Heroin withdrawal

Kleber HD, Weissman MM, Rounsaville BJ, et al Imipramine as treatment for depression in addicts. Arch Gen Psychiatry 40 649-633, 1983 Kleber HD, Riordan CE, Rounsaville BJ, et al Clonidine in outpatient detoxification from methadone maintenance. Arch Gen Psychiatry 42 391-394, 1983 Kleber HD, Topazian M, Gaspari J, et al Clonidine and naltrexone in the outpatient treatment of heroin withdrawal. Am J Drug Alcohol Abuse 13 1-17, 1987 Kornetsky C. Brain stimulation reward, morphine-induced stereotypy, and sensitization implications for abuse. Neurosci Biobehav Rev 27 777-786, 2004 Kosten TR, Kleber HD Buprenorphine detoxification from opioid dependence a pilot study. Life Sci 42 633-641, 1988... 

The higher than expected frequencies of alcohol PCP - and heroin PCP-related deaths also would have occurred if the combinations were preferred by the users. The motivation may involve the injection of heroin to moderate the adverse effects of PCP, or the use of PCP to ease the pain of heroin withdrawal. Another explanation assumes a stimulant effect of PCP. The use of stimulants, especially cocaine, with heroin is increasingly popular among heroin users (Kozel et al. 1982). 

Unnecessary detoxification with drugs should be avoided if possible (e.g., if symptoms are tolerable). Heroin withdrawal reaches a peak within 36 to 72 hours, and methadone withdrawal peak is reached at 72 hours. 

Addictive Disorders and their Treatment, 2,19-24 Lin SK, Strang J, Su LW, Tsai CJ Hu WH (1997). Double-blind randomised controlled trial of lofexidine versus clonidine in the treatment of heroin withdrawal. Drug and Alcohol Dependence, 48, 127-33 linehan MM, Dimeff LA, Reynolds SK, Comtois KA, Welch SS, Heagerty P Kivlahan DR (2002). Dialectal behavior therapy versus comprehensive validation therapy plus 12-step... 

Lintzeris N, Bell J, Bammer G, Jolley DJ Rushworth L (2002). A randomized controlled trial of buprenorphine in the management of short-term ambulatory heroin withdrawal. Addiction, 97, 1395-1404 Lowe E Shewan D (1999). Patterns of alcohol use among methadone clients in a Glasgow housing estate. Journal of Psychoactive Drugs, 31, 145-54... 

The time of onset, intensity, and duration of abstinence syndrome depend on the drug previously used and may be related to its biologic half-life. With morphine or heroin, withdrawal signs usually start within 6-10 hours after the last dose. Peak effects are seen at 36-48 hours, after which most of the signs and symptoms gradually subside. By 5 days, most of the effects have disappeared, but some may persist for months. In the case of meperidine, the withdrawal syndrome largely subsides within 24 hours, whereas with methadone several days are required to reach the peak of the abstinence syndrome, and it may last as long as 2 weeks. The slower subsidence of methadone effects is associated with a less intense immediate syndrome, and this is the basis for its use in the detoxification of heroin addicts. However, despite the... 

The drug methadone, although not chemically related to heroin, mimics many of its effects. It has been widely used to treat heroin addicts because it prevents craving for the latter drug as well as the symptoms of heroin withdrawal. However, methadone can also be abused and has become part of the illegal drug market in some areas. 

BUPRENORPHINE (Also known as Temgesic and Sub-utex.) New substances that have proven to reduce cravings associated with heroin withdrawal. May also be helpful in treating cocaine addiction. 

Barbiturate withdrawal time is related to whether the drug is short or long-lasting. Symptoms accompanying withdrawal include apprehension, weakness, tremors, anorexia, muscle twitches, and possible delirium. However, barbiturate withdrawal is seldom symptom-free and can be more difficult than heroin withdrawal. 

Physical dependence on barbiturates can develop within a month of use, and it is extremely dangerous because of the very serious and sometimes fatal withdrawal reactions—reactions that are worse than those of morphine or heroin withdrawal. Medical supervision is necessary because suddenly stopping or rapidly decreasing the dose can result in symptoms that include delirium and severe convulsions, sometimes beginning within hours of the last dose. 

Heroin withdrawal is much less dangerous than alcohol and barbiturate withdrawal. Withdrawal symptoms are craving for opioid, restlessness, irritability, increased sensitivity to pain, nausea, cramps, muscle and bone aches, insomnia, anxiety, cold flashes with goose bumps (cold turkey), and movements (kicking the habit).5... 

Seven cases of acute strabismus related to opiate abuse in Switzerland between 1993 and 2001 have been reported (35). In five cases the symptoms coincided with heroin withdrawal and acute esotropia occurred a few days after heroin was stopped. The other two patients developed acute exotropia that was related to opiate abuse. All the symptoms disappeared spontaneously. It is likely that changes in the blood opioid concentration disrupted the oculomotor system and affected binocular vision, although the exact mechanism underlying this phenomenon is not known. 

Some addicts even claim that opiates help them to resist disease. Many heroin users say they doii t get colds or other respiratory infections as long as they take their drug. Since the symptoms of heroin withdrawal rcseml)lc those of a respiratory flu, it is possible that the drug somehow suppresses this kind of reaction. No one has investigated this claim of addicts it would make an interesting subject of research. 

Heroin withdrawal is much like alcohol withdrawal. 

Sudden withdrawal of clonidine from patients on antihypertensive therapy produce symptoms clinically similar to opiate withdrawal. These include headache, nervousness, tachycardia, stomach pains, and sweating. It may be this apparent similarity that gave someone the idea to treat heroin withdrawal symptoms with clonidine. It seems to work with some addicts and is now experimental for this application. 

Table 8. Signs and symptoms of heroin withdrawal following cessation of heavy use ("cold turkey").

Naloxone may precipitate a severe withdrawal state in abusers of opioid analgesics with symptoms starting in less than 15-30 minutes Methadone alleviates most of the symptoms of heroin withdrawal A young male patient is brought to the emergency room of a hospital suffering from an overdose of cocaine following intravenous administration. His symptoms are unlikely to include... 

Cross tolerance/cross dependence occurs when tolerance or dependence develops to different drugs which are chemically or mechanistically related. For example, methadone relieves the symptoms of heroin withdrawal because patients develop cross dependence to these two drugs. 

Methadone causes drowsiness, lightheadedness, dizziness, and a transient drop in blood pressure. Therefore, the nurse should discuss how to prevent orthostatic hypotension. Methadone is used to treat heroin withdrawal. 

Addressing the possibility of a patient becoming addicted to marijuana, the lOM report found that according to all evidence, dependence among marijuana users is rare. Further, the researchers said the dependence and withdrawal symptoms associated with smoked marijuana are mild and subtle compared with the profound physical syndrome of alcohol or heroin withdrawal. 

The Chinese are studying an extremely toxic substance isolated from a fish to see whether it can ease cancer-related pain and the symptoms of heroin withdrawal. What kind offish ... 

Heroin withdrawal peaks 32-72 h after last use mostly subsides by day five... 

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