special subjects
Opioids
Treatment of Opioid Toxicity or Withdrawal
An opioid overdose requires emergency treatment, but the ultimate and difficult goal of treatment is to help people control their use of opioids. Treatment can include Emergency treatment Detoxification Possible maintenance treatment (for people who are unable to quit) Rehabilitation An opioid overdose is a medical emergency that must be treated quickly to prevent death. Breathing may require support, sometimes with a Mechanical Ventilation , if the overdose has suppressed breathing. A medication callednaloxoneis given as an antidote to the opioid, rapidly reversing all adverse effects. It is given by injection or by nasal spray. Because some people briefly become agitated and delirious before they become fully conscious, physical restraints may be applied for a short time. Becausenaloxoneprecipitates withdrawal symptoms in people who are dependent on opioids, it is used only when necessary (as when breathing is weak). People recovering from an overdose should be observed for several hours until the effects ofnaloxonehave worn off to be sure that no side effects of the opioid remain. If people took an opioid with long-lasting effects (such asmethadoneor slow-release forms of other opioids), they are usually observed for a longer time. If symptoms redevelop, people may be given another dose ofnaloxone, be admitted to the hospital, or both. There are several approaches to detoxification: Stopping the opioid and allowing withdrawal to run its course (cold turkey detoxification) Substituting a similar but less potent drug, then gradually decreasing the dose and stopping the drug may cause side effects, such as Low Blood Pressure and drowsiness. Stopping Substitutiontypically involves giving drugs such asmethadoneandbuprenorphine, which are then slowly decreased and eventually stopped completely. sometimes cause Overview of Abnormal Heart Rhythms . Therefore, people on this drug are monitored closely when it is started or if the dose is changed. Buprenorphineis a mixed opioid agonist and antagonist. That means ithassome of the effects of opioids (agonist) but also blocks some of the effects of opioids (antagonist). It does not require supervision in a special program, and thus doctors who are trained in its use can prescribe it in their office. In many countries,buprenorphinehas replacedmethadonein detoxification programs. Detoxification must be followed by Rehabilitation to prevent a return to opioid use. Ongoing treatment may include long-term counseling and support and medications such as For people who continually return to using opioids (called opioid use disorder), another approach—called maintenance—is often preferred. It involves substituting a prescribed medication at a regular dose that the user takes for a long time (months or years) rather than decreasing the dose and eventually stopping the medication.Methadone,buprenorphine, ornaltrexonemay be used as substitutes for opioids. Maintaining opioid users with regular doses of one of these medications enables them to be socially productive because they do not have to spend time getting the illicit opioid and because the medications used do not interfere with functioning the way that illicit drug use does. For some opioid users, the treatment works. For many, lifelong maintenance is necessary. Methadonesuppresses withdrawal symptoms and the craving for the opioid without making opioid users overly drowsy or elated. However, opioid users must appear once a day at a clinic wheremethadoneis dispensed in the amount that prevents severe withdrawal symptoms, minimizes craving, and supports daily functioning. Buprenorphineis being used more and more because it can be prescribed by doctors in their office. Thus, opioid users do not have to go to a special clinic. Naltrexoneis a medication that blocks the effects of opioids (opioid antagonist). Before startingnaltrexone, people must be fully detoxified from opioids, or a severe withdrawal reaction can occur. Depending on the dose,naltrexone’s effects last from 24 to 72 hours. Thus, the medication can be taken once a day or as few as 3 times a week. Because this medication has no opioid effects,naltrexoneis most useful for opioid users who are strongly motivated to remain free of opioids and who are not severely dependent on opioids. Regardless of which approach is used, ongoing counseling and support is essential. Support may include specially trained doctors, nurses, counselors, opioid maintenance programs, family members, friends, and other people with the same substance use disorder (support groups). The therapeutic community concept emerged nearly 25 years ago in response to the problems of heroin use.Samaritan Daytop VillageandPhoenix Housepioneered this nondrug approach. Opioid users live in a communal, residential center for an extended period of time. These programs help people build new lives through training, education, and redirection. The programs have helped many people, but initial dropout rates are high. Questions about precisely how well these programs have worked and how widely they should be applied remain unanswered. Because these programs require a lot of resources to run, many people may be unable to afford them. 