Narcotic (Opioid) Dependence

Typical profile of a narcotic-dependent person

• Male or female: 16–30 yrs

• Main opioids—heroin, codeine, oxycodone, morphine

• Family history: often severely disrupted (e.g. parental problems, early death, separation, divorce, alcohol or drug abuse, sexual abuse, mental illness, lack of affection)

• Personal history: low threshold for toleration, unpleasant emotions, poor academic record, failure to fulfil aims, poor self–esteem

Many of the severe problems are due to withdrawal of the drug.

Withdrawal effects These develop within 12 h of ceasing regular usage. Max. withdrawal symptoms usually between 36–72 h:

• anxiety and panic

• irritability

• chills and shivering

• excessive sweating

• ‘gooseflesh’ (cold turkey)

• loss of appetite, nausea (possibly vomiting)

• lacrimation/rhinorrhoea

• tiredness/insomnia

• muscle aches and cramps

• abdominal colic

• diarrhoea

Management Management is complex because it includes not only the medical management of physical dependence and withdrawal but also of the individual complex social and emotional factors. The issue of HIV prevention also has to be addressed. Patients should be referred to a treatment clinic and then a shared care approach can be used. The treatments include ‘cold turkey’ with pharmacological support, acupuncture, megadoses of vitamin C, methadone substitution and drug-free community education programs.

Methadone maintenance programs that include counselling techniques are widely used for heroin dependence.

Naltrexone, the oral opioid antagonist, and buprenorphine, which is now the preferred agent, have a place in management.

Methadone used appropriately can save lives but if not can be fatal.

• If autonomic signs, use clonidine

• If anxiety, use diazepam