The word Opioid is a combination of “opium” + “oid”. Giving the meaning “opiate-like”. (Opiate: A drug derived from or containing opium such as morphine, codeine, thebaine etc.). Opioids are compounds that have the ability relieve pain and induce narcosis. They do so by binding to specific receptors present in the brain, spinal cord and other nervous tissues that are otherwise regulated by endogenously produced chemicals like endorphins and enkephalins. Opioids were traditionally introduced as pain-relieving medications but these days they have a variety of other indications which include the following:

•             Acute post-operative pain

•             Pain befalling after an injury or trauma

•             Pain arising because of some chronic disease process such as arthritis

•             Pain caused by malignancies

•             Suppression of cough and diarrhea

•             To eliminate addiction of some stronger opioids, weaker ones are used

•             In achieving anesthesia

Below is the list of some commonly used opioids:

•             Codeine

•             Morphine

•             Hydrocodone

•             Fentanyl

•             Remifentanil

•             Meperidine

•             Methadone

•             Tramadol etc.

These pain relievers are usually safe if taken as per advice and prescription of a physician for a short period of time but as they have the potential of producing euphoria (a feeling of intense excitement and happiness), they are commonly misused. Furthermore, they possess a tremendous potential of establishing physiological as well as psychological dependence, tolerance, and addiction. Due to this property, opioids are indeed one of the most commonly abused substances. Once a person develops dependence on an opioid, it becomes a very tough job to withdraw from it. But it is necessary to withdraw from these drugs as they can have some fatal adverse effects if used for longer periods of time and may even lead to the death of the user. The main symptom of opiate addiction is that a person keeps taking the drug even being fully aware of the consequences and dangers of it to health, personal, and professional life because he just can’t control the craving. Some serious adverse effects of opioids are listed below:

•             Sedation

•             Nausea, vomiting, and constipation

•             Disturbance in breathing pattern

•             Urinary retention

•             Tolerance, dependence, and addiction

•             Confusion, hallucinations, and delirium

 

•             Itching

•             Hormonal imbalances

•             Mood disturbances

•             Hypothermia

•             Arrhythmias

•             Orthostatic hypotension

 

Opioid withdrawal refers to abruptly halting or decreasing the intake of these drugs. It is an extremely challenging task because of several reasons. The person starts to get very uncomfortable and distressing physical and psychological symptoms as soon as he stops or reduces the amount of drug.

There are many reasons why opioid withdrawal becomes so uncomfortable and painful. It’s dependence, tolerance, and addiction all occur as a result of the neurobiological changes resulting from chronic opioid abuse. 

Opioids stimulate the production of endorphins which are chemicals responsible for reducing the perception of pain in a person’s brain. When a person takes opioids, the body starts to depend on them with time for more and more endorphin production and less on its own and when he stops taking the drugs, the perception of pain that was decreased returns abruptly making everything painful for him.

Moreover, when an opioid is ingested, it is shuttled via bloodstream to the CNS where they adhere to and activate the opioid receptors. This biochemical interaction exerts the analgesic effects and secondarily trigger the release of a neurotransmitter named dopamine which imparts a pleasurable and rewarding sensation. In addition to this, it also blocks the release of another neurotransmitter Noradrenaline which makes the person feel sleepy and calm. Over time the body begins to adapt to this increased amount of dopamine and low levels of noradrenaline. When someone suddenly halts taking an opioid, he will experience very low levels of dopamine and very high levels of noradrenaline. This out-of-balance combination is the basis of some of the unpleasant symptoms related to opioid withdrawal.

 

Further prolonged consumption exerts more long-lasting effects in the brain and they body that may underlie the compulsive drug-seeking behavior and related adverse consequences of withdrawal.

The severity of discomfort of the withdrawal can be influenced by a number of factors, such as:

·         The specific drug(s) used.

·         The dose in which it was used.

·         The frequency of use.

·         The time period of use.

·         Physical and mental health status.

A person who has used higher doses, more frequently, for longer periods is likely to have more severe uncomfortable withdrawal symptoms.

Following is a list of discomforting symptoms appearing as result of an opioid withdrawal

Early withdrawal symptoms (that appear within 6-12 hours for short-acting opioids and 30 hours for long-acting opioids) may include:

Agitation

Body aches

Anxiety

Insomnia

Flu-like symptoms

Tachycardia

Fever

Hypertension

 

Late withdrawal symptoms (that appear after 48-72 hours) may include:

Nausea, vomiting, and diarrhea

Gastro-intestinal cramps

Extreme mood swings

Drug cravings

Goosebumps

Dilated pupils

 

After all this discussion, the main question lies in how to overcome these distressing symptoms of withdrawal.

Several medications have showed their effectiveness to reduce the untoward effects of opioid withdrawal including:

Methadone, Buprenorphine, and Probuphine: These opiate drugs help the recovering person by alleviating withdrawal symptoms and decreasing cravings without inducing a significant euphoric and addictive effect.

Clonidine: An anti-hypertensive medicine, can also be used to alleviate some withdrawal symptoms of opioids. Since clonidine itself is not an opioid, it has little to no potential for addiction or abuse.

Naltrexone: Can be used for preventing relapse.

 

Opiate detoxification: In the field of drug abuse rehabilitation, detoxification is the cluster of strategies used for managing acute intoxication, if required, and reduce withdrawal symptoms. The medical model of detox constitutes a treatment clan of doctors, nurses, and clinicians to abet in the withdrawal and detox process. Frequently, some combination of the aforementioned medications and other non-pharmacological interventions are applied to eliminate uncomfortable symptoms.

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