You don't need HEROIN to be a HERO Opioids

1. You don't need HEROIN to be a HERO Opioids have been used for Analgesic and other medicinal purposes for thousands of years but also have a history of misuse for their psychoactive effects. Heroin, Morphine, Methadone, Fentanyl, Codeine etc are examples of most commonly used opioids. A substance specific syndrome that occurs after stopping or reducing the amount of drug/ substance that has been used regularly over a prolonged period and which is characterized by physiological signs and symptoms in addition to psychological changes is called Withdrawal. DSM-5 CRITERIA FOR OPIOID WITHDRAWAL A.Presence of either of the following : 1. Cessation of (reduction of) opioid use that has been heavy and prolonged (i.e several weeks or longer ) 2.Administeration of an opioid antagonist after a period of opioid use. B.Three (or more) of the following developing within minutes to several days after Criterion A: 1. Dysphoric mood . 2. Nausea or vomiting 3. Muscle aches. 4. Pupillary dilation, piloerection,sweating 5. Diarrhoea 6.Yawning 7. Fever 8. Lacrimation or Rhinorrhea 9. Insomnia C. The signs and symptoms in Criterion B cause clinically significant distress or impairment in social, occupational or other important areas of functioning D.the signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance. Treatment of Withrawal: Medical : Opioid agents- Methadone:- synthetic narcotic that substitutes heroin. It suppresses withdrawal symptoms. A daily dose of 20-80 mg suffices to stabilize a patient. Methadone once

2. withdrawn can also lead to abstinence syndrome but can detoxified easily by clonidine (0.1--0.3 tds or qid) Other opioid substitutes- Buprenorphine, Levomethadyl Opioid Antagonists- blocks effect of opioid and do not exert narcotic effect hence no dependence . eg: Naloxone, Naltrexone Neonatal addiction : Although opioid withdrawal is rarely fatal for otherwise healthy individual ,it is hazardous to fetus and can lead to fetal death. Low dose of Methadone(10-40mg daily). Withdrawal if necessary is less hazardous in 2nd trimester. Standard care for withdrawal : •Patient in withdrawal should be accommodated separately from those who have completed withdrawal. •The withdrawal area should be quiet and calm •Patient should be offered opportunities to engage in meditation, moderate physical activities or other calming practices •Offering the patient an accurate realistic information about drugs, dependency and withdrawal through lectures can help alleviate anxiety and fear. •It is not advisable to engage the patient in counseling or psychotherapy as they may be vulnerable and confused •During withdrawal patients may become disruptive and difficult to manage as they may be scared of a closed setting. In such cases calming the patient is important. Reducing the number of people attending them, careful explanation and assurance reduces risk of self harm. •For the patients who are disoriented providing a reality check of where they are is necessary •For the ones experiencing hallucinations , assuring that the environment is simple and uncluttered . Lastly it is very common for people who have completed withdrawal to relapse to drug use. It is unrealistic to think that withdrawal management will lead to sustained abstinence . Rather withdrawal management is an important 1st step before patient commences psychosocial treatment . DR. NIMISHA HARISHCHANDRA NAIR ( JAGRUTI PSYCHIATRIC REHABILITATION CENTRE)