Withdrawal state opioid

In studies of its use in treating alcohol, opioid, and nicotine dependence, naltrexone has not been reported to cause depression or dysphoria. Patients who complain of naltrexone-associated dysphoria often have co-morbid depressive disorders or depression resulting from opioid or alcohol withdrawal states (549). Co-morbid depression is not a contraindication to naltrexone. Small pilot studies have supported the use of naltrexone in combination with antidepressants for the treatment of patients with co-mor-bid depression. The risk of non-fatal overdose is significantly increased after naltrexone treatment, as a result of reduced tolerance, compared with patients taking substitution methadone (550). 

Six cases of complications loosely related to the use of naltrexone pellet implantation during the highly controversial rapid and ultra-rapid opioid detoxification procedures have been reported (22). These included pulmonary edema, prolonged opioid withdrawal states, drug toxicity, withdrawal from cross-dependence to alcohol and benzodiazepines, aspiration pneumonia, and death. The risk of these controversial procedures and of naltrexone in this novel delivery system are high a robust scientifically validated program of research is needed to justify such treatment packages. 

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... 

Personality variables, state of mind at time of withdrawal, and expectations of severity of symptoms all may affect withdrawal severity (Kleber 1981). One study found that merely providing addicts information about the withdrawal syndrome resulted in lower levels of withdrawal symptoms (Green and Gos-sop 1988). Naloxone rapidly induces a severe withdrawal syndrome, which peaks within 30 minutes and then declines rapidly. Until the antagonist is eliminated, only partial suppression of the withdrawal syndrome is possible, and then only by using very high opioid doses, which may cause respiratory depression when naloxone is metabolized. 

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. 

Tolerance, Dependence, and Addiction Liability. Patients treated with long-term opioid therapy often develop tolerance and usually become physically dependent on narcotic analgesics as well. Tolerance results when exposure to a drug results in its decreased effectiveness with time and larger doses are required to achieve the same response (26). Physical dependence is also an adaptive state that is characterized by a specific constellation of withdrawal symptoms that occur upon abrupt cessation or significant reduction in the dose of the opioid or administration of an opioid antagonist (26). Addiction, however, is distinct from physical dependence, and "the term addiction should never be used when physical dependence is meant" (22). The... 

GHB was investigated as an anesthetic agent but was discontinued because of its lack of analgesia and because of adverse side effects including seizures. It is used outside the United States to treat alcohol and opioid withdrawal and was recently approved in the United States under the name Xyrem for the treatment of narcolepsy. 

Thus, the word opioid dependence can mean two different things one, a biological state produced in all receiving chronic opioid administration, primarily characterized by appearance of withdrawal phenomena when the opioid is abruptly stopped and two, a clinical syndrome seen in some opioid consumers, characteristics of which may include tolerance and... 

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