STAGE 4. Selecting the theoretical approach

What steps should be completed?

Step 1: Select the theoretical approach or approaches on which the intervention will be based

PHARMACOLOGICAL TREATMENTS FOR OPIOID DEPENDENCE

What is detoxification based on?

Suppressing continued opiate use or administering some antagonists causes opioid withdrawal syndrome (OWS), characterised by a set of signs and symptoms of varying intensity and severity, depending on the degree of dependence. OWS usually starts between 8-10 hours after the last dose and reaches its maximum in 36-72 hours, during which time symptoms such as muscle cramps, runny nose, lacrimation, yawning, pupil dilation, tachycardia, hyperthermia or hypothermia and hypertension may be observed, accompanied by anxiety and a more or less compulsive desire to use again. Serious complications are rare, except in acute withdrawal induced by antagonists if they are not treated.

Specific or symptomatic medicines are used in a programmed way to prevent symptoms, partly because of their potential severity, but mainly to make the patient as comfortable as possible to encourage motivation and adherence to the treatment.

The classic guidelines for detoxification are based on the use of opioid agonists, alpha-2-adrenergic antagonists and symptomatic pharmacological treatment. The most common are methadone, buprenorphine, a methadone/buprenorphine combination, and clonidine. The guidelines for short detoxification (4 to 5 days) usually include the use of naloxone, clonidine, and naltrexone.

What is cessation based on?

In addition to psychological and social interventions, various pharmacological treatments are used in opiate cessation treatment:

• Naltrexone (opioid antagonist). Prevents the addict from experiencing the reinforcing effects associated with the use of heroin or other opiates. The objective is that the repeated absence of the desired effects (euphoria, etc.) and the perception of the futility of using drugs for that purpose, extinguish that behaviour.
• Methadone, buprenorphine (opioid agonists). Induce stable opiate levels in the brain, leading to a significant reduction in the desire to use heroin or other opiates, and reducing their euphoric effects if they are used.