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For instructor materials including Power Points, Answers to Clinical Encounter Questions, please contact [email protected].
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Content Update
May 16, 2025
Buprenorphine subcutaneous extended-release injection (Brixadi®): A Weekly and Monthly Buprenorphine Injection for Opioid Use Disorder: Buprenorphine subcutaneous (SC) extended-release (ER) injection in both weekly and monthly formulations is a partial opioid agonist recently approved for treatment of moderate to severe opioid use disorder (OUD). Approval was based on findings that suggest the SC formulation was noninferior to the sublingual product in mean negative urine drug screens and responder rates and superior in the cumulative distribution function. Common adverse effects included injection site reactions, nasopharyngitis, headache, nausea, urinary tract infection, vomiting, constipation, and insomnia. Patients should be monitored for OUD diagnostic criteria, cravings, opioid withdrawal, toxicity and side effects.
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LEARNING OBJECTIVES
Upon completion of the chapter, the reader will be able to:
Identify the prevalence of use for alcohol, opioids, central nervous system (CNS) stimulants, cannabinoids, and tobacco in the US population.
Explain the commonalities of action of substances on the reward system in the brain.
Determine when a patient meets criteria for substance use disorder.
Identify the typical signs and symptoms of intoxication and withdrawal associated with the use of alcohol, opioids, CNS stimulants, cannabinoids, and tobacco.
Determine the appropriate treatment measures to produce a desired outcome after episodes of intoxication and withdrawal.
Choose specific pharmacotherapeutic options based on patient-specific factors.
Recommend a comprehensive medication treatment and monitoring program to help maintain recovery and prevent relapse to substance use.
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Substance use disorders (SUDs) are highly prevalent worldwide. In the United States, patterns of substance use have been cyclical. For example, cocaine was first isolated from coca leaves in 1860. Its use was advocated by many in the medical establishment until the mid-1890s when it became evident that chronic use might be addictive in some individuals and could have deleterious physiologic effects. Its use decreased after prescribing and dispensing restrictions in the early 20th century. In the 1980s, a smokeable formulation (ie, crack) became available, and cocaine use again became epidemic. This historically cyclic nature of substance use is common to many substances with abuse potential.
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Pharmacotherapy has a role in treatment of some substance-related disorders, including intoxication, withdrawal, and/or long-term relapse prevention. These substances include alcohol, opioids, central nervous system (CNS) stimulants, cannabinoids, and tobacco. This chapter focuses on pharmacotherapy for these common substance-related disorders. Although other substances can be misused (eg, benzodiazepines), they are not the focus of this chapter.
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EPIDEMIOLOGY AND ETIOLOGY
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The National Survey on Drug Use and Health (NSDUH) uses a representative sample of individuals 12 years or older to determine the annual prevalence of licit and illicit substance use.1 In 2018, 164.8 million Americans (60.2% of the population) used a substance, including alcohol, tobacco, or illicit substances in ...