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07-SEPTEMBER-2008 03:17:44 - Opioid dependency or section by expanding it. Further information might be found on the talk page or at requests for expansion. August 2007 Opioid dependency Classification and external resources ICD-10 F11..2 ICD-9 304.0 Opioid dependency is a medical diagnosis characterized by an individual's inability to stop using opioids even when objectively in his or her best interest to do so. In 1964 the WHO Expert Committee on Drug Dependence introduced dependence as A cluster of physiological, behavioural and cognitive phenomena of variable intensity, in which the use of a psychoactive drug or drugs takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and persistent drug-seeking behaviour. Determinants and problematic consequences of drug dependence may be biological, psychological or social, and usually interact. The core concept of the WHO definition of drug dependence requires the presence of a strong desire or a sense of compulsion to take the drug; and the WHO and DSM-IV-TR clinical guidelines for a definite diagnosis of dependence require that three or more of the following six characteristic features be experienced or exhibited: 1. A strong desire or sense of compulsion to take the drug; 2. Difficulties in controlling drug-taking behaviour in terms of its onset, termination, or levels of use; 3. A physiological withdrawal state when drug use is stopped or reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same or a closely related substance with the intention of relieving or avoiding withdrawal symptoms; 4. Evidence of tolerance, such that increased doses of the drug are required in order to achieve effects originally produced by lower doses; 5. Progressive neglect of alternative pleasures or interests because of drug use, increased amount of time necessary to obtain or take the drug or to recover from its effects; 6. Persisting with drug use despite clear evidence of overtly harmful consequences, such as harm to the liver, depressive mood states or impairment of cognitive functioning. The Walid-Robinson Opioid-Dependence WROD Questionnaire was designed based on these guidelines. Contents 1 Causes 2 Symptoms of withdrawal 3 Prognosis 4 References 5 External links Causes Somewho? argue that this is a physical condition characterized by the dysregulation of the endogenous opioid receptor system, which results from chronic exposure to opiates during the period of abuse. In addition there may be associated physiological dysfunction in the reward circuitry of the brain which results from chronic exposure to naturally occurring opiates such as morphine or codeine or synthetically derived opiates opioids such as Demerol or oxycodone. Others feel that the disease state is a failure to relate to other individuals and that the opioid use itself, while critical for the diagnosis, is only the first target of treatment. Treatment approaches include abstinence-based and harm-reduction methodologies. Both include participation in detoxification through the use of methadone or other long-acting opioids. Alternative detox protocols call for total abstention from all opiates, with the use of various benzodiazepines and other medications to reduce the uncomfortable withdrawal symptoms associated with abstinence. In an abstinence-based approach, a gradual taper of the medications follows detox, while in the harm-reduction approach, the patient remains on an ongoing dose of methadone or buprenorphine. Symptoms of withdrawal Symptoms of withdrawal from opiates include, but are not limited to, depression, leg cramps, abdominal cramps, vomiting, diarrhea, insomnia, and cravings for the drug itself. Detoxification is best conducted in an in patient facility that provides a controlled environment. Patients who are isolated and exposed solely to care givers and other patients in this environment have a better rate of staying clean than out-patients.citation needed Additional withdrawal symptoms include, but are not limited to, rhinitis irritation and inflammation of the nose, lacrimation tearing, severe fatigue, lack of motivation, moderate to severe and crushing depression, feelings of panic, sensations in the legs and occasionally arms causing kicking movements which disrupt sleep, increased heartrate and blood pressure, chills, gooseflesh, headaches, anorexia lack of appetite, mild or moderate tremors, and other adrenergic symptoms, severe aches and pains in muscles and perceivably bones, and weight loss in severe withdrawal. Depending on the quantity, type, frequency, and duration of opioid use, the physical withdrawal symptoms last for as little as 5 days and as much as 14 days. When long acting opioids like Methadone or BuprenorphineSuboxone,Subutexare used for an extended period physical withdrawal symptoms can last up to two months and are sometimes followed by a very long period of depression, fatigue, and trouble sleeping which could last up to two years which is sometimes referred to as P.A.W.S or Post Acute Withdrawal Syndrome which is more severe and tends to occur more frequently with long acting opioids.citation needed The user, upon returning to the environment where they usually used opiates, can experience environmentally implied physical withdrawal symptoms well-after regaining physical homeostasis - or the termination of the physical withdrawal phase by synthesis of endogenous opioids endorphins and upregulation of opioid receptors to the effects of normal levels of endogenous opioids.citation needed These implied symptoms are often just as distressing and painful as the initial withdrawal phase. Prognosis It can take up to two months for the brain's opioid receptors to return to their normal efficacy to endogenous opioids, meaning depression and anxiety can linger for this time period. Opioid use usually leaves no permanent damage to the brain or the opioid receptors.citation needed References War on Drugs-War on Pain Management By Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II 2006. 1 Volkow N. What do we know and what don't we know about opiate analgesic abuse? Keynote address, Wednesday, March 30, 2005. Program and abstracts of the 24th Annual Scientific Meeting of the American Pain Society; March 30-April 2, 2005; Boston, Massachusetts. Fishbain DA, Rosomoff HL, Rosomoff RS 1992, Drug abuse, dependence, and addiction in chronic pain patients. Clin J Pain 82:77-85. Hoffmann NG, Olofsson O, Salen B, Wickstrom L 1995, Prevalence of abuse and dependency in chronic pain patients. Int J Addict 308:919-927. Chabal C, Erjavec MK, Jacobson L et al. 1997, Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors. Clin J Pain 132:150-155. Kouyanou K, Pither CE, Wessely S 1997, Medication misuse, abuse and dependence in chronic pain patients. J Psychosom Res 435:497-504. Reid MC, Engles-Horton LL, Weber MB et al. 2002, Use of opioid medications for chronic noncancer pain syndromes in primary care. J Gen Intern Med 173:173-179. Narcotic Psychotropic Drugs: Achieving Balance in National Opioids Control Policy © World Health Organization, 2000. Diagnostic and Statistical Manual of Mental Disorders, Fourth ion, Text Revision 2002. 2 WHO Expert Committee on Addiction-Producing Drugs, Thirteenth Report, World Health Organization Technical Report Series No. 273. Geneva: World Health Organization, 1964. WHO. 5th Review of Psychoactive Substances for International Control. Geneva: World Health Organization, November 16-20, 1981. NIDA. Trends in Prescription Drug Abuse 2006. 3 American Pain Society APS Bulletin Volume 9, Number 5, September/October 1999. Mahowald ML, Singh JA, Majeski P. - Opioid use by patients in an orthopedics spine clinic // Arthritis Rheum. 2005 Jan;521:6-10. Use of Essential Narcotic Drugs to Treat Pain is Inadequate, Especially in Developing Countries. International Narcotics Control Board INCB, Annual Report, 3 March 2004. Walid MS, Hyer LA, Ajjan M, Barth ACM, Robinson JS. Prevalence of opioid-dependence in spine surgery patients and correlation with length of stay. J Opioid Management 2007, Volume 3, Number 3. PMID: 18027538 Walid MS, Hyer LA, Ajjan M, Robinson JS: Predicting Opioid-Dependence Using Pain Intensity and Length of Pain Suffering in Pre-Spine-Surgery Patients. The Internet J Pain, Symptom Control and Palliative Care. 2007; Volume 5, Number 2. 4 External links http://www.drugabuse.gov/infofacts/heroin.html http://www.na.org/ v d e WHO ICD-10 mental and behavioral disorders F · 290-319 Neurological/symptomatic Dementia Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Elopement, Sundowning, Wandering · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse · opioids opioid dependency · sedative/hypnotic benzodiazepine withdrawal · cocaine cocaine dependence · general Intoxication, Drug abuse, Physical dependence, Withdrawal Psychotic disorder Schizophrenia disorganized schizophrenia · Schizophreniform disorder · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood affective Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder Ganser syndrome · Somatoform disorder Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia Hypersomnia, Insomnia · Parasomnia REM behavior disorder, Night terror · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development developmental disorder Specific: speech and language expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp · Scholastic skills dyslexia, dysgraphia, Gerstmann syndrome · Motor function developmental dyspraxia Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech stuttering · cluttering Retrieved from http://en..org/wiki/Opioid_dependency Categories: Substance-related disordersHidden categories: Articles to be expanded since August 2007 | All articles to be expanded | Articles with specifically-marked weasel-worded phrases | All articles with statements | Articles with statements since August 2008 | Articles with statements since March 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page This page was last modified on 15 August 2008, at 01:27
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