COURSE of opioids:

Introduction


Withdrawal is caused after the cessation of intake of specific drugs. In the case of opioids, it occurs if the daily consumptions exceed 3 weeks or more, which then require a medical supervisor for withdrawal, dependence on opioids also depends upon previous exposure to opioids.


In the case of previous exposure, dependence and withdrawal could last longer due to relapse (Sevarino, 2019). Withdrawal is also impacted by the level of tolerance to opioids. Opioids drugs vary in effecting patients’ symptoms of withdrawal onset, the severity of withdrawal, course of medications, and the degree of supervision required during withdrawal (Paice, 2016). The withdrawal symptoms of opioids, not life-threatening but still require medical supervision, as they are quite difficult and uncomfortable for patients.


Opioids have different ranges to effect patients, which could be short term (heroine) or long term (methadone). The same is the case in their withdrawal as mild-moderate or severe. The most used way to measure the severity of withdrawal is by using the COWS assessment. It has different symptoms that add up to form a number 0- 47 ranging mild (5-12) moderate (13-23) moderate-severe (23-36) and extremely severe (37-onwards) (Shah & Huecker, 2019).


Common withdrawal symptoms of opioids are as follow:


1. Nauseous anxiety insomnia diarrhea muscle cramps

2. Hot and cold flush

3. Restlessness

4. Runny nose, high blood pressure, headache and abdominal pains


The treatment course depends upon the type of opioids and the nature of withdrawal. A short term used of opioids agonist or detoxification by anti-agonist or it could be treated by the cessation of opioids gradually


The medications used for the treatment of withdrawal are also used in combination with other drugs to treat the symptoms caused by withdrawal. The patient also needs emotional and mental support to go through the whole process. This should also be the main priority as mental stress and disorientation are also the main symptoms of withdrawal. Continuous observance is a very important and efficient strategy to deal with patients’ behavior. Patients cannot be treated for withdrawal without getting mental help as well (DOLAN, 2010; Tetrault & O'Connor, 2008).


Some of the medicines which are used are acetaminophen (for mild withdrawals) or ibuprofen (Case-Lo, July 12, 2019). Patients should be checked for symptoms and complications twice a day. Clonidine is also effective in severe cases. Clonidine helps in the reduction of withdrawal symptoms e.g. vomiting nausea etc. It has its side effects. It lowers blood pressure thus blood circulations should be continuously checked in case of clonidine administration. However, medical supervision is very important in severe cases. Some milder opioids can also help in reducing the effects of the withdrawal of heavy opioids e.g. suboxone naloxone. Methadone is also helpful in ling term withdrawal of opioids. For long-term withdrawal treatment, it helps to reduce cravings and symptoms. Also, complicate things for patients with respiratory hepatic impairment Crohn’s disease or alcohol dependence. Along with hydroxyzine and loperamide to cure nausea and diarrhea. Plenty of fluid can also help to maintain to electrolyte level of the body. Diazepam can be used for anxiety or restlessness. Quinine sulphate for muscle cramps (Judd et al., 1998).


Conclusion


At the end, the patient personal environment also plays a huge role during withdrawal and treatment. A good environment, healthy emotional and moral support with strong will power favor the positive results. Follow-ups are also very important for the revered patients as it helps to monitor any early signs of relapse and keep progress report.


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