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Opioids 

Opioids
Chapter:
Opioids
DOI:
10.1093/med/9780198714750.003.0011
Page of

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date: 17 July 2018

Chapter 11 of Addiction Medicine covers one of the major aspects of addiction medicine practice namely opioid use disorders. The prevalence of different opioids and how pharmaceutical opioids contribute to opioid-related problems through their inappropriate use is described. The pharmacology of opioids is summarized and diagnostic guidelines for opioid use disorder and the opioid withdrawal syndrome are presented. The section on management covers the treatment of opioid overdose and approaches for withdrawal management including tapering regimens, the use of buprenorphine and methadone, treatments using symptomatic agents, and rapid opioid detoxification. Assessment, including identification of virus and other infections, is summarized and there are detailed clinical protocols on agonist maintenance, including practical tips on avoidance of interactions. The place of naltrexone is described. The chapter ends with summaries of comorbid psychiatric disorders, the role of self-help organizations, and harm reduction and prevention.

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