Practicing out of New Castle, Pennsylvania, Dr. J. Fred Stoner is a board-certified pain management physician as well as a pathologist. Over the last few decades, the use of opioid drugs as analgesics has risen significantly, and with that has come the illicit use of them as well, both recreationally and due to addiction. As a pain management physician, Dr. Stoner recognizes the importance of managing his patients’ pain, but also helping them in the best way possible, and believes patients should keep an eye out for any signs or symptoms of opioid withdrawal, be it for themselves, or in their family and friends.
Opioids are a neurological drug that can be traced back thousands of years, and come from the Papaver somniferum seed, commonly known as the opium seed. More recently, opioids and its synthetic analogues have been created to help in pain management, most notably for patients suffering from chronic pain, with morphine, codeine, heroin, and fentanyl being a few that are widely recognized.
Science of Addiction
Opioids act on the mu-opioid receptors of the nervous system, helping to reduce the amount of pain signaling to the brain to decrease perceived pain. Most patients that have been started on an opioid have chronic pain and may be taking the medications for a long period of time. Over time, the chemistry of the brain begins to change, and they become more tolerant to the same dosage of medication and find themselves needing increased doses to provide the same relief as before. Dr. J. Fred Stoner also explains that opioid receptors have been extensively studied to find that genetically some patients are more prone to addiction and dependence. With increasing usage, a patient can become dependent on the drug due to decreased pain sensation as well as feelings of euphoria due to activation of the reward centers in the brain, and when it is stopped, they can experience both physical and psychological symptoms.
For patients who have been taking opiates for a longer period of times (more than a few weeks), withdrawal symptoms may become apparent when suddenly stopping, or if missing a dose. For shorter acting medications, symptoms can become apparent within 10–12 hours after the last dose, while with longer acting medications such as morphine, these symptoms will usually occur after about 30 hours after the last dose. The severity of symptoms will generally depend on how long the patient has been using the drug, as well as at what dose. Symptoms of opioid withdrawal can be broken down into early and late symptoms, with agitation, anxiety, muscle aches, running nose, sweating, and tearing eyes being a few early symptoms. Late symptoms may include diarrhea, stomach cramps, nausea and/or vomiting, and goose bumps. Dr. J. Fred Stoner notes that symptoms may last a few days to a few weeks, with a peak of symptoms occurring around the 72-hour mark for most patients. Other signs to look out for include a racing or irregular heartbeat, hypertension, and respiration rate.
Treatment for both addiction and withdrawal include a combination of support therapy, medications, and counseling. Some commonly used medications include methadone, with many physicians working in clinics designed specifically for that purpose and are commonly referred to as methadone clinics. Methadone is used to help both with withdrawal symptoms, as well as a longer-term method of decreasing dependence, with many patients eventually being able to wean down their dosage over time. Buprenorphine is another medication that is commonly used to help in opiate withdrawal as well as long-term maintenance. Clonidine can be used to help with short-term withdrawal symptoms of muscle aches, running nose, anxiety, and agitation, while naloxone is generally used in overdose situations.
Dr. J. Fred Stoner hopes that in the future there will be newer, better alternatives to opioids for pain relief but presently understanding the potential dangers of opioids and their withdrawal symptoms can be a major asset in avoiding an addiction.
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