Review Question - QID 105631

This patient is experiencing heroin withdrawal. The appropriate treatment to relieve withdrawal symptoms is methadone.

The signs and symptoms of opioid withdrawal include anxiety, insomnia, anorexia, excessive perspiration, mydriasis, rhinorrhea, nausea, stomach cramps, and diarrhea. Unlike alcohol withdrawal, opioid withdrawal is rarely life threatening. However, treatment of symptoms is generally recommended by using methadone or suboxone (buprenorphine and naloxone combination), which are long acting opioid agonists. These drugs can also be used for long term maintenance to prevent heroin abuse.

Donaher and Welsh review the use of a the drug buprenorphine for management opiod withdrawal and addiction. Buprenorphine is a partial mu-opioid receptor agonist, and therefore has a lower abuse potential when compared to methadone. Buprenorphine is also easily available for use in the outpatient setting, however, the authors note that the drug may not be effective for those patients who require a high methadone dose.

Blum et al. review the use of suboxone for management of opioid addiction and note that the current literature suggests it is just as effective as methadone maintenance with the advantages described above. In addition, they state it is possible that the chronic blockade of opiate receptors by naloxone and the partial agonisim of buprenorphine may actually downregulate dopaminergic activity and decrease the relapse potential of opioid addicts.

Illustration A depicts a chart detailing the signs and symptoms of opioid withdrawal based on the time elapsed since last dose. Illustration B is a photographic example of needle track marks seen in the antecubital fossa.

Incorrect Answers:
Answer 1: Dantrolene is a muscle relaxant used for the treatment of neuroleptic malignant syndrome.
Answer 3: Flumazenil is a competitive inhibitor of at the GABA receptor and is used for benzodiazepine overdose.
Answer 4: Naloxone is an opioid receptor antagonist used for treatment of opioid overdose. Use of naloxone in this patient would make his symptoms worse.
Answer 5: Lorazepam is a benzodiazepine used for the management of alcohol withdrawal.