Withdrawal and Treatment – Opioid Use Disorder (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:00 Now, when that person who's using heroin chronically or using an opioid chronically stops the use of that drug, the physical response is withdrawal.

    00:13 And it's quick. It starts within 6 to 8 hours of the last use, and it peaks over three days, but it can actually last for 10 days.

    00:25 And the pain that these individuals go through is terrible.

    00:31 What do we see when we see this withdrawal? We see that they are very depressed. They are nauseated. They are vomiting.

    00:44 They have muscle aches so that every single muscle in their body is aching.

    00:51 They have a runny nose. They have red eyes.

    00:55 They might look like they have the flu, and this runny nose is something that shows up pretty early in withdrawal.

    01:02 They have diarrhea. Terrible, terrible explosive diarrhea.

    01:07 They may start having a very high fever.

    01:10 We're gonna see the goosebumps on their skin.

    01:13 And of course, we have that pupillary dilation now, right? Constricted when they're using, and when it goes away, we have pupillary dilation.

    01:27 How do we help somebody to recover from opioid use disorder? Well, first, we're gonna talk about the idea medication assisted treatment, also known as MAT.

    01:42 There are basically three drugs that have been approved by the Food and Drug Administration, the FDA, for the treatment of opioid dependence.

    01:52 The first one is buprenorphine, the second one is methadone, and the third is naloxone or naltrexone.

    02:03 Buprenorphine is available by mouth, under the tongue, sub dermally as an implant, or injected subcutaneously.

    02:16 Methadone is available orally by tablets or in an oral concentrate.

    02:23 So, the patient will drink it. Naloxone is available orally.

    02:31 Naltrexone is available orally or IM and is called Vivitrol.

    02:40 One of the things with any of the medications, from buprenorphine and methadone especially, is that once it is given to the patient, we have to make sure that the patient doesn't cheek it if they are taking it orally.

    02:57 What is cheeking? Cheeking is when they take the pill and they push it up into the cheek, and then when you're not looking, they can spit it out, and they can sell it on the street. Both methadone and buprenorphine have street value.

    03:13 So, that is why the sublingual is usually used or the implant or the injectable.

    03:23 And for methadone, usually, it's put into an oral concentrate where the person swallows the oral concentrate, but still, you ask them to open their mouth, stick out their tongue, and you look and make sure it's not cheeked.

    03:39 There are other therapies besides medication assisted treatments, and that is behavioral added with the pharmacological ones.

    03:51 So, when we put together therapy with medication in all recovery, we see that we have a better outcome.

    04:01 What's one of the therapies that's open to people who would like to have therapy by peer? Well, that would be narcotics anonymous, also known as NA, which is a 12-step program, and patients go in and have peers who are their companions.

    04:24 And they usually have a sponsor who is a peer who has gone through recovery and been able to stay without using any drugs for a period of time, and that sponsor helps that person go through the 12 steps.

    04:41 Right now, there are online as well as in-person, again, 12-step programs.

    04:49 So, narcotics anonymous have the online and the in-person meetings.

    04:55 We always wanna think about treating the whole person, not just treating the person's disorder.

    05:03 So, think about milieu treatment.

    05:07 Milieu treatment, meaning they were gonna put them in an environment that is safe for them to recover in.

    05:14 An environment that allows them to become recovered and helps them, supports them to move into behaviors that take the place of all the time that they used to spend looking, craving, getting, using, recovering.

    05:35 There are detox for inpatients, as well as for outpatients, and they usually are the best starter to make sure that a person is able to recover.

    05:48 So, when we're using medication assisted treatment, we wanna make sure that that treatment, those medication, are going to help this person to decrease the use of opioids.

    06:01 In doing so, we're hoping that it's going to increase their social functioning.

    06:06 When they have an increased social functioning, that helps them to adhere to or follow the treatment guidelines.

    06:16 We wanna make sure that if a woman is pregnant, that this decreased use of opioids help to decrease the effect that opioid use disorder have on the fetus.

    06:31 For us, it's really important to check our stigma at the door to be able to listen to this patient with an opioid use disorder the same way we would listen to someone who had metabolic syndrome and hear what they're saying.

    06:50 Respect the struggle that they're going through to help their body recover from this terrible, terrible disorder.

    06:58 So, the way that we can help is not only by reducing the stigma that we might be carrying, we have to check that at the door, but also help others that you're working with by listening and connecting to this patient and getting the patient the proper help that he or she needs.

    07:19 Let's look at a patient case scenario now.

    07:25 Nurse Jay is working in pediatrics and has a young 15-year-old patient admitted for a knee injury after a very, very vigorous baseball game.

    07:36 When doing rounds, Nurse Jay notices that the patient, Pat, is extremely drowsy.

    07:44 Jay wonders if Pat had received any pain medication in the emergency room but doesn't remember if it was mentioned in change of shift.

    07:57 Nurse Jay walks in, sees that Pat's respirations are only 12, and they're very shallow.

    08:08 Nurse Jay calls out, "Pat. Pat." Pat doesn't move.

    08:14 What is the next thing that Nurse Jay should do? Should Nurse Jay call a code? Go back to the nurse's station, check the electronic records, see when and if any analgesics were administered? Tap Pat on the shoulder for a response? Call Pat's name out? Don't be concerned. Just move on to the next room.

    08:41 Pat's young, otherwise healthy, nothing to worry about.

    08:45 What do you think the answer is? If you said tap Pat on the shoulder for a response while calling Pat's name, you are correct.

    08:56 Giving Pat a little - a little bit of a shake on his shoulder would really be helpful.

    09:02 If the eyes open, then you say, "Take a nice deep breath, Pat.

    09:07 Come on. Take a nice deep breath." You might find someone to sit in the room with Pat and then go check your electronic health record to find out when the last analgesic was administered.

    About the Lecture

    The lecture Withdrawal and Treatment – Opioid Use Disorder (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Opioid Use Disorder (Nursing).

    Included Quiz Questions

    1. 6–8 hours
    2. 3–4 hours
    3. 11–15 hours
    4. 16–20 hours
    1. Nausea
    2. Muscle aches
    3. Pupil dilation
    4. Dry mucous membranes
    5. Constipation
    1. Buprenorphine
    2. Methadone
    3. Naloxone
    4. Disulfiram
    5. Wellbutrin
    1. Goals for treatment include decreased opioid use and increased social functioning.
    2. Benzodiazepines are first-line treatment.
    3. Narcotics Anonymous is an inpatient, physician-led program.
    4. Studies show that behavioral therapy alone shows the best treatment outcomes.
    1. It can last for up to 14 days.
    2. It peaks at 3 days.
    3. It causes a depressed mood.
    4. It can cause flu-like symptoms.

    Author of lecture Withdrawal and Treatment – Opioid Use Disorder (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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