20 Miss. Code. R. 2-IV

Current through December 10, 2024

Section 20-2-IV - Opioids Pharmacology

A.Important Distinctions

* Tolerance refers to a state of adaptation in which exposure to a drug over time causes higher doses to be required to produce the same physiologic effect and/or marked diminished effect with continued use of the same amount of that drug.

* Dependence refers to a set of disturbances and body homeostasis that lead to withdrawal symptoms which are produced with abrupt discontinuation or rapid reduction of a medication. Administration of an antagonist can also initiate withdrawal symptoms.

* Addiction is a primary chronic neuro-biological disease with genetic, psychological, and environmental factors influencing its development and manifestations. It is a behavior pattern of drug craving and seeking which leads to preoccupation with drug procurement and aberrant pattern of use. The drug use is frequently associated with negative consequences.

B.Choice of Opioids

The following guidelines apply when choosing an opioid.

1. There is no evidence that one long-acting opioid is more effective than another in improving function.

2. There is also no evidence that long-acting opioids are superior to short-acting opioids for improving function or pain or causing less addiction.

3. Long-acting opioids should not be used in the treatment of acute, subacute, or postoperative pain.

4. When choosing long-acting opioids for chronic pain management, it is reasonable to consider cost given the lack of superiority profiles for one medication over another.

5. There is no single formula for pharmacologic treatment of patients with chronic non-malignant pain.

6. Medications with a greater safety profile should be used initially.

7. Use of methadone requires special precautions. Methadone may cause cardiac arrhythmia due to QT prolongation and has been linked to a greater number of deaths secondary to its prolonged half-life.

8. Meperidine should not be used for chronic pain. Meperidine and its active metabolite normeperidine present a serious risk of seizure and hallucinations.

C.Dosing and Time to Therapeutic Effects

Oral route is the preferred route of analgesic administration. Transbuccal administration should be avoided in the treatment of chronic, nonmalignant pain. Immediate release fentanyl products (Actiq, Subsys) are not to be used for chronic, nonmalignant pain.

D.Side Effects

Opioid-induced side effects vary greatly, depending on the individual patient. Common side effects include nausea, vomiting, drowsiness, unsteadiness, confusion, dry mouth, pruritus, sweating, hallucinations, myoclonus, and respiratory depression. Constipation is the most common problem associated with long-term opioid administration and should be anticipated and treated prophylactically.

E.Drug Interactions

1. Patients receiving opioid agonists should not be given a mixed agonist/antagonist such as Pentazocine because doing so may precipitate withdrawal syndrome.

2. Sedating medications should be avoided or limited to very low doses, although total elimination of sedating medications is desirable whenever clinically feasible.

a. Avoid concurrent opioid and benzodiazepine use whenever possible.

20 Miss. Code. R. 2-IV

Adopted 6/14/2017