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Opiates are the extracted substance from the poppy plant family (papaver somniferum). These substances are being used recreationally as well as medically. These substances have a special effect on their consumer called Tolerance and Dependence. Abrupt cessation of opioids causes severe withdrawal syndromes including. (Andrew Stolbach, MD, MPH, FAACT, FACMT, FACEPRobert S Hoffman, n.d.)


For the past 2 decades, since 1990 the opioid use and deaths caused by its toxicity have reached epidemic proportions. This has been seen with both prescription opioid drugs like morphine and nonprescription opioids like heroin.

· In the United States, 5.7 million people have used heroin at some point in their lives.

· Year 2017 has a record of 28,466 deaths that increased to 31,335 deaths by the year 2018.


From 1999 to year, 2014 the prevalence of opioid use in pregnant women has increased 4 folds, which means 1.5 to 6.5 cases per 1000 delivery hospitalization. (Eric Strain, n.d.)


Patients often have specific symptoms related to opioid overdose. The main diagnosis, if a person has opioid toxicity, is "Pinpoint pupil", in which the person who encounters opioid toxicity has his pupil constricted. Some of the symptoms with the withdrawal of drugs are presented below.

Early symptoms:

· Agitation

· Anxiety

· Muscle aches

· Lacrimation

· Sweating

· Yawning

Late symptoms:

· Abdominal cramping

· Diarrhea

· Dilated pupils

· Goosebumps


When a person becomes physically dependent on a drug and needs its dose to prevent the withdrawal symptoms, this is called dependence.


When more drug is needed for the same effect that was being achieved with a lower dose, this is called tolerance.


There lie in four categories depending on the number of users.

· Painkillers – 3.3 million users

· Tranquilizers – 2 million users

· Stimulants – 1.7 million users

· Sedatives – 0.5 million users


It is very difficult for a person to withdraw from its addiction. Counseling, medication, and support are the key methods to bring an addicted person back to life. This can be done in a different setting like

· At home, although this method is very difficult, withdrawal can be achieved at a very slow rate.

· Using facilities to detoxification (detox)

· Regular hospitals (for severe symptoms)

· Outpatient treatment center called (rehabs)

Although in each setting, treatment is being done with the help of other medications. This treatment is called medication assist.



This rug is used for detoxification of opioid toxicity also used for long-term maintenance therapy for opioid dependence. Slowly the dose is tapered off over a long time. This helps in reducing the intensity of withdrawal symptoms. The complete dose should be split in small doses for the patients with a fast metabolism. (Rockville (MD), 2006)

It is seen that people may live with a low dose of methadone for years. Some of the reports declare that the use of methadone for withdrawal is better than the abstinence based approach. (Mattick et al., 2009)


This molecule also helps with the withdrawal symptoms of opiates with a short period. It detoxifies the effects of opioids and helps in maintenance therapy for the long term. Sometimes combined with Naloxone, to help with dependence and misuse. There is enough evidence on the effectiveness of buprenorphine. (T.V. Parran,b,e,* C.A. Adelman,a,b B. Merkin,b,e M.E. Pagano,d R. Defranco,b R.A. Ionescu, 2010)


Acts as an adjunct therapy to reduce anxiety, muscle aches, sweating, rhinorrhea, cramping, and agitation.

Other drugs are used as additional therapy to help with vomiting and diarrhea, sleep. Naltrexone helps to prevent relapse, in oral and IV formulations.

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