Heroin withdrawal syndrome

There are two main treatments for the opiate withdrawal syndrome. One is replacement therapy with methadone or other X agonists that have a longer half-life than heroin or morphine, and produce mild stimulation rather than euphoria. They also produce cross-tolerance to heroin, lessening heroin s effect if patients relapse. Withdrawal is also treated with the 0C2 agonist clonidine, which inhibits LC neurons, thus counteracting autonomic effects of opiate withdrawal — such as nausea, vomiting, cramps, sweating, tachycardia and hypertension — that are due in part to loss of opiate inhibition of LC neurons. 

LSD produces a rapid and complete tolerance, but it is not powerfully reinforcing the way drugs of abuse like cocaine and heroin are. LSD does not produce any known withdrawal syndrome (Abraham et al. 1996). It does not produce positive reinforcement in animal self-administration models. Concurrently in humans, it does not lead to patterns of repeti-... 

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... 

For detoxification of a heroin-dependent addict, low doses of methadone (5-10 mg orally) are given two or three times daily for 2 or 3 days. Upon discontinuing methadone, the addict experiences a mild but endurable withdrawal syndrome. 

Therapeutic uses Methadone is used in the controlled withdrawal of addicts from heroin and morphine. Orally administered, methadone is substituted for the injected opioid. The patient is then slowly weaned from methadone. Methadone causes a milder withdrawal syndrome, which also develops more slowly than that seen during withdrawal from morphine. 

Some studies have suggested that there may be links between the development of dependence to cannabinoids and to opiates (42). Some of the behavioral signs of rimonabant-induced withdrawal in THC-treated rats can be mimicked by the opiate antagonist naloxone (43). Conversely, the withdrawal syndrome precipitated by naloxone in morphine-dependent mice can be partly relieved by THC (44) or endocannabinoids (45). Rats treated chronically with the cannabinoid WIN55212-2 became sensitized to the behavioral effects of heroin (46). Such interactions can also be demonstrated acutely. Synergy between cannabinoids and opiate analgesics has been described above. THC also facilitated the antinociceptive effects of RB 101, an inhibitor of enkephalin inactivation, and acute administration of THC caused... 

Smolka M, Schmidt LG. The influence of heroin dose and route of administration on the severity of the opiate withdrawal syndrome. Addiction 1999 94(8) 1191-8. 

A low-efficacy opioid can reduce the effectiveness of a high-efficacy opioid by successfully competing with the latter for receptors. Partial agonist (agonist/antagonist) opioids, e.g. pentazocine, will also antagonise the action of other opioids, e.g. heroin, and may even induce the withdrawal syndrome in dependent subjects. 

Morphine or heroin dependence is more disabling physically and socially than is opium dependence (treatment of pain in opioid dependent subjects, see p. 343). Chronic exposure to opioids leads to adaptive changes in the endogenous opioid system and no doubt in receptor numbers, sensitivity and cellular response. The abrupt withdrawal of administered opioid usually provokes rebound or a withdrawal syndrome. This consists largely of the opposite of the normal actions of opioids. Also, noradrenergic mechanisms are modulated by endogenous opioids and these mechanisms are depressed by continuous opioid administration. Abrupt withdrawal reboimd can be described as noradrenergic storm. ... 

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. 

Opioids (especially methadone and heroin) are the most common cause of serious neonatal drug withdrawal symptoms. Other dmgs for which a withdrawal syndrome has been reported include phencyclidine (POP), cocaine, amphetamines, tricyclic antidepressants, phenothiazines, benzodiazepines, barbiturates, ethanol, clonidine, diphenhydramine, lithium, meprobamate, and theophylline. A careful dmg history from the mother should include illicit drugs, alcohol, and prescription and over-the-counter medications, and whether she is breast-feeding. 

Acute abstinence syndrome (withdrawal) - In chronic pain patients in whom opioid analgesics are abruptly discontinued, anticipate a severe abstinence syndrome. This may be similar to the abstinence syndrome noted in patients who withdraw from heroin. Severity is related to the degree of dependence, the abruptness of withdrawal, and the drug used. Generally, withdrawal symptoms develop at the time the next dose would ordinarily be given. 

---