Question

how to management opioids withdrawal? (educate the patients)

Answer 1

Chronic use of opioids, ofeten initiated for pain management, can lead to dependence and sudden withholding of drug can lead to life threatening opioid withdrawal.

Withdrawal symptoms can range from nausea and vomiting, photophobia, icreased lacrimation and nasal discharge to severe autonomic hyperactivity which leads to breathing difficulties, hypertension and palpitations.

Patients can be agitated or aggressive and difficult to approach.

The management of withdrawal symptoms is mainly symptomatic

1. Hypertension - Clonidine, an alpha 2 agonist is given in small doses

2. Sleep disorders- Benzodiazepines

3. Diarrhoea- loperamide

4. Monitoring of withdrawal symptoms with SOWS scale, Short opioid withdrawal scale and medications are modified accordingly

5. Adequate hydration should be ensure

6. Methodone, Buprenorphine for tapered withdarwal.

Management of addiction is done by either gradual cessation of the opioid, use of an opioid with decreased action for short term to tide over the symptoms or use of oipid antagonists. The decision of which path to choose rests on the chronicity and severity of the withdrawal.

1. Methodone is used for gradual cessation. The advantage is that the patient's physiology can adjust better to the gradual reduction.

2. Partial agonist like buprenorphine are used for short term to tide over the period of acute withdrawal.

3. Naloxone or naltrexone are opiod antagonists that are used to antagonise the effects of oipoids. They are usaually reserved for severe symptoms or overdose.