Heroin withdrawal tips
The human brain has its own neurotransmitters which produce what we call ‘highs’ or pleasurable experiences. The sense of euphoria which we experience following winning a race, is thus such a high. One such brain’s own drugs are opiates like dynorphins, enkephalins and opiomelanocortins.
This same effect can be produced artificially by using drugs like heroin and morphine. Heroin has to be taken either in the inhaled form or intravenously since it is not effective when taken orally.
Heroin has the ability to produce tolerance, dependence & withdrawal effects. Tolerance is produced when the drug is needed to be taken in increased doses to produce the same effect as before. Following neuroadaptive mechanisms which produce receptor desensitisation, a state of drug dependence gets created. In this stage it is likely that the patient who abuses heroin will experience withdrawal effects.
The initial comedown of heroin withdrawal can vary in time and intensity, and although typically withdrawal symptoms will begin 6 to 12 hours after the last dose, peaking within 1 to 3 days, and gradually subsiding over 5 to 7 days. However, some users experience weeks or months of withdrawal symptoms, known as acute withdrawal syndrome (PAWS).
Withdrawal effects can be either physiological or psychological. Physical effects of withdrawal are symptoms of autonomic hyperactivity like tremor, sweating, hypertension, piloerection (goosebumps) and feeling like ‘cold turkey’. Runny nose and a general feeling of being unwell is also experienced.
For the person who is dependent, the above symptoms are excruciatingly untolerable. Thus it leads to drug seeking behaviour. So initial quest of the patient to produce euphoria by using drugs, now becomes a quest to stop the withdrawal symptoms from occurring.
Feeling depressed, anxious or irritable, also known as having a dysphoric mood, is a normal part of heroin withdrawal, and is the debt for the euphoria you experienced during the heroin high. Although these feelings are often intense during heroin withdrawal, they tend to pass once the withdrawal stage is over. (www.addictionsabout.com)
If a person who is dependent on heroin needs to undergo detoxification, the following steps may help.
Clonidine (partial alpha2 agonist) or propranolol to reduce the sympathetic effects. Methadone –to prevent the craving and withdrawal drug seeking behaviour. Buprenorphine can also be used to reduce the craving during withdrawal.
Both methadone and buprenorphine are mu receptor agonists and partial agonists.
Naloxone & Naltrexone can also be used in conjunction with methadone or buprenorphine. General medication to prevent runny nose and nausea and vomiting. (Stahl’s essential psychopharmacology)
In addition to the above medication detoxification should be maintained by a long term treatment adherence plan.