2024 Addiction Medicine Board Certification Review Course-2024 - A Comprehensive Review of Opioid Use Disorder

Video Transcription

Video Summary

Julie Kmyk, an addiction psychiatrist, provides an exhaustive review of opioid use disorder, focusing on its pharmacology, diagnosis, epidemiology, and treatment options.<br /><br />She categorizes commonly misused opioids including tramadol, buprenorphine, codeine, morphine, methadone, fentanyl, and heroin, while noting their varying bioavailability based on administration routes. Opioids are lipid-soluble, able to cross the blood-brain barrier and placenta, leading to euphoric and analgesic effects, but also risks of dependency and negative health impacts.<br /><br />Julie distinguishes between major opioid receptors (mu, kappa, delta) and their effects, ranging from euphoria and pain relief to respiratory depression and dysphoria. Endogenous opioids like endorphins interact with these receptors, with cross-tolerance enabling rotating opioid treatments.<br /><br />New synthetic opioids like kratom differ in effects and legality but pose similar health risks. The epidemic’s roots trace back to increased opioid prescriptions between 1999-2008, influenced by misinformation on addiction risks and aggressive pharmaceutical marketing.<br /><br />Julie discusses diagnostic criteria for opioid intoxication, withdrawal, and use disorder, emphasizing DSM-5 guidelines, and highlighting effective withdrawal treatments—alpha-2 agonists like clonidine, and buprenorphine-naloxone. Maintenance treatment, such as methadone and extended-release buprenorphine, is preferred for long-term management to mitigate relapse and overdose risk.<br /><br />Emerging opioids and legal initiatives like naloxone access laws aim to combat overdose increases. Julie’s presentation underscores an integrated approach combining pharmacotherapy, patient education, and legislative support to address the opioid crisis.

Keywords

opioid use disorder

pharmacology

diagnosis

epidemiology

treatment options

commonly misused opioids

tramadol

buprenorphine

codeine

morphine

methadone

fentanyl

heroin

opioid receptors

opioid crisis