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Discussion Response: Substance Abuse And Addictions

Discussion Response: Substance Abuse And Addictions

Response 1

The posting reflects the student’s effort and ability to read and articulate the assignment prompts. It has a clear purpose: to inform, persuade, and discuss intoxication issues. The response is presented systematically through subheadings to provide a context within a specific area and grab the reader’s attention. Importantly, it cites recent and substantial sources (from 2019-2021) to validate the information provided Discussion Response: Substance Abuse And Addictions.

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I agree with the posting’s context, especially the last three sections that discuss the substance abuse screening tools, withdrawal and detoxification, and the tools used to prevent the client from returning to stimulant use. Also, the sections validate what Lappin et al., (2017) and Limani et al., (2018) capture in their research. Lastly, one thing that didn’t stand out about the posting is grammatical errors. The first two sections, specifically have grammatical errors. All in all, the prompts were discussed in detail.

References

Lappin, J. M., Darke, S., & Farrell, M. (2017). Stroke and methamphetamine use in young adults: a review. Journal of neurology, neurosurgery, and psychiatry, 88(12), 1079–1091. https://doi.org/10.1136/jnnp-2017-316071

Limanaqi, F., Gambardella, S., Biagioni, F., Busceti, C. L., & Fornai, F. (2018). Epigenetic Effects Induced by Methamphetamine and Methamphetamine-Dependent Oxidative Stress. Oxidative medicine and cellular longevity, 2018, 4982453. https://doi.org/10.1155/2018/4982453 Discussion Response: Substance Abuse And Addictions

 Response 2

Dear XYZ,

Your posting is substantive and reflects that you understood the assignment and conducted thorough research before tackling it. I’m impressed by its coherency and how you’ve discussed all the stated drugs in detail. Importantly, I love how you’ve captured the black box warnings under each section and backed them up with reliable and current sources. What stands out most is how you’ve organized your response in paragraphs with each discussing one drug at a time.

Consequently, I’m certain that your posting is substantial and valid as it reflects Kraft et al., (2017) and Faul et al., (2017) ideas. However, I’m worried whether citations like Drug (2018) and NAMI (2021) are reliable and acquired from medical and nursing journals and conferences.

References

Faul, M., Bohm, M., & Alexander, C. (2017). Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies – United States, 2007-2014. MMWR. Morbidity and mortality weekly report, 66(12), 320–323. https://doi.org/10.15585/mmwr.mm6612a2 Discussion Response: Substance Abuse And Addictions

Kraft, W. K., Adeniyi-Jones, S. C., Chervoneva, I., Greenspan, J. S., Abatemarco, D., Kaltenbach, K., & Ehrlich, M. E. (2017). Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome. The New England journal of medicine, 376(24), 2341–2348. https://doi.org/10.1056/NEJMoa1614835

There are two different discussions posted that needs two different responses. Please do not respond to both discussions as one. There needs to be two separate responses and each response needs it own separate references. thanks

 

 

DISCUSSION 1

Explain what intoxication and/or overdose of stimulants looks like. What signs/symptoms will the patient be exhibiting? What tools are used? What does withdrawal and detoxification look like in the patient (signs/symptoms). What is most commonly used to prevent the client from returning to stimulant use?

 

Stimulant use disorders have a range of issues linked with the use of methamphetamine, amphetamines and cocaine.  Providers should look out for these signs: taking more stimulants than intended, not wanting to cut down or control use of stimulants, experiencing urges and cravings for stimulants and having withdrawal symptoms when the medication is not taken   (Khoramizadeh et al., 2019)


Signs and symptoms of intoxication of stimulants

Stimulants are indicated for patients that may lack executive functioning such as hyperactive, inattentive, unable to focus or remembering details, unable to manage or control impulses or emotions.  Methylphenidate and amphetamine are the stimulates uses to treat these symptoms. Before prescribing these medications, the provider must warn of the black box warning, such as cardiac considerations and abuse and misuse.

Overdose of stimulants such as amphetamines and cocaine cause an increase dopamine concentration in the mesolimbic dopamine system pathway which produces arousal and euphoria. Some other intoxication of stimulates are impaired judgement, altered mental status, confusion and paranoia; they may become accusatory or distrustful and suspicious of people.  The paranoia may cause them to become angered quick, get into fights, hypervigilant and unable to sleep (Vasan and Olango, 2022).

In additional these patients my experience agitation, suicidal ideation, delusions, auditory or visual hallucination; however, those that overdosed on cocaine may experience tactile hallucination.  The physical symptoms from the increase norepinephrine concentrations are hyper-stimulation, hypervigilance which cause insomnia, mydriasis, diaphoresis, hyperthermia, hypertension, abdominal pain, dyspnea, tachycardia or even arrhythmias and seizures (Khoramizadeh et al., 2019).

 

What tools are used

Screening tools used for substance abuse problem such as:

  • CAGE-AID Questionnaire – a questionnaire version of CAGE that was adapted for the use of illegal and prescription drug use and abuse (Eurich et al., 2019).
  • Screening, Brief Intervention and Referral to Treatment (SBIRT) – a comprehensive approach of screening tests, intervention and treatment to manage substance abuse (Karno et al., 2020).
  • Urine drug screening is also obtained to further check serum levels for any misuse of stimulants and opioids.

 

What do withdrawal and detoxification look like in the patient (signs/symptoms)

Providers should educate patients about the acute withdrawal phase, which is the moment after the medication is no longer in your body and can generally last up to five days.  However, any symptoms lasting more than five days are also called post acute withdrawal phase (Khoramizadeh et al., 2019).  Amphetamine withdrawals are not seen as deadly or dangerous as alcohol, benzodiazepine, or opioid withdrawal.  Withdrawal symptoms to note in those that are taking stimulants are that the individuals become fatigue, experience excessive sleeping with vivid dreams, irritability and have an increased appetite which may last for several days. These individuals may also have pupil constriction and depressed moods during withdrawal (Khoramizadeh et al., 2019) Discussion Response: Substance Abuse And Addictions.

 

What is most commonly used to prevent the client from returning to stimulant use?

According to Stahl (2021), non-stimulants may be considered for treatment for those patients that may be prone or potential to stimulant abuse.  The most commonly preventative measure used is the norepinephrine and dopamine reuptake inhibitor (NDRI) bupropion; however, it is used off label in ADHD.  One of the advantages of this medication is that it has minimal 5-HT/serotonergic effects. Other non-stimulant medication that may be used are atomoxetine, clonidine and guanfacine.  Naltrexone is also used to prevent accidental overdose; however, may not control cravings (Stahl, 2021).

Medication combined with psychotherapy also help prevent stimulant misuse. Motivational interviewing therapy is a psychotherapy treatment that can help those overcome feelings and insecurities.  Individuals can become motivated to change their behavior to help reduce or maybe stop stimulant abuse and misuse (Wheeler, 2021).

 

DISCUSSION 2

A-I: Explain the drugs used to increase abstinence from alcohol, heroin, and opiates. Include the dosage and black box warnings. The drugs that you must include are naltrexone (ReVia, Trexan), Buprenorphine/naloxone (Suboxone), Disulfiram (Antabuse), Levomethadyl (Orlaam), and methadone (Dolophine).

  •    Naltrexone is an opioid antagonist given for the treatment of alcohol use disorder and opioid dependence (Singh & Saadabadi, 2022). This medication is FDA-approved for alcohol use disorder and opioid dependence treatment (Singh & Saadabadi, 2022). Off-label use is for the treatment of cholestatic pruritus in adults (Singh & Saadabadi, 2022). Naltrexone inhibits the effects of opioids and stops opioid inebriation and physiologic dependence of opioid users (Singh & Saadabadi, 2022). Naltrexone alters the hypothalamic-pituitary-adrenal axis so that it can suppress alcohol consumption (Singh & Saadabadi, 2022). Naltrexone can be given as an oral tab at a dose of 50 mg, and the standard dosage for alcohol abuse is 50 to 100 mg (Singh & Saadabadi, 2022). The clinician should initially start the patient at 25 mg PO for one dose and should be repeated in one hour if there aren’t any withdrawal symptoms (Singh & Saadabadi, 2022). Naltrexone can also be given in a depot injection at a dosage of 380 mg (Singh & Saadabadi, 2022). The IM type requires injection using needles provided for administration into the upper outer area of the gluteal region; providers must avoid injecting into the blood vessels (Singh & Saadabadi, 2022). The medications cannot be given via IV, SubQ, or fatty tissue (Singh & Saadabadi, 2022). Since many individuals with a substance use disorder tend to be non-compliant with the oral route, an IM injection is what is recommended (Singh & Saadabadi, 2022). Research indicates that outcomes for individuals with alcohol dependence who have been given naltrexone are more favorable when given as an IM injection (Singh & Saadabadi, 2022). There is no longer a black box warning for Naltrexone, but individuals with hepatic impairment need care taken when it is being prescribed and can worsen cirrhosis (Singh & Saadabadi, 2022). Naltrexone is excreted in the urine in individuals with renal impairment, and caution is recommended when giving naltrexone to individuals with renal impairment (Singh & Saadabadi, 2022).

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  • Suboxone is a drug that works in the brain to manage opioid use disorder. Opioids like heroin and prescription pain killers (NAMI, 2021). Buprenorphine is the active medication in buprenorphine/naloxone (NAMI, 2021). It is identified as a partial opioid agonist meaning it partly works similar to an opioid, and the effects are weaker than full agonists such as methadone and heroin (NAMI, 2021). It has a “ceiling effect, ” meaning the opioid effects level off even with additional dose increases and reduces the chance of misuse, side effects, and dependency (NAMI, 2021). Buprenorphine decreases the effects of opioid withdrawal cravings and symptoms without having full opioid potency or effects (NAMI, 2021). This assists patients who take the drug abstain from other opioids (NAMI, 2021). The naloxone portion of Suboxone is identified as an opioid antagonist (NAMI, 2021). It is only activated and absorbed in the body if the tab or film is injected instead of dissolved under the tongue as ordered (NAMI, 2021). If it is injected into the blood, it will cause an opioid-dependent patient to have uncomfortable withdrawal symptoms (NAMI, 2021). This helps discourage patients dependent on IV drug use from injecting Suboxone (NAMI, 2021). The recommended initial dosage in adults and adolescents older than 15 is two Suboxone 2 mg/0.5 mg (NAMI, 2021). This can be given using two Suboxone 2 mg/0.5 mg as one dose and can be completed twice on day 1, to decrease uncomfortable withdrawal symptoms and keep the individual in treatment (NAMI, 2021). The black box warning for Suboxone is that the FDA has discovered that taking opiate medications with benzodiazepine or other sedating drugs can cause serious adverse effects like decreased respiratory rate, trouble breathing, and death (NAMI, 2021). Individuals taking opioids with sedating medications, benzodiazepines, or alcohol, need to seek immediate medical assistance if they begin to have unusual lightheadedness or dizziness, extreme sleepiness, difficulty breathing or slowed breathing, or unresponsiveness (NAMI, 2021).
  • Disulfiram is FDA approved to treat alcohol dependence. It is a second-line option in individuals with adequate clinical supervision (Stokes et al., 2021). It is safe and effective in supervised acute and long-term treatment of patients dependent on alcohol and motivated to stop alcohol use (Stokes et al., 2021). Disulfiram is only available in an oral tablet (Stokes et al., 2021). Doses are available in tabs of 250 mg to 500 mg. Tabs can be crushed and mixed with liquids and must be taken once daily (Stokes et al., 2021). Disulfiram should never be accepted until the individual abstains from alcohol for 12 hours or more (Stokes et al., 2021). Individuals must avoid alcohol and alcohol-containing products for 14 days after disulfiram, as there is research on disulfiram-alcohol reactions within two weeks of stopping the medication (Stokes et al., 2021). There is no advantage to increasing the dosage of disulfiram to more than 500 mg/day (Stokes et al., 2021). Patient’s should be given extensive education on signs of disulfiram-alcohol reaction prior to administration (Stokes et al., 2021). The black box warning for Disulfiram is that it must never be given to a person in a state of alcohol intoxication or without their full understanding (Stokes et al., 2021). The provider needs to instruct the family accordingly (Stokes et al., 2021).
  • Levomethadyl belongs to a collection of medications called narcotic analgesics (Drugs, 2018). It is utilized as a replacement for illegal opioids in addiction treatment programs (Drugs, 2018). This medication isn’t a cure for addiction (Drugs, 2018). It is a portion of an overall program that can involve attending support group meetings and counseling (Drugs, 2018). It helps prevent withdrawal symptoms that can happen when an addict stops taking other narcotics (Drugs, 2018). In detoxification treatment, the amount of levomethadyl is gradually lowered until the addict becomes drug-free (Drugs, 2018). Maintenance treatment is utilized long-term to assist the addicts in avoiding street drugs (Drugs, 2018). In long-term use, levomethadyl can reduce an addict’s cravings for other narcotics (Drugs, 2018). In adults, the initial dose of levomethadyl for individuals who have not taken methadone is between 20-40mg (Drugs, 2018). The first dose for individuals who have taken methadone will be a bit higher than the amount of methadone the patient was taking daily, but not more than 120 mg (Drugs, 2018). Your provider will adjust your dosage, contingent on whether you have withdrawal symptoms or side effects after the initial dose (Drugs, 2018). If needed, there could be a change in the dose until the proper dosage for the patient has been found (Drugs, 2018). Most patients will get levomethadyl TID weekly, on Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday (Drugs, 2018). Some patients need a higher dose on Friday or Saturday, so the medication will last until the next appointment (Drugs, 2018). In detoxification treatment, the dosage of levomethadyl will progressively decrease until the individual can discontinue the medication (Drugs, 2018). Maintenance treatment can be continued as long as needed (Drugs, 2018).
  • Methadone is a drug used to treat and manage opioid use disorder and as a pain-reliever in chronic pain (Durrani & Bansal, 2022). It is a synthetic long-term opioid agonist drug (Durrani & Bansal, 2022). For opioid use disorder, the initial dosage is 30 to 40 mg daily and is titrated up by 10-20 mg weekly to an ideal of 80-150 mg daily (Durrani & Bansal, 2022). Long-term treatment is ideal if it lasts at least 14 months (Durrani & Bansal, 2022). Opioid withdrawal dosage for adults is an initial dose of 10-20 mg and raised by 10 mg up until the withdrawal symptoms are under control, typically at about 40 mg (Durrani & Bansal, 2022). Stabilize dosing for 2-3 days and then decrease dose by 10 to 20% each day and evaluate for withdrawal symptoms (Durrani & Bansal, 2022). The black box warning for methadone categorizes severe respiratory depression as the most dangerous side effect of taking methadone (Durrani & Bansal, 2022) Discussion Response: Substance Abuse And Addictions.