Opioid Substance, its Withdrawal, and Scale for Managing withdrawal

Introduction


Opioids are the chemicals obtained from the plant “Papaver somniferum.” These substances can be obtained naturally or can be made synthetically. Some of the forms of opioids are the modified forms of natural substances so are termed as semi-synthetic. The heavy use or misuse of opioids leads to the physical or physiological dependence on these substances which is known as its withdrawal symptoms.


Story of Lindsey


‘As all that glitters is not gold.’

The use of opioids is an essential evil in case of extreme pain. It is a euphoric drug. There is a life story of a woman with exaggerated opioid effects. You cannot imagine the age at which Lindsey started using heroin and other such substances. The teenage is the start of life, the initial life with such drugs is a bad-luck. She started using drugs at this age and at the age of just 18 years she was kicked out of her home due to her physical dependence of the opioids.


The clinical symptoms which the lady and other people in the opioids dependence face are cravings for more and more along with anxiety. Lindsey faced these and started taking more drugs and ended up in jail. The increased resting respiratory rate is another symptom of this drug. Diaphoresis, restlessness, and tachycardia are the most common withdrawal symptoms of opioids. The gastrointestinal tract can become upset leading to vomiting and diarrhea.

(Kevin A Sevarino, MD, 2019)


Do not take this discussion to heart because the withdrawal is not fatal. The management of withdrawal syndrome is categorized into two parts. The first one is the supportive therapy (Gerald F. O’Malley , DO & Rika O’Malley , MD, 2020) which includes motivation and encouragement and the second one is medication therapy comprising of opioid agonists and others. (Alexander M. Dydyk; Nitesh K. Jain; Mohit Gupta., 2020)


For that woman, it’s about 9 months of her free life. She overcame all this dependence by her will power. She was given naloxone for her treatment, but that drug failed unless her intentions and belief in overcoming this deadly evil.


The opioid withdrawal syndrome


It has a variable duration of each type of opioid.

· For short-acting opioids

o It starts within 8-12 hours of the last dose and has a duration of 4-10 days

· For long-acting opioids

o It starts within 12-48 hours of the last dose and have a duration of 10-20 days (Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings., 2009)


This scale helps in the evaluation of the type of treatment required by the patient. The assessment is as follows:


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