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Diagnosis and Treatment of Opioid Dependence

  • Abraham Wikler

Abstract

The diagnosis of physical dependence on opioids can be established only by the demonstration of typical opioid-abstinence phenomena, either by isolating the patient without abstinence-suppressing medication for at least 48 hr and observing the development of pupillary dilatation, frequent yawning, lacrimation, rhinorrhea, piloerection, sweating, restlessness, vomiting, and rise in pulse rate, respiratory rate, and rectal temperature, or by administering a narcotic antagonist and observing the appearance of such opioid-abstinence signs within a few minutes. For this purpose, either nalorphine (Nalline) or naloxone (Narcan) may be used. As a narcotic antagonist, naloxone is about 10 times as potent as nalorphine, which also possesses some opioid-agonist properties. An experienced physician may administer the narcotic antagonist (1-4 mg of nalorphine or 0.1—0.4 mg of naloxone) slowly by intravenous injection, constantly observing the patient for early opioid-abstinence signs such as pupillary dilatation, increase in respiratory rate, lacrimation, rhinorrhea, and sweating. The appearance of these signs establishes the diagnosis of physical dependence on opioids, and further intravenous injection of the narcotic antagonist should be stopped, as it may precipitate a more severe and potentially dangerous abstinence syndrome. For less experienced physicians, the subcutaneous route is safer.

Keywords

Methadone Maintenance Opioid Dependence Heroin Addict Heroin Addiction Abstinence Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Plenum Press, New York 1980

Authors and Affiliations

  • Abraham Wikler
    • 1
  1. 1.Department of PsychiatryUniversity of Kentucky Medical CenterLexingtonUSA

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