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Etiology of Opioid Abuse: Neurobiology of Addiction Cortex Prefrontal Cortex NAc Thalamus VTA • Mu opioid receptors distributed widely in the brain. • While binding in the thalamus produces analgesia, binding in the cortex produces impaired thinking/balance; • Ventral tegmental area (VTA)/nucleus accumbens (NAc) is associated with euphoria that some experience (i.e. the “high”). This area is the reward pathway • Binding in this reward pathway is believed responsible for reinforcing effect leading to potentially to addiction.
• Tolerance: Repeated Dosing: Opioid Tolerance and Withdrawal • Need more for same effect • Less effect with same amount • Occurs for euphoria, sedation, respiratory depression, vomiting, analgesia • Minimal tolerance to constipation, miosis, sweating • Can attain high levels of tolerance with gradual increases to doses that would otherwise be lethal • Withdrawal: • Upon reduction or cessation of opioid use/administration
Page 1 and 2: Patricia Pade, MD University of Col
Page 3 and 4: Objectives • To provide a brief o
Page 5 and 6: Chronic Pain • 116 million people
Page 7 and 8: Opioid Use • Use of opioids has i
Page 9 and 10: Fatal Drug Poisoning • Between 19
Page 11: Opioid Pharmacology: How do these M
Page 15 and 16: Brief pharmacology overview: full o
Page 17 and 18: Brief pharmacology overview: opioid
Page 19 and 20: The Use of Buprenorphine/Naloxone t
Page 21 and 22: The Problem for Veterans
Page 23 and 24: Improvement Change: Creation of Co-
Page 25 and 26: Patient population • Referrals fr
Page 27 and 28: Initial Evaluation A. PAIN Detailed
Page 29 and 30: Buprenorphine induction process •
Page 31 and 32: Study participants Participant Data
Page 33 and 34: Months Average duration of opioid u
Page 35 and 36: Number Number Number 60 40 Co-morbi
Page 37 and 38: Adjuvant Medications Na and Interve
Page 39 and 40: Ongoing monitoring for compliance
Page 41 and 42: 93/143 patients remained in treatme
Page 43 and 44: Conclusions 11. Patients with co-oc
Page 45 and 46: Office Based Opioid Treatment: Bupr
Page 47: References 1. Institute of Medicine

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