General Management of Opioid Withdrawal

Withdrawal from Interruption in Opioid Use


The excessive recommendation of opioids has resulted in a wildfire of its misuse worldwide. (Kaushal Shah, Billy Stout, n.d.)


There are more than 1.5 Million people who suffer from opioid abuse in the United States of America. For this, the psychiatrist should have a good know-how of medications and their appropriate indications.


The management of opioids needs an intensive care because the withdrawal has both physical and psychological effects on the patient. The first most management includes the opioid agonist therapy. This therapy reduces the physical dependence along with psychological dependence. (World Health Organization, 2009)


Opioid Agonist Maintenance Therapy


In most cases, methadone, in the form of oral solution and buprenorphine, in the form of sublingual tablets is used.


If we compare the treatment of methadone and buprenorphine with that of detoxification (elimination of opioid side effects) and no treatment, the use of the former said drugs have a role in decreasing the criminal activities and mortality. Both of these drugs have a role in the reduction of opioid overdose and better treatment retention. (British Psychological Society, 2008)


Comparison of Methadone with Buprenorphine in the Maintenance treatment


The clinical trials show that the cost-effectiveness of methadone is greater than that of buprenorphine. However, the efficacy of both drugs is same. The pharmacological activity of buprenorphine is a little different from the methadone.


Methadone including Maintenance Therapy


The starting dose of methadone is recommended to be less than 20mg. The methadone dose depends upon the tolerance level of opioids. The dose of methadone is adjustable. The accuracy of dosing is necessary.


In usual the range of methadone dose is about 60-120mg. The regular supervision along with testing and clinical assessment is essential for this maintenance therapy.


Buprenorphine including Maintenance Therapy


Unlike methadone, the dose of buprenorphine depends upon three factors

· The duration of action of opioid used

· The time of last dose of opioid used

· The pattern of utilization

The usual dose of this drug is about 8-24mg once a day. But the range may differ according to the requirement.

Just like methadone, the exact supervision and evaluation of the patient is necessary.


Withdrawal and Relapse Treatment


The treatment for withdrawal is mostly referred for the patients who are willing to leave the drug addiction. The will power of some of the patients makes them chose this therapy. I have heard a story of a woman in the United States; she withdraws the addiction of opioids with her self-motivation and encouragement.


The drugs, namely, methadone and buprenorphine along with alpha-2 agonists are recommended for withdrawal therapy. However, the opioid agonists are the preferred treatments.


This therapy is recommended for both ambulatory patients as well as inpatients. It is a very costly treatment and is recommended mainly for patients with “psychiatric comorbidity,” or “poly-substance dependence.”


Relapse Management


For the treatment of relapse, the use of naltrexone is mostly recommended.


Conclusion


The opioids are the drugs with a lot of side effects. But if keen observation and evaluation is done, the problems occurring due to this medicine can be reduced greatly. And if it does not go right, the management of the problem is still there for the persons who want to live. (Jason Luty, (ku.oc.rednoyeulb@7063h600ls), Colin O’Gara, Mohammed Sessay, 2005)

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