Opiate Addiction and Withdrawal

Opiate addiction is a series of physiological, behavioral and cognitive phenomena where opiate use is repeated and maintained despite the development of marked problems caused by its use. The World Health Organization defines substance dependence as a syndrome where the use of the substance takes on a much higher priority than other behaviors that once had greater value. There are more than 20 opiates globally in clinical use. In developed countries, heroin is the most common substance that leads to abuse or dependence. Dependence to opiates other than heroin is observed most frequently among individuals who become dependent during the course of a medical treatment, healthcare professionals who can readily access opiates and people who can get the substance from medical suppliers or treatment programs.

To identify opiate dependence in an individual, three or more of the following manifestations should have occurred together for at least one month or, if persisting for periods of less than one month, should have occurred together repeatedly within a 12-month period:

  1. A strong desire or sense of compulsion to take the substance;
  2. Impaired capacity to control substance-taking behavior in terms of its onset, termination or levels of use, as evidenced by the substance being consumed in larger amounts or over a longer period than intended, or by a persistent desire or unsuccessful efforts to reduce or control substance use;
  3. A physiological withdrawal state when substance use is reduced or ceased, as evidenced by the characteristic withdrawal syndrome for the substance, or by use of the same (or closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
  4. Evidence of tolerance to the effects of the substance, such that there is a need for significantly increased amounts of the substance to achieve intoxication or the desired effect, or a markedly diminished effect with continued use of the same amount of the substance;
  5. Preoccupation with substance use, as manifested by alternative pleasures or interests being given up or reduced because of substance use; or a great deal of time being spent in activities necessary to obtain, take or recover from the effects of the substance;
  6. Persistent substance use despite clear evidence of harmful consequences as evidenced by continued use when the individual is actually aware, or may be expected to be aware, of the nature and extent of harm.

What is opiate use-related withdrawal syndrome?

Withdrawal is a clinical condition that occurs on the cessation or reduction of the use of a psychoactive substance that has been taken repeatedly, usually for a prolonged period and/or in high doses.

Three of the following findings should have to be present in opiate abstinence syndrome:

  • Strong desire for opiate agent
  • Rhinorrhea or sneezing
  • Excess tear formation
  • Muscle pain or cramps
  • Abdominal pain
  • Nausea or vomiting
  • Diarrhea
  • Dilated pupils
  • Repeated feeling of chilling
  • Tachycardia or hypertension
  • Yawning
  • Restless sleep

How opiate dependence and withdrawal are treated?

The treatment of opiate dependence and withdrawal is performed in clinics and intensive care units where close monitoring and medical intervention by healthcare providers is possible. The treatment of dependence is a process where medical drug therapy and psychotherapy are conducted in concert. Drug therapy has great value during the detoxification period. Treatment success is directly related to the drugs used.


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