Withdrawal from morphine

The LC neurons express a variety of autoreceptors, which allow compounds such as clonidine to decrease, and others such as yohimbine to increase LC firing (Buccafusco, 1992). Clonidine is used in the treatment of opiate withdrawal, since it decreases LC firing during the withdrawal from morphine. 

Bonci A, Williams JT Increased probability of GABA release during withdrawal from morphine. J Neurosci 1997 17 796. [PMID 8987801]... 

Crippens, Donita, and Terry E. Robinson. 1994. "Withdrawal from Morphine or Amphetamine Different Effects on Dopamine in the Ventral-Medial Striatum Studied with Microdialysis." Brain Research 650 56-62. 

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. 

Feng P Wilson QM, Meissler Jr JJ, Adler MW, Eisenstein TK (2005) Increased sensitivity to Salmonella enterica serovar Typhimurium infection in mice undergoing withdrawal from morphine is associated with suppression of interleukin-12. Infect Immun 73 7953-7959. 

Rahim RT, Adler MW, Meissler Jr JJ, Cowan A, Rogers TJ, Geller EB, Eisenstein TK (2002) Abrupt or precipitated withdrawal from morphine indnces immnnosnppression. J Neuroimmunol 127 88-95. 

Rahim RT, Meissler Jr JJ, Zhang L, Adler MW, Rogers TJ, Eisenstein TK (2003) Withdrawal from morphine in mice snppresses splenic macrophage fnnction, cytokine production, and costimnlatory molecnles. J Nenroimmnnol 144 16-27. 

There have been few studies of acetylcholine release during nicotine withdrawal. Rada et al. (2001) found that withdrawal from continuous nicotine infusion resulted in significantly increased acetylcholine release in the NAcc, concomitant with somatically expressed withdrawal behaviors. This was similar to the effect of morphine withdrawal on NAcc acetylcholine release. Since dopamine release was decreased at the same time, the transmitter balance in the NAcc was radically altered. 

Opioids are known to alter mood states. For example, opiates such as morphine produce euphoria and pain relief. Prolonged use of and withdrawal from opiates produce depressive-like symptoms as well. Based on the mood-altering effects of opiates, the role of endogenous opiates in psychiatric symptoms of various diseases has been studied. In addition, endogenous opioids are believed to play a role in neuronal circuitry responsible for reward and pleasure. Therefore, it is thought that perhaps the anhedonia observed in depressed patients is due to dysregulation of endogenous opioids in neuronal reward circuitry. 

In common with other opioids, dextropropoxyphene can produce dependence (11). However, it has also been used to withdraw patients from morphine (12). 

TTS fentanyl is not useful in acute or postoperative pain, because of the risk of respiratory depression due to the long delay and decay time, which do not allow adequate dose finding (44). Some patients have acute symptoms of morphine withdrawal, in spite of adequate pain control, when they are converted from morphine to transdermal fentanyl. The mechanism has not yet been determined (48,49). 

Due to the intense study of the problem of drug addiction, the methods of treatment are improved annually. Substitution of the administration of methadone for morphine followed by withdrawal from methadone is a recent advance in withdrawal therapy. Methadone suppresses the signs of abstinence from morphine and, during rapid withdrawal of methadone, the signs of abstinence are milder than those observed during rapid withdrawal of morphine. 

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