider use when talking to a woman with OUD about consent?
15.
How should stigma for OUD in American Indian & Alaska Native Communities be addressed on the Individual level?
16.
What do the interconnected issues of historical and contemporary trauma in tribal communities highlight?
17.
What are the Risk Mitigation Strategies upon initation of long-term opioid therapy?
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Answers:
A. Unconsciousness or inability to awaken orally or upon sternal rub; Slow or shallow breathing or breathing difficulty such as choking sounds or a gurgling/snoring noise from a patient who cannot be awakened; Fingernails or lips turning blue/purple; Slow heartbeat and/or low blood pressure.
B. a patient deliberately misuses a prescription, uses an illicit opioid (such as heroin), or uses an opioid contaminated with other even more potent opioids (such as fentanyl) or a patient takes an opioid as directed but the prescriber miscalculated the opioid dose, or an error was made by the dispensing pharmacist, or the patient misunderstood the directions for use. It can also occur when opioids are taken with other medications—for example, prescribed medications such as benzodiazepines or other psychotropic medications that are used in the treatment of mental disorders—or with illicit drugs or alcohol that may have adverse interactions with opioids
C. In order to create clinically significant toxicity, an adequate dose of fentanyl must be absorbed into the blood stream and enter the central nervous system. Simply being in a room where fentanyl is present will not result in toxicity or overdose.
D. “I know you can do this” or “I’ll stick by you through this.” Make yourself or a team member available to the patient to provide support, if needed. Let patients know that while pain might get worse at first, many people have improved function without worse pain after tapering opioids.
E. A therapeutic trial.
F. any fentanyl used by someone it was not prescribed for. Fentanyl is a powerful pain medication. It is an opioid, like morphine, codeine, oxycodone (oxys) and methadone. Fentanyl is most often prescribed as a slow-release patch to people with long-term, severe pain. Fentanyl is much stronger than most other opioids—up to 100 times stronger than morphine—and is very dangerous if misused. Even a small amount can cause an overdose and death... may be swallowed, smoked, snorted or injected.
G.Individuals with mental health comorbidities. Adults with mental health conditions receive 51.4% of the total opioid prescriptions distributed in the U.S. each year and are nearly twice as likely to use opioids long term for pain.
H. a) tapering the opioid dose b) rotating to buprenorphine and then gradually tapering the buprenorphine dose and c) offering or arranging medication-assisted treatment. The choice of exit strategy cannot be done casually or with a one-size-fits-all” approach; it should be guided by a biopsychosocial assessment of the patient, including evaluation of co-occurring medical and psychiatric conditions, substance use disorders, and the patient’s social support system
I. The increase in fertility that results from effective opioid use disorder treatment.
J.acute tissue injury, such as what occurs after an injury or a surgical operation or a dental surgical procedure; or when a disease process is causing ongoing tissue injury (such as what can occur in advancing cancer or in sickle cell disease).
K. methadone or buprenorphine mono-product rather than withdrawal management or abstinence.
L. benzodiazepines in a person presenting for medication treatment with methadone or buprenorphine
M. I know it’s hard to share personal information about opioid use and treatment; Your consent is voluntary. I will continue to support you no matter what you decide; I know information-sharing regulations are complicated and can be difficult to understand. Can you tell me who’s okay to have this information and who’s not?; You have legal protections, and I will abide by them. Do you understand these protections? Do you feel protected by them?
N. Medically accurate and non-judgmental language emphasizes that OUD is a medical disease, not misconduct by the woman.
O. The complexity in finding the right balance between punitive approaches by law enforcement, treating addiction and trauma, harm reduction strategies, and supporting community members affected by others’ drug use.
P. Provide educational resources on the pathology of addictions, Address the myth that MAT services substitute one addiction for another, and include individuals who have gone through the recovery process to destimatize and normalize conversations about recovery.
Q. Ongoing, random urine drug testing (including appropriate confirmatory testing); Checking state prescription drug monitoring programs; Monitoring for overdose potential and suicidality; Providing overdose education; Prescribing of naloxone rescue and accompanying education
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