Hydromorphone: Treatment and rehabilitation

Last modified: Sunday, 31. May 2009 - 4:22 pm

Addiction to hydromorphone and other prescription painkillers is one of the major reasons behind admittance to drug rehabilitation clinics. Treatment for opiate addiction has been occurring in the United States since the early part of the twentieth century. In these early days of treatment, doctors in private practice prescribed narcotics to those addicted to opiate drugs. Later, governments outlawed this practice and began operating clinics where morphine could be obtained by addicts. Eventually, these clinics were also closed. At that point in time, addicts began to be treated in public health hospitals or placed in jail.
The problem of opiate drug abuse both with illegal and prescription narcotics increased during the 1960s. In the years that followed, researchers and clinicians looked to new methods to treat the growing problem. Genetic factors have gained importance as one of the major underlying factors in narcotic and other types of dependence. The idea is that addicts have a stronger vulnerability to substance-abuse behaviors than those with no such inclination. Mental illness, previous history of substance abuse, and other environmental factors are undoubtedly important in the development of narcotic addiction.
It is important that patients who use hydromorphone and other narcotic analgesics not stop taking these drugs suddenly. Doses should be gradually tapered down with the help of the prescribing physician. Rapid cessation of these drugs can produce withdrawal symptoms. Although these withdrawal symptoms are not life threatening, they can cause significant discomfort. These symptoms begin with insomnia, restlessness, anxiety, and yawning and progress to more serious symptoms, such as vomiting, fever, sweating, abdominal pain, nausea, diarrhea, muscle aches, and other body pain.
Symptoms begin about 72 hours after the last dose and include anxiety, weakness, increased irritability, muscle twitching, kicking movements, significant backache, hot and cold flashes, anorexia, insomnia, muscle spasm, and intestinal spasm. Additional symptoms can include repetitive sneezing, increased body temperature, increased blood pressure, diarrhea, vomiting, increased respiratory rate, and increased heart rate.
If withdrawal symptoms do develop, some medical approaches can be used to treat symptoms. One approach uses the drug clonidine, which is typically used to treat patients with high blood pressure. Clonidine has been found to lessen some of the withdrawal symptoms. Tranquilizers can be used to treat symptoms such as insomnia and anxiety. Ibuprofen or naproxen can treat symptoms such as muscle ache, headache, or joint pain. Another approach is to replace hydromorphone, or any other narcotic analgesic, with methadone, a narcotic that has long been used to help treat heroin addicts.
The Drug Addiction Treatment Act of 2000 allows opioids to be distributed to physicians for the treatment of opioid dependence. This allows physicians to treat opioid-addicted patients on an individual basis and eliminates the need for the patient to attend a methadone clinic. Patients receiving this treatment should have been opioid-dependent for more than one year, had at least two previously unsuccessful opioid treatment episodes during a calendar year, and had a relapse to opioid dependence after previous opioid treatment. The only currently approved drugs under this act are methadone and levo-alpha-acetylmethadol. The treatment program not only involves drug therapy with these agents but also provides a combination of counseling and rehabilitation activities.

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