Opioid withdrawal is an important clinical syndrome that can result in serious discomfort. The clinical manifestation of opiate withdrawal causes severe fluid loss, leading to hemodynamic instability (Srivastava et al., 2020). Severe withdrawal effects can lead to loss of life. The scenario involves a client who reported to the worksite immediately after injecting heroin in the parking lot. The consequences of abrupt heroin withdrawal can affect the normal functioning of individuals, and opioid substitution therapy (OST) alongside buprenorphine or methadone medications is critical in managing the withdrawal effects.
Opiate withdrawal may happen if an individual is physically reliance on opiates and then abruptly stops using the substances. Withdrawal can also be experienced due to a significant reduction of substances used by individuals. From the scenario, Shawn used heroin once, and he is likely to experience associated withdrawal signs. Srivastava et al. (2020) stated that the duration of opiate withdrawal primarily depends on the half-life of the specific opiate drug used. Opiates such as heroin have short half-lives of 3-5 hours, and the withdrawal onset starts within twelve hours after using the substance. The withdrawal from heroin lasts 4-5 days, though it can extend up to fourteen days (Srivastava et al., 2020). The delay in heroin withdrawal could be supported by the reality that the brain’s primary active molecule after administering heroin is not the drug itself but 6-acetymlophine and morphine (Lerner & Klien, 2019). These primary active molecules have prolonged half-lives (Lerner & Klien, 2019). According to Bluthenthal et al. (2020), the experience of opiate withdrawal is featured by physical symptoms, such as bone pain, anxiety, muscle aches, vomiting, abdominal cramps, diarrhea, and nausea. These symptoms may have negative impacts on the ability of an individual to engage in regular activities.
The client may experience protracted withdrawal symptoms if he fails to use the substance for the next two weeks. Protracted withdrawal encompasses the existence of substance-specific signs dominant in acute withdrawal, though they persist beyond the overall duration taken by normal acute withdrawal (Lerner & Klien, 2019). The common protracted withdrawal symptoms for opioids include anxiety, sleep disturbance, and depression. Shawn is at increased risk of experiencing the protected symptoms because of the abrupt stoppage of opioid use. Research has indicated that opioid users who abstained from using the substances experienced reduced capacity to concentrate compared to individuals who have never used opioids (Lerner & Klien, 2019). Individuals recovering from heroin use are likely to show difficulties in executive control functions. Shawn is likely to experience anxiety and sleep disturbance for the next fourteen days. Consequently, the client may be unable to perform his day-to-day activities if the withdrawal is not managed properly.
Pharmacological interventions are beneficial in helping individuals with opioid issues overcome the withdrawal effects. O’Connor et al. (2020) stated that OST with buprenorphine or methadone is the first-line management in controlling dependence on opioids. OST is safe and efficient in reducing illicit opiate use, enhancing the psychological and physical welfare of users (O’Connor et al., 2020). Nevertheless, emerging evidence suggests that the risk of mortality continues to be high during the initial four weeks of the therapeutic process and the last four weeks of ending the treatment (O’Connor et al., 2020). This makes it necessary to provide high-quality care for patients receiving the OST treatment, and patients must be encouraged to embrace medication adherence to achieve the desired outcomes.
Buprenorphine and methadone are the recommended medication drugs for managing opioid discontinuation. Srivastava et al. (2020) stated that buprenorphine is approved for managing opioid use disorder, and it has a substantial utility in controlling detoxification. Individuals with discontinuation problems treated using buprenorphine encounter less severe withdrawal, confirming the effectiveness of the medication (Srivastava et al., 2020). When using this drug, it is critical to wait for the withdrawal symptoms to emerge. According to Srivastava et al. (2020), buprenorphine is extremely potent and can precipitate withdrawal if given shortly following the ingestion of a complete μ-opioid receptor agonist. Directions for using the drug require that 2-4 mg of the medication be administered once the mild-to-moderate symptoms emerge. The patient should be given an additional 2-4 mg after two hours if the signs persist.
Methadone is also efficient in managing discontinuation from opioids. The initial dose of methadone should be 10-30 mg, and the correct amount is computed based on an individual’s history of using substances and the discontinuation’s severity (Srivastava et al., 2020). The patient should be monitored for objective symptoms prior to initiating treatment as a protocol for standard practice. The recommended drugs for opiate discontinuation can be used to help Shawn manage his symptoms.
In conclusion, the effects of opiate withdrawal can be severe on a person’s life. Heroin has short half-lives, though its withdrawal symptoms can persist for up to two weeks. The common symptoms of protracted withdrawal include anxiety, sleep disturbance, and depression, and the client from the scenario is at heightened risk of experiencing such symptoms if he stops using heroin abruptly. OST is an evidence-supported treatment approach for managing withdrawal from opioid-associated substances. Proper care must be taken during the initial four weeks of treatment due to high mortality rates. Medications such as buprenorphine and methadone are approved for managing opiate discontinuation and should be administrated appropriately to guarantee positive outcomes.
References
Bluthenthal, R. N., Simpson, K., Ceasar, R. C., Zhao, J., Wenger, L., & Kral, A. H. (2020). Opioid withdrawal symptoms, frequency, and pain characteristics as correlates of health risk among people who inject drugs. Drug and Alcohol Dependence, 211, 107932. https://doi.org/10.1016/j.drugalcdep.2020.107932
Lerner, A., & Klein, M. (2019). Dependence, withdrawal and rebound of CNS drugs: An update and regulatory considerations for new drugs development. Brain Communications, 1(1), fcz025. https://doi.org/10.1093/braincomms/fcz025
O’Connor, A. M., Cousins, G., Durand, L., Barry, J., & Boland, F. (2020). Retention of patients in opioid substitution treatment: A systematic review. PloS One, 15(5), e0232086. https://doi.org/10.1371/journal.pone.0232086
Srivastava, A. B., Mariani, J. J., & Levin, F. R. (2020). New directions in the treatment of opioid withdrawal. Lancet, 395(10241), 1938–1948. https://doi.org/10.1016/S0140-6736(20)30852-7
write