Opioids addiction

Naltrexone (Trexan) is the only opioid antagonist currently in use for treatment of addiction. Naloxone is used to treat opioid overdose and to test for opioid addiction but has a short half-life and is relatively ineffective orally cyclazocine s dysphoric side effects make it unacceptable (Resnick et al. 1980). Patients who are likely to continue to use naltrexone and to benefit from treatment are those who have established careers (e.g., health professionals) and family support and are well motivated. Up to 70% of such clients are abstinent at 1-year follow-up (Washton et al. 1984). Programs that utili2e additional rehabilitative services have better results than those that provide minimal services. Successful treatment is also associated with taking naltrexone... 

A 2.5-yeat follow-up study of opioid addicts in methadone maintenance treatment found that prevalence of cocaine use only shghtly declined and that... 

Anxiety disorders are common in the population of opioid-addicted individuals however, treatment studies are lacking. It is uncertain whether the frequency of anxiety disorders contributes to high rates of illicit use of benzodiazepines, which is common in methadone maintenance programs (Ross and Darke 2000). Increased toxicity has been observed when benzodiazepines are co-administered with some opioids (Borron et al. 2002 Caplehorn and Drummer 2002). Although there is an interesting report of clonazepam maintenance treatment for methadone maintenance patients who abuse benzodiazepines, further studies are needed (Bleich et al. 2002). Unfortunately, buspirone, which has low abuse liability, was not effective in an anxiety treatment study in opioid-dependent subjects (McRae et al. 2004). Current clinical practice is to prescribe SSRIs or other antidepressants that have antianxiety actions for these patients. Carefully controlled benzodiazepine prescribing is advocated by some practitioners. 

The management of comorbid medical and psychiatric conditions has become an essential component of effective opioid addiction treatment. Hepatitis C has now surpassed AIDS as the most common cause of death in... 

Joe GW, Simpson DO Mortality rates among opioid addicts in a longitudinal study. AmJ Public Health 77 347-348, 1987... 

Kosten TR, Rounsaville BJ, Kleber HD A 2.3-year follow-up of depression, life crises, and treatment effects on abstinence among opioid addicts. Arch Gen Psychiatry 43 733-738, 1986a... 

Rounsaville BJ, Kosten TR, Kleber HD The antecedents and benefits of achieving abstinence in opioid addicts a2.5-year follow-up study. Am J Drug Alcohol Abuse 13 213-229, 1987... 

Seecof R, Tennant FS Subjective perceptions to the intravenous rush of heroin and cocaine in opioid addicts. Am J Drug Alcohol Abuse 12 79—87, 1987 Sees KL, Delucci KL, Masson C, et al Methadone maintenance vs. 180-day psycho-socially enriched detoxification for treatment of opioid dependence a randomized controlled trial. JAMA 283 1303-1310, 2000 Sells SB Treatment effectiveness, in Handbook on Drug Abuse. Edited by Dupont RE, Goldstein A, O Donnell J. Washington, DC, U.S. Government Printing Office, 1979, pp 105-118... 

Simpson DD, Marsh KL Relapse and recovery among opioid addicts 12 years after treatment. NIDA Res Monogr 72 86—103, 1986 Simpson DD, Joe GW, Bracy SA Six-year follow-up of opioid addicts after admission to treatment. Arch Gen Psychiatry 39 1318-1323, 1982... 

Tennant FS LAAM maintenance for opioid addicts who cannot maintain with methadone. NIDA Res Monogr 81 294, 1988... 

A dramatically different pattern is found in surveys of drug abuse treatment facilities. Substance abuse treatment centers have reported that more than 20% of patients use benzodiazepines weekly or more frequently, with 30%— 90% of opioid abusers reporting illicit use (Iguchi et al. 1993 Stitzer et al 1981). Methadone clinics reported that high proportions ofurine samples are positive for benzodiazepines (Darke et al. 2003 Dinwiddle et al. 1996 Ross and Darke 2000 Seivewright 2001 Strain et al. 1991 Williams et al. 1996). The reasons for the high rates of benzodiazepine use in opioid addicts include self-medication of insomnia, anxiety, and withdrawal symptoms, as well as attempts to boost the euphoric effects of opioids. 

The opioid antagonists naloxone and naltrexone bind to aU three opioid receptors, p, K, and 8. These compounds are antagonists due to their inability to elicit downstream effects of these receptors once bound (Sarton et al. 2008 Yaksh and Rudy 1977). Interestingly, both antagonists have a high binding affinity for MORs. Naloxone is used to reverse the effects of an acute opioid overdose because of its rapid onset of action. Naltrexone elicits similar actions, but has a longer onset and duration of action and hence, is used for the maintenance of treatment for opioid addicts. 

Recognize when long-term maintenance therapy is indicated for an opioid addict, and describe how to choose and initiate a maintenance regimen. 

Esteban J, Gimeno C, Barril J, Aragones A, Climent JM and de la Cruz-Pellin M (2003). Survival study of opioid addicts in relation to its adherence to methadone maintenance treatment. Drug and Alcohol Dependence, 70, 193-200. 

Opioid addiction Striatum from 129P3/J SWR/J C57BL/6J Inbred mouse lines opioid resistant, opioid sensitive Markers for susceptibility to morphine addiction [32]... 

Cessation of chronic cannabis use is known to produce a withdrawal syndrome consisting of restlessness, irritability, insomnia, nausea, and muscle cramping (table 10.9) (O Brien 1996). However, this syndrome is only seen in people who use high daily amounts and then suddenly stop (O Brien 1996). These symptoms are not usually seen in clinical populations, and frequent users of cannabis are not driven by a fear to avoid a withdrawal syndrome as seen in opioid addiction. 

Fontanesi B. (1998). Regional cerebral blood flow and comorbid diagnosis in abstinent opioid addicts. Psychiatry Res. 83(2) 117-26. 

A derivative of methadone, L-a-acetyl-methadol (LAAM) has been approved for the treatment of opioid addiction. In some addicts whose degree of tolerance is not known, the patient is first given methadone to stabilize the withdrawal signs and is then switched to LAAM. LAAM has an advantage over methadone in that it has a longer duration of action. Dosing is required only three times per week in most addicts to prevent withdrawal. 

Babies bom to opioid-addicted women also exhibit withdrawal signs, but because of the slower metabolism of opioids in the newborn, the withdrawal signs are more protracted. The babies are often treated with the opium preparation paregoric to reduce withdrawal signs. 

Other treatments for opioid addiction are described in detail in Chapter 35. 

Hydromorphone is eight times as potent as morphine but has less bioavailability following oral administration. Its side effects do not differ from those of morphine but are more intense. Hydromorphone is indicated for use in severe pain and in high doses for relief of pain in opioid-addicted patients. 

Methadone (Dolophine) has an analgesic profile and potency similar to that of morphine but a longer duration of action and better oral bioavaUabUity. The kinetic properties of methadone and its derivative, LAAM, have been shown to be useful in the treatment of opioid addiction, as discussed in Chapter 35. 

Use in treating opioid addiction limited to approved programs... 

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