opiate addiction

Kicking an Opiate Addiction: Detoxification and Maintenance

opiate addiction

Opiate Addiction

Opiates are outranked only by alcohol as humanity’s oldest, most widespread, and most persistent drug problem.

Although law enforcement, psychiatry, and pharmacological science have been seeking solutions for over a century, more than one million opiate addicts remain in the United States alone.

Still, in recent years new drug treatments and refinements of older psychological and social therapies are offering some hope of relief.

Dozens of opiates and related drugs (sometimes called opioids) have been extracted from the seeds of the opium poppy or synthesized in laboratories.

The poppy seed contains morphine and codeine, among other drugs. Synthetic derivatives include hydrocodone (Vicodin), oxycodone (Percodan, OxyContin), hydromorphone (Dila-udid), and heroin (diacetylmorphine).

Some synthetic opiates or opioids with a different chemical structure but similar effects on the body and brain are propoxyphene (Darvon), meperidine (Demerol), and methadone. Physicians use many of these drugs to treat pain.

Opiates enhance the effects of the neurotransmitters called endorphins and enkephalins by acting at nerve receptors for these natural body chemicals.

They suppress pain, reduce anxiety, and at sufficiently high doses produce euphoria. Most can be taken by mouth, smoked, or snorted, although addicts often prefer intravenous injection, which gives the strongest and most immediate pleasure.

Opiates do not have serious side effects at therapeutic doses, although they can cause constipation and depress breathing. Addicts neglect their health and safety for many reasons, including a tendency to ignore pain and other normal physical warning signals.

The use of intravenous needles can lead to infectious disease, and an overdose, especially taken intravenously, often causes respiratory arrest and death.

Detoxification

For some addicts, the beginning of treatment is detoxification — controlled and medically supervised withdrawal from the drug. (By itself, this is not a solution, because most addicts will eventually resume taking the drug unless they get further help.)

The withdrawal symptoms — agitation; anxiety; tremors; muscle aches; hot and cold flashes; sometimes nausea, vomiting, and diarrhea — are not life-threatening, but are extremely uncomfortable. The intensity of the reaction depends on the dose and speed of withdrawal.

Short-acting opiates tend to produce more intense but briefer symptoms. The effect of a single dose of heroin, a relatively short-acting drug, lasts 4–6 hours, and the withdrawal reaction lasts for about a week.

No single approach to detoxification is guaranteed to be best for all addicts. Many heroin addicts are switched to the synthetic opiate methadone, a longer-acting drug that can be taken orally or injected.

Then the dose is gradually reduced over a period of about a week. The anti-hypertensive (blood pressure lowering) drug clonidine is sometimes added to shorten the withdrawal time and relieve physical symptoms.

continue reading the full Harvard Health story here

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