Heroin withdrawal, treatment

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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... 

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. 

Cannabis carries some potential for dependence and addiction. Compared to cocaine, heroin, alcohol, and nicotine, cannabis has lesser addictive potential and withdrawal effects, but some users do develop compulsive and maladaptive use patterns that require treatment (Taylor 1998). Individuals with underlying psychopathology or tendencies for substance abuse should be particularly leery of using cannabis in the interests of avoiding compulsive use patterns. 

Opium has been used as a medicine for hundreds of years, inevitably creating countless addicts. Scientists have conducted a never-ending search for effective cures for opium addiction, morphine addiction (morphinism), and heroin addiction. For most of its history, opium addiction was treated as a disease with no cure, and doctors concerned themseives with treating the symptoms of addiction rather than the root cause. As a result, other opiates were used to lessen the effects of withdrawal. The addict is placed on a regimen of opiates that slowly decrease over time, weaning the addict from his or her addiction. This process of treatment is still used today. 

Lee attended for a short series of counselling appointments to do the preparatory work for a detoxification. His parents had become aware of the problem, and after initial distress they were keen to help him through his treatment With the counsellor s advice, Lee reduced his heroin use to the minimum which he needed to stop him withdrawing, and it was arranged that he had our standard detoxification regime of lofexidine and additional symptomatic medication. He had taken a week off work to do the detoxification, and daily home visits were undertaken. 

As indicated, buprenorphine can offer a quicker option than methadone, with a three-day course reported to be effective for withdrawal from heroin (Cheskin et al. 1994). The side-effects of clonidine which render it unsuitable for community treatment can be manageable in the inpatient setting, although the drug is being superseded by lofexidine where that is available. Controlled studies have found clonidine and lofexidine to be equally effective in alleviating withdrawal symptoms in inpatient detoxification from heroin (Lin et al. 1997) and from methadone (Khan et al. 1997), with lofexidine resulting in less hypotension and fewer adverse effects. Another double-blind controlled study found lofexidine to be broadly as effective as a ten-day methadone detoxification in inpatient opiate withdrawal (Bearn et al. 1996). 

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