Opioid use disorder and mild TBI
D. Prescribe buprenorphine at 16 mg daily
This patient with opioid use disorder (OUD) illustrates a casualty of our iatrogenic OUD epidemic, which included 14% of Americans reporting opioid abuse by 2007.1 Opioids were overprescribed in response to gross underestimation of iatrogenic OUD rates in patients treated for chronic pain.1,2 Pharmacotherapy of OUD with TBI should consider 6 neurobiological principles: (1) coactivation of neuronal and inflammatory immune receptors (Toll-like receptor 4), (2) 1 receptor activating 2 second messenger systems, (3) convergence of 2 receptor types on 1 second messenger, (4) antagonist-induced receptor trafficking, (5) genetic receptor variants (μ-opioid) influencing analgesia and tolerance, and (6) cross-tolerance vs receptor antagonism.3,4