What is opioid?
Opioid are substances which act through opioid receptors and are similar to opium
(morphine).
Types of opioids
There are broadly
three types of opioids-
1. Morphine and derivatives of morphine-
morphine, codeine and diacetylmorphine
2. Semisynthetic opioids-buprenorphine
and oxycodone
3. Synthetic opioids- fentanyl,
pethidine and methadone
Some street
names are- opium, smack, brown sugar and heroin.
What is opioid addiction?
Opioids are
highly addictive substances which produce high degree of dependence. The more a
substance is potent and pure the higher degree of dependence. Dependence could
be defined as general for all substances and are as follows
1. Craving
2. Tolerance
3. Withdrawal
4. Use despite harm
5. Loss of control
6. Neglect of alternate pleasurable
activities
The fulfillment
of any of three above criteria within one year seals diagnosis of dependence.
There are certain
features associated with withdrawals of opioids only like
1. Goose flesh
2. Diarrhea
3. Body-ache
4. Yawning
5. Lacrimation
6. Watering of nose
Complicated withdrawal
include seizures, delirium, psychosis
Treatment of opioid dependence
Treatment of
opioid dependence follows two basic approaches
A. Complete abstinence
B. Substitution therapy
Candidates for
complete abstinence are
i. Low
potency opioid users
ii. Short
duration of use
iii. Few
relapses
iv. Strong
willed
v. Non
intravenous drug users
Candidates for
opioid substitution therapy are
i. High
potency opioid users
ii. Long
duration of use
iii. Multiple
relapses
iv. Weak
willed
v. Intravenous
drug users
For complete abstinence following
approaches are advised
a) Symptomatic approach in this symptomatic
treatment is given which includes clonidine, ibuprofen and diazepam and slowing
tapering them to stop their use. Finally the patient is put on opioid
antagonist naltrexone or nalmefene. This technique has low rate of success.
b) Therapy with opioid agonists or
partial agonists- these include using tramadol, buprenorphine and other opioids
in detoxification phase. The drugs are gradually decreased and stopped. Then the
patient is put on naltrexone or nalmefene which is continued till 6-8 months
and stopped.
For opioid substitution following
approaches are followed
a) Buprenorphine
b) Methadone
The main
goal of opioid substitution is harm reduction.
Joining
self-help groups such as narcotic anonymous will be of great help to maintain
success achieved
Wishing you
a long and healthy life
Dr Hitesh
Sharma
MBBS, MD (Psychiatry)
For asking a query or phone/video consultation with me visit-https://www.icliniq.com/hitesh
For asking a query or phone/video consultation with me visit-https://www.icliniq.com/hitesh
