Discuss the treatment of opioid withdrawal, detoxification, and addiction
Discuss the treatment of opioid withdrawal, detoxification, and addiction
Opioid withdrawal syndrome is a collection of typical clinical signs, which include tachycardia, hypertension, mydriasis, piloerection, rhinorrhoea, lacrimation, insomnia, nausea, vomiting, and diarrhea. The pharmacotherapeutic agents used to treat opioid withdrawal target the primary pathophysiological mechanisms of the syndrome (Srivastava et al., 2020). The current standards of treatment for medically supervised withdrawal include therapy with μ-opioid receptor agonists (methadone), partial agonists (buprenorphine), and α2-adrenergic receptor agonists (clonidine and lofexidine). Buprenorphine, alone and in combination with naloxone, is approved to treat opioid use disorder (Srivastava et al., 2020). Clonidine is used to treat opioid withdrawal symptoms via its anti-adrenergic actions that specifically target noradrenergic hyperactivity in locus coeruleus neurons that contribute to opioid withdrawal symptoms.
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Opioid detoxification involves Clonidine-naltrexone, which are used for rapid detoxification within 4-5 days. Clonidine is administered in higher doses for detoxification and suppresses autonomically mediated clinical features of abstinence (Kosten & Baxter, 2019). Naltrexone blocks opioid receptor sites and, as a result, opioid-reinforcing properties. Clonidine-naltrexone treatment is usually started after confirmation of physical dependence. The drug combination is designed to cut down the time of withdrawal to 5 days.
The essential drugs used to treat opioid addiction are Buprenorphine and methadone. However, the pharmacologic treatment should be combined with behavioral counseling for a Medication Assisted Treatment (MAT) approach. The current guidelines recommend comprehensive treatment of opioid addiction with methadone, buprenorphine, or a combination of buprenorphine and naloxone. The American Psychiatric Association (APA) guidelines outline the following therapy modalities as effective interventions for managing opioid dependence: Substitution of opioids with methadone or buprenorphine, followed by a slow taper (Kosten & Baxter, 2019). Immediate discontinuation of opioids with clonidine to curb withdrawal symptoms and clonidine-naltrexone detoxification.
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References
Kosten, T. R., & Baxter, L. E. (2019). Review article: Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment. The American Journal On Addictions, 28(2), 55–62. https://doi.org/10.1111/ajad.12862
Srivastava, A. B., Mariani, J. J., & Levin, F. R. (2020). New directions in the treatment of opioid withdrawal. Lancet (London, England), 395(10241), 1938–1948. https://doi.org/10.1016/S0140-6736(20)30852-7
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