Net Guide: Opioid Addiciton

Pain Management, November 2010, Volume 3, Issue 7

A collection of links and resources from across the web focused on one specific condition. These resource range from useful websites to clinical trials.

//Patient Education

Designed to offer information on addiction across a wide spectrum and offer tips and strategies, this site can be a good starting point for your patients who may suspect they are becoming or are addicted to opioids. provides an overview of opioid addiction and a number of articles on common opioids, opioid withdrawal symptoms, and medical treatments for opioid addiction. In addition there are links to online support groups, and general articles on addiction, including “How Addiction Affects the Brain,” “What is Methadone?,” or “The Genetics of Addiction.” There are also videos, blogs, news, and more.

Addiction Survivors

Drug addiction can be very isolating. Send your patients here to let them know they are not alone in their struggle. Addiction Survivors is a website that features is a “not-for-profit organization dedicated to providing peer support communities for those with addiction disorders and their families and friends.” Featured here are a number of community forums dedicated to opioid addiction, alcohol dependence, stimulant addictions, and gambling addictions.

This site describes opioids as “the most effective analgesics by far” and goes on to explain what they are and how they work by binding to opioid receptors in the brain. It also described antagonist drugs, such as Naltrexone, and their role in reversing opioid addiction. Further explanation is also given on agonist-antagonist drugs and how they work to trigger certain receptors and block others. The descriptions can help a patient frame the addiction process and better understand what is transpiring within their bodies. The site also describes how opioid treatments are typically selected for the patient and then further delves into “Physical Dependence, Addiction, and Tolerance.” The site explains the difference between physical dependence and addiction. “Addiction is defined by a loss of control over the drug, compulsive use of the drug, and continued use of the drug even if it is harming the person or others,” it reads.

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//Medical Websites

Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain

Last updated February 2009, these guidelines can help practicing physicians better manage their patient’s treatment with opioids and may help prevent misuse. Developed by the “The American Pain Society and the American Academy of Pain Medicine,” the guidelines are based on a “systematic review of the evidence on chronic opioid therapy for chronic noncancer pain.” They were also reviewed by a multidisciplinary expert panel. The recommendations discuss risk stratification; informed consent and opioid management plans; initiation and titration of chronic opioid therapy; use of methadone; patient monitoring; dose escalations, opioid rotation, and much more.

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//Online CME

COPE - Collaborative Opioid Prescribing Education

Credits: 1.00

Fee: $45.00

Expires: April 30, 2011

Multimedia: SLIDES/AUDIO

The program is designed to offer physicians useful tools that they can use at the start of opioid treatment. This program features didactic exercises, video tools, quizzes and “extensive background information.” The latest evidence based practices will be discussed as well.

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Appropriate Use of Opioid Therapy For Patients With Pain

Credits: 1.00

Fee: None

Expires: December 31, 2010

Multimedia: VIDEO/AUDIO

This activity will cover the clinical strategies available to help prevent opioid misuse, abuse, and diversion. It features an expert panel and discusses how to implement the useful strategies. Upon completion, physicians should be able to “Describe how to apply the Universal Precautions to the assessment and management of patients with chronic opioid therapy.” (Hurry up, it expires soon.)

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Stemming the Tide of Opioid Abuse and Diversion with Abuse-Deterrent Choices

Credits: 1.00


Expires: May 1, 2011

Multimedia: AUDIO/VIDEO

This activity focuses on abuse-deterrent choices for pain management treatment and will provide “updated information.”

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Critical Issues in Managing Pain with Opioid Therapy

Credits: 1.00


Expires: June 30, 2011

Multimedia: VIDEO/AUDIO

The activity reviews evidence “that demonstrates the prevalence of chronic pain and its debilitating costly effects when inadequately treated.” It will instruct physicians on how to implement a “pain management plan” that utilizes risk assessment tools and monitors strategies.

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Effect of Ultra-rapid Opiate Detoxification on Withdrawal Syndrome

Journal: Journal of Addictive Diseases (October 29, 2010)

Authors: Safari F, Mottaghi K, Malek S, et al

Purpose: The study was designed to examine the effect of ultra-rapid opiate detoxification (UROD) “on the presence or absence of withdrawal syndrome in a group of patients with opiate dependency.”

Results: The study included 173 patients with opiate addiction. The participants were evaluated both before and after UROD “using the Objective Withdrawal Scale.” The most prevalent withdrawal sign before UROD was anxiety. The researchers found that the opioid dependent patients that “underwent UROD showed the highest rate of withdrawal symptoms at one hour after anesthesia. Most of these symptoms subsided after 24 hours.” They concluded that for opioid dependent patients “UROD can be applied for detoxification with safety.”

Characteristics of Prescription Opioid Abusers in Treatment: Prescription Opioid Use History, Age, Use Patterns, and Functional Severity

Journal: Journal of Opioid Management (July-August 2010)

Authors: Butler S, Black R, Serrano J, et al

Purpose: The study is designed to examine whether prolonged use of prescription opioid drugs leads to, or is associated with, “abuse of other drugs” and increases “more risky drug-related behavior, and more functional problems.”

Results: The researchers examined data from the Addiction Severity Index-Multimedia Version Connect system. The team had access to 55,341 client assessments at substance abuse treatment centers. The researchers concluded that “Overall findings supported the hypothesis that length of opioid abuse is associated with higher risk of drug use patterns as well as functional problems.”

A Clinical Trial Comparing Tapering Doses of Buprenorphine with Steady Doses for Chronic Pain and Co-existent Opioid Addiction

Journal: Journal of the American College of Cardiology (September 2010)

Authors: Blondell R, Ashrafioun L, Dambra C, et al

Purpose: The study compares the effects of discontinuing opioids and the effectiveness of opioid replacement protocols.

Results: The team enrolled participants into one of two six-month treatment protocols of buprenorphine/naloxone sublingual tablets. The participants had been treated with opioids for chronic non-cancer pain and had an opioid addiction. One group received tapering doses for detoxification and the other group received “steady doses for opioid replacement.” Based on the results, the researchers concluded that the participants “were more likely to adhere to an opioid replacement protocol.” Additionally, the second group demonstrated “improved pain control and physical functioning.”

Quality of Life Under Maintenance Treatment with heroin versus Methadone in Patients with Opioid Dependence

Journal: Drug and Alcohol Dependence (August 19, 2010)

Authors: Karow A, Reimer J, Schäfer I, et al

Purpose: The researchers sought to examine health-related quality of life (HRQOL) in patients with “severe opioid dependence” through a longintudinal study.

Results: The 938 participants were randomly assigned to four groups of medical and psychosocial treatment. The groups were: “heroin (diacetylmorphine) versus methadone and case management (CM) versus psychoeducation (PSE) respectively.” The results revealed that while both forms of maintenance and psychosocial treatment improved HRQOL during the observation peroid,” maintenance with heroin improvement in HRQOL exceeded maintenance with methadone. Additionally, HRQOL improved HRQOL significantly “in subjects treated with PSE compared with CM.”

//Clinical Trials

Treatment Study Using Depot Naltrexone (1/6) Philadelphia Coord/Data Mgmt Site

Study Type: Interventional

Age/Gender Requirements: 18-60 years

Sponsor: National Institute on Drug Abuse (NIDA)

Purpose: The study is designed to “determine whether the addition of a monthly injection of depot naltrexone to treatment as usual (TAU) will significantly improve outcome in parolees and probationers with a history of opioid addiction compared to TAU alone.”

Efficacy of Extended Release Tramadol for Treating Prescription Opioid Withdrawal

Study Type: Interventional

Age/Gender Requirements: 18-55 years (male/female)

Sponsor: University of Kentucky

Purpose: The researchers seek to examine two different doses of extended-release tramadol to treat opioid withdrawal. They will also be evaluating whether or not “tramadol itself produces withdrawal after it is no longer taken.”

Science-Based Treatment for Opioid-Dependent Adolescents

Study Type: Interventional

Age/Gender Requirements: 13-18 years (male/female)

Sponsor: National Development and Research Institutes, Inc.

Purpose: The researchers seek to “evaluate ways to optimize outcomes from combined behavioral-pharmacological treatment for opioid-dependent youth.”

Buprenorphine and Methadone for Opioid Dependent Chronic Pain Patients

Study Type: Interventional

Age/Gender Requirements: 18 years (male/female)

Sponsor: State University of New York at Buffalo

Purpose: The researchers seek to analyze buprenorphine and methadone for the treatment of chronic pain in patients who have become addicted to prescription narcotics. The study is designed to determine which treatment is more effective.

From the HCPLive Network:

Kicking Addiction with an Injectable Drug

Vivitrol was approved by the FDA to treat opioid dependence. The drug is to be used after patients with opioid dependence have undergone detoxification treatment and is designed to treat and prevent relapse.

Getting to the Bottom of Prescription Drug Overdose

A Rhode Island Hospital research study aimed at reducing the state's leading cause of accidental death among adults, will be supported by a $250,000 grant from the Centers for Disease Control and Prevention (CDC).


Drug Abuse: A Far-Reaching Reality

Proper pain assessment is critical when considering the appropriate prescribing and dispensing of prescription drugs for pain, because these agents carry a high risk of abuse and misuse.

Pharma Focus

Vivitrol (Naltrexone)

Vivitrol (naltrexone for extended-release injectable suspension)

Recently approved for use in patients with opioid addiction, the website for this prescription medication — initially used to treat patients with alcohol addiction - contains information on proper usage for both health professionals and patients. The health professionals’ page contains information on how to get patients started on the medication, links to request more information, guidelines, patient testimonies, and more. The patient site contains information on how Vivitrol works, how it may help, safety information, and articles on dependence. The state is primarily dedicated to information that highlights the drug as a treatment for alcohol dependence, but may soon contain information for those seeking to use the treatment in opioid detoxification therapy.