Thursday, May 9, 2013


  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)
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