Drug Abuse IV: Major Drugs of Abuse

Question 1

Opioid Detoxification

Clonidine-assisted withdrawal

Answer 1

§ Centrally acting alpha2-adrenergic agonist
§ Most effective against symptoms related to autonomic hyperactivity (nausea, vomiting, diarrhea)
§ Provides modest relief from muscle aches, restlessness, anxiety, and insomnia
§ Does not diminish opioid craving

Question 2

Opioid Detoxification

§Rapid withdrawal §Ultrarapid withdrawal

Answer 2

§Administration of naloxone or naltrexone: Immediate withdrawal
§ Withdrawal process accelerated
§ Ultrarapid procedure: General anesthesia or heavy sedation with IV midazolam [Versed]
§ In both procedures, clonidine may be added to ease symptoms
§No more effective than standard withdrawal techniques
§Considerably more expensive

Question 3

Methadone substitution

Answer 3

§ Long-acting oral opioid
§ Most commonly used agent § Approximately 10 days
§ Buprenorphine
§ Substituted for opioid the addict is
physically dependent on
§ Prevents symptoms of withdrawal

Question 4

Drugs for Long- Term Opioid Addiction Management

Answer 4

§ Three groups of medications
§ Opioid agonists, opioid agonist-
antagonists, and opioid antagonists § Methadone
§ Maintenance and suppressive therapy § Buprenorphine
§ Maintenance therapy and detox facilitation
§ Naltrexone
§ Discourages renewed opioid abuse

Question 5

Barbiturates

Answer 5

Acute toxicity
§ Maintain respiration and remove drug
§ Naloxone: Reverses opioid poisoning but is not effective against barbiturate poisoning

Question 6

Methamphetamines

Answer 6

Treatment: Cognitive behavioral therapy, matrix model, bupropion [Wellbutrin, Zyban], modafinil [Provigil, Alertec], and Ibudilast