Opioid use disorder

Meet the patient

A 29-year-old man is found slumped in a fast-food toilet, respiratory rate 6, pinpoint pupils, cyanosed lips. Paramedics give intranasal naloxone; he wakes swearing and refuses to stay. Four hours later on the ward he is drowsy again.^[10][12]

Two facts decide whether he lives this week. First, fentanyl outlasts naloxone — re-sedation is expected, never a surprise. Second, the most dangerous day of his life is the day he walks out after a detox, tolerance gone, buying the same bag.^[4][13] This topic is the answer to "what do you do for him next" — beyond the naloxone.

Examiners punish three failures on OUD: thin nosology that muddles dependence with addiction, a loose grip on the overdose-and-withdrawal emergencies, and pharmacology with no agent, dose, route, monitoring or contraindication.^[4][11][14]

References20ShowHide

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2. [2]Mattick RP, Breen C, Kimber J, Davoli M Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence Cochrane Database Syst Rev, 2014.PMID 24500948
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