Substance Misuse

Patient Information

Patient A

-family history of heart disease

-addiction for 10 years

-woman, 35 years old

Patient B

-suffering from COVID19

-History of asthma

-addicted for 4 years

Pharmacology

Various treatments options available

The medications that are available for the treatment of opioid use disorder are opioid agonists and partial agonists that are maintenance medications (Bell and Strang, 2020). Researchers have noted that patients suffering from opioid use disorder that follow detoxification with complete abstinence have higher chances of relapsing. The Foods and Drugs Association has approved medications such as lofexidine, methadone, and buprenorphine as some of the medications that are used in the reduction of opioid withdrawal.

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Methadone is one of the treatment options. Synthetic opioid agonist is useful in the elimination of the withdrawal effects besides relieving drug cravings through the action of the opioid receptors that are located in the central nervous system. These are the same receptors that opioids such as heroine, opioid pain medications, and morphine activate (Bell and Strang, 2020). Methadone activates the receptors slowly relative to other opioids thus the treatment doses does not produce euphoria.

Another option for the treatment of opioid use disorder is buprenorphine, which is a partial agonist that binds to the same opioid receptors but produces less activation relative to the full agonists (Bell and Strang, 2020). It also reduces the cravings for the drugs as well as reducing the withdrawal symptoms without production of euphoria. Studies have noted the similarity in the effectiveness of the medication just like methadone should the dosage be right and for enough period. The medication has been in the market for 18 years since FDA approved it (Bell and Strang, 2020). It is also the first medication that qualifies for prescription by physicians via the drug addiction treatment act

Other medications that are used in the treatment include opioid antagonists that block the opioid receptors. These medications do not reduce the withdrawal symptoms and the cravings but prevents any opioid from offering rewarding effects such as euphoria (Oesterle et al., 2019). One of the medications is Naltrexone that is used for continuing opioid use disorder treatment. Its usage has however been limited since it has a poor adherence and tolerability by patients (Koehl et al., 2019). Vivitrol is another opioid receptor antagonist that was recently approved and has ln lasting effects and is good for patients that lack ready access to health care or are facing difficulty with compliance to taking medications regularly (Bell and Strang, 2020). Researchers have indicate that the use of methadone, buprenorphine and naltrexone reduce the use of opioids as well as related symptoms. They also lower the risk of transmission of infectious diseases. They increase the possibility of an individual remaining in treatment (Volkow, 2018).

Is methadone the best option? Why

For many years, methadone has been used in the treatment of opioid use disorder. Studies have reported its effectiveness in the reduction of opioid use as well as opioid use-associated transmission of infectious diseases (Cochran et al., 2020). Methadone treatment has also been reported to significantly improve the outcomes relative to other treatment options. When compared to buprenorphine, they are both noted to be effective in the reduction of opioid use (Cochran et al., 2020). However, same doses of buprenorphine have been reported to be less effective compared to methadone in studies that involve patients suffering from opioid use disorder. These are the reasons why methadone is the best treatment for the patients. Besides, the diversion risk of methadone in the treatment of opioid use disorder has been reported to be very low. Diversion has been associated with lack of access to medication by the patient.

Practice

Role of pharmacist in providing holistic care

Pharmacists should be obligated to take the leadership role in delivering and ensuring the best patient outcomes. Pharmacists are the experts in safety and efficacy of medications. With that knowledge, they are able to put the patient’s preferences and the expected goals in formulating the best cause of treatment (Bratberg et al., 2020). The pharmacist can monitor the response of the medication that the patients have been put on. From the results, the pharmacist, with the assistance of other medical professionals, can decide rationally which drugs will be best suited for each of the cases considering the underlying conditions of the patients. Patient-centred care is the best approach for a pharmacist to realise the best results for each patient they serve (Bratberg et al., 2020).

Medication assisted treatments has been noted to be effective in providing better outcomes even for opioid use disorder patients. Medication-assisted treatment comprises the use of medicines and counselling in treatment of disorders, mainly substance use disorders (Muzyk et al., 2019). The pharmacist’s role in serving the patients should not only be left at the level of filling prescriptions and proving technical assistance on the most appropriate medication. The pharmacist as a professional should socially interact with the patient to form a connection and use the trust in guiding the patients to recovery. Opioid use disorder is not easy to come out of without proper assistance from medical practitioners. The best patient outcomes have been realised when the treatment plan has been combined with the behavioral therapies and counselling (Bratberg et al., 2020).

Legal requirements

A prescription for controlled drugs such as methadone should contain various details. The prescription should include the issue date, name and address of the patient, the name, address, and registration number from the DEA of the practitioner, drug name, the appropriate strength and quantity needed, the dosage form, the directions for use, refills (only if authorized), and the manual signature of the prescriber symptoms (Rosenblatt et al., 2015). The original copy of the prescription must be provided to the pharmacist before they dispense the drugs to the patient. It is the pharmacist’s job to authenticate if the medicine is needed to serve a legitimate medical issue. The proper decision will be guided by the quantity indicated on the prescription and the period between signing and filling of that prescription. The authorization needed for refilling is a new prescription written by the prescriber symptoms (Rosenblatt et al., 2015). This means that not all Schedule II medications are meant to be refilled.

Checks before dispensing

The pharmacist should always read and interpret the prescription given by a patient for before looking at the medicines contained there in. Some medicines such as methadone are sensitive therefore; a pharmacist should take caution when dispensing them symptoms (Rosenblatt et al., 2015). This is to say that the pharmacist needs to check if the doses given are the most suitable. It is also the pharmacist’s role to ask if the patient is already on other medication as clarification. This is meant to avoid drug-drug interactions, which can be fatal or hinder the action of some medicines. A pharmacist should also check the labels and sign off on the prescription when it has been filled.

Pharmaceutical science

Both patients indicated that they were administering heroin intravenously. Skin infections may often result from the habit. Abscesses often result from intravenous administration of drugs by addicts. The main cause of the infections is bacteria and fungi contained in many of the substances used by the addicts. The pathogens can also be in the equipment used in the delivery of the drugs. Non-sterile materials and poor hygiene greatly increases the probability of developing skin infections. The scarring and needle marks can stigmatize the drug users for a very long time even after reforming from the habit. The inflammation of the interior lining of the heart (endocarditis) can occur from intravenous delivery of drugs. The bacteria that can be present on the needles used by the addicts can also be a cause of endocarditis. Sharing needles can be a source of transmission of blood related problems such as hepatitis. HIV/AIDS can also result from sharing needles. The risk of overdosing greatly increases when drugs are directly injected into the blood stream symptoms (Rosenblatt et al., 2015). The issue is that the addicts are not in positions of managing the quantities they are injecting into their systems. The high feeling is the major concern of the addicts. Overdoses can lead to other serious problems and sometimes death can occur. Other problems that can result from regular intravenous heroin use are collapsed veins, wound botulism, lockjaw, and flesh-eating disease.

Issue of compliance

Compliance is affected by many factors. The pharmacist as a professional works to ensure that the patient is compliant with the directives they will provide. Sending a representation potentially prevents that process. It is the pharmacist’s job to talk to the patient face-to-face so that they can evaluate the effectiveness of the regimen the patient is on and develop the solutions that may be needed in case there are problems. The sensitivity of the medication may bar the pharmacists from administering the medication and this can massively affect the patient. The representation is a sign that the patient does not value the interactions they have with the pharmacist symptoms (Rosenblatt et al., 2015). It may also be a sign that the patient has not been made aware of the importance of the interaction achieved by physically going to pick the prescription himself. The physician’s drug orders can be enforced through proper education and the pharmacist is part of the process of ensuring the patient is compliant. Improving compliance will be based on promoting the self-monitoring by the patient.

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References

Bell, J. and Strang, J., 2020. Medication treatment of opioid use disorder. Biological psychiatry, 87(1), pp.82-88.

Bratberg, J.P., Smothers, Z.P., Collins, K., Erstad, B., Ruiz Veve, J. and Muzyk, A.J., 2020. Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles. Journal of the American College of Clinical Pharmacy, 3(2), pp.478-484.

Cochran, G., Bruneau, J., Cox, N. and Gordon, A.J., 2020. Medication treatment for opioid use disorder and community pharmacy: expanding care during a national epidemic and global pandemic.

Koehl, J.L., Zimmerman, D.E. and Bridgeman, P.J., 2019. Medications for management of opioid use disorder. American Journal of Health-System Pharmacy, 76(15), pp.1097-1103.

Muzyk, A., Smothers, Z.P., Collins, K., MacEachern, M. and Wu, L.T., 2019. Pharmacists’ attitudes toward dispensing naloxone and medications for opioid use disorder: a scoping review of the literature. Substance abuse, 40(4), pp.476-483.

Oesterle, T.S., Thusius, N.J., Rummans, T.A. and Gold, M.S., 2019, October. Medication-assisted treatment for opioid-use disorder. In Mayo Clinic Proceedings (Vol. 94, No. 10, pp. 2072-2086). Elsevier.

Rosenblatt, R.A., Andrilla, C.H.A., Catlin, M. and Larson, E.H., 2015. Geographic and specialty distribution of US physicians trained to treat opioid use disorder. The Annals of Family Medicine, 13(1), pp.23-26.

Volkow, N.D., 2018. Medications for opioid use disorder: bridging the gap in care. The Lancet, 391(10118), pp.285-287.


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