Treatment of Opioid (opium) Abuse

Withdrawal symptoms are generally opposite to that of acute drug intoxication like nausea, vomiting, coughing, sweating, salivation, tearing, running nose, twitching of muscles, fever, increase in respiratory rate and increase in blood pressure. There is intense craving for the drug, with sleeplessness and yawning. With shorter acting drugs like morphine and heroin, the withdrawal symptoms generally develop within 8 to 16 hours of taking the last dose. Symptoms become severe in 2 to 3 days and disappear in 5 to 8 days. But some of the symptoms may persist for more than 6 months and probably contribute to relapse.

Treatment of withdrawal symptoms: A thorough physical examination including assessment neurological function is done. Look for systemic or local infection and abscess. Blood should be tested for hepatitis B and HIV. Before starting treatment, proper nutrition should be provided with vitamins and mineral supplementation.

Two modalities can be used to treat opioid dependency. In the first modality, any one of the opioid drugs like methadone 10 to 25 mgs twice a day is given to reduce symptoms. Patient is stabilized at that dose for several days. Than the dose is reduced by 20 % everyday from the original dose till it becomes zero. This way there will be fewer withdrawal symptoms.

In the second modality, symptomatic treatment is given to the patient. Diarrhea is treated with anti diarrheal loperamide, nose block with nasal decongestant, pain with non opioid drugs like ibuprofen etc. During treatment blood pressure must be monitored closely.

A special case of opioid withdrawal is seen among the newborn infants made passively dependent to opioid through mother’s opioid abuse during pregnancy. Withdrawal symptoms of new born consist of crying, tremor, irritability, increased reflexes, diarrhea, increased respiratory rate, sneezing, hiccup, and yawning. Management of these babies is same as that of adults, but the dose has to be adjusted to suit the infant. The dose of methadone is 0.1 to 0.5 mgs per kg per day and in decreasing the dose for 10 to 20 days. Infants of drug dependence also benefit from breast feeding if mother is taking methadone.

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