tatalaksana adiksi napza-mat-adhi wibowo nurhidayat-pit pdui 2015
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Tatalaksana Adiksi Medication Assisted Treatmentdr.Adhi Wibowo Nurhidayat, SpKJ, MPH
RSJ Soeharto Heerdjan
Jakarta
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KasusTn. M, 25 tahun, ketergantungan opiat
cara suntik, dengan riwayat rehabilitasi napza 4 kali @6 bulan. Menggunakan opiat sejak tujuh tahun yang lalu.
HIV positifSaat ini relaps, dosis ¼ gram/suntik, 3 kali
suntik sehari. Menyuntik terakhir 2 jam SMRS, saat ini datang sendiri ke RS
Treatment Plan : Rehabilitasi NAPZA atau MAT?
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Modalitas Terapi
MetadonLAAMBuprenorfinBuprenorfin- NaloksonNatrekson
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Peserta Program Terapi
Ketergantungan OpioidMinimal satu tahun sebelum
mengikuti programMinimal berusia 18 tahun
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Pertimbangan Khusus
6 bulan keluar dari LapasPernah ikut OTP dua tahun yang
laluHamilUsia di bawah 18 tahun
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Metadon
Full mu opioid agonistAman dan efektifMenahan nyeri 4-6 jamMenahan sakaw 24-36 jamOral solution, liquid, tablet,
bubuk
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LAAM
Full mu opioid agonistOral solution, coloredWaktu lebih lamaTidak diberikan harian2001 FDA Warning –
potentially fatal cardiac arrhythmiaTidak diproduksi lagi sejak 2004
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Buprenorfin (Subutex)
Partial opioid agonist pada mu receptor
Partial opioid antagonist pada kappa receptor
Bisa untuk rumatan atau medically supervised withdrawal
SublingualCeiling effect
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Buprenorfin-Nalokson (Suboxone)
Kombinasi partial mu opioid agonist (buprenorfin) dan agonist (nalokson)
SublingualBuprenorfin: nalokson =
4:1
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Naltrekson
Full mu opioid antagonistBlok efek heroin, morfin, dan metadonDapat memicu opioid withdrawalDapat mem-blok efek opioid sampai 72
jamKepatuhan yang burukEfektif mencegah relapsAman
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Efek yang tidak diinginkan
Konstipasi
Berkeringat
Insomnia
Penurunan libido
Pusing
Mual muntah
Cemas
Nyeri sendi
Mudah lelah
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ta
THANKYOU