#Medication For Opioid Use Disorder

[patriciafortunato]

I wrote about some personally meaningful topics here and here.

Thank you to wonderful colleagues and friends.

[sopranoentravesti]

Sorry to be a member of the intelligentsia on main, but I’m really not interested in hearing your takes on psychology or neuroscience when you get all your information from YouTube videos and refuse to read a book or a paper on whatever your chosen topic du jour is

[intheroomblog]

Effective Opioid Addiction Treatment at Fitchburg Center

Discover expert care at Fitchburg Comprehensive Treatment Center, offering specialized opioid addiction treatments. Through a combination of Medication-Assisted Treatment (MAT) and personalized counseling, we help individuals on their path to recovery. Our professional team provides a safe and supportive environment tailored to your needs. Experience transformative care with us today.

[shrinksinsneakers]

I recently had an interesting discussion with one of our residents about the risk of developing schizophrenia after experiencing substance-induced psychosis. 

[macgyvermedical]

Harm Reduction Ideas for Substance Use Disorder

Recently I have been listening to a podcast called The Curbsiders Addiction Medicine. If you are a clinician that works even sometimes with people who use substances (every clinician ever), it is a fantastic look at all the harm reduction practices you can use to make these individuals safer. Plus, you get free CME.

I’m hardly going to do the podcast itself justice with this post, but I wanted to share some things I learned from it:

If the dangers of using substances (social and legal consequences, time commitment, health problems, money problems, etc…) was a deterrent, people wouldn’t be doing it. But it’s not. Because uncontrolled substance use is a chronic disease that generally does not get better without treatment. When people are treated, not only do they generally use less, but they have a much lower chance of death and a much higher chance of a happy, productive life- whatever that means for the patient.

Previously (even a few years ago) we hung such treatment on the requirement that people be abstinent from substances in order to receive help. This works for some people, but far from everyone.

The evidence shows that best thing we can do for many individuals is to make their use safer and less of a burden on their life and health. This is called harm reduction, and it WORKS.

Here are some evidence-based ideas for how to help your patients:

Create a space where you are working together with your patient and following your patient’s lead. Do they want to become abstinent? Great! Do they want to use less or use in a more controlled way? Also great! Do they want to continue use in a safer way? You guessed it, also great! Support them in whatever their goal is

Provide or prescribe safe, clean tools of use. Things like clean needles, Pyrex pipes, and straws. This decreases rates of infection and abscesses

Prescribe medications that reduce cravings or reduce/eliminate withdrawal (methadone, buprenorphine, topiramate, bupropion, naltrexone) without requiring abstinence

Teach people safer use practices and safer routes, such as rectal (booty bumping) or oral (parachuting) instead of injection drug use

Prescribe PrEP if people are at risk of HIV without requiring abstinence

Test for and treat the consequences of substance use (such as HIV and Hep C) without requiring abstinence

Provide fentanyl and xylazine test strips so people know what is in the substances they are using and can adjust doses/use pattern accordingly

Recommend Never Use Alone hotlines to prevent overdose death or better yet, take turns using with a buddy

Prescribe naloxone to anyone who uses any substance- nearly all street drugs are contaminated with synthetic opioids and naloxone is an effective way to prevent deaths

People use substances for a reason, especially early in their journey- pain, coping with depression/other mental illness, ADHD, and social issues like being unhoused. Treat the problem if you can find it, and you can help people significantly decrease use or use in a more controlled way

Be aware that return to use (or return to uncontrolled use) is a thing you can plan for with the patient and manage before it even happens

It’s hard sometimes to change the idea of addiction/substance use disorder as something that can only be treated as a reward for staying sober. But thats why so few people seek treatment for it. The evidence does not equivocate. Harm reduction WORKS.

[allthecanadianpolitics]

A study conducted by the B.C. Centre for Disease Control has found that prescribing medical-grade opioids dramatically reduced the rates of deaths and overdoses for drug users living in B.C. The study, published in the British Medical Journal, is described as "the first known instance of a North American province or state providing clinical guidance to physicians and nurse practitioners for prescribing pharmaceutical alternatives to patients at risk of death from the toxic drug supply." Researchers looked at anonymized health-care data of 5,882 people between March 2020 and August 2021, all of whom had opioid or stimulant use disorder. Those individuals filled a prescription under the B.C. Risk Mitigation Guide — clinical guidance developed in March 2020 to allow for physical distancing during the COVID-19 pandemic, and to reduce deaths through harm reduction.

Continue Reading

Tagging @politicsofcanada

[lifewithchronicpain]

Many patients have horror stories to share about their experiences in hospital emergency rooms, where they’ve been treated as drug seekers and denied opioid pain medication.

“I had a broken arm and was given nothing for pain when leaving the emergency room,” one patient told us. “They now treat everyone like a drug seeking addict even if you have legitimate pain!”

“My last ER visit has caused me PTSD. It was awful they put me in a room and turned the light off and left me there for hours,” said another.

“The emergency rooms are horrible,” said a patient with a fractured rib. “I wasn’t even asking the ER for meds. I wanted an x-ray or something because I was in excruciating pain.”

A new study found that the risk of developing addiction or opioid use disorder after being treated with intravenous opioids in the ER is quite low – less than one-tenth of one percent (0.002%).

Out of 506 patients treated with IV opioids in two Bronx emergency rooms, only one met the criteria for long-term or persistent opioid use six months later.

“These data suggest that the use of IV opioids for acute pain among opioid-naive patients is extremely unlikely to result in persistent opioid use,” wrote lead author Eddie Irizarry, MD, an emergency medicine physician at Montefiore Medical Center.

I’ve had many an ER visit in the past where I needed an opioid and they kept refusing until eventually they realize that I really do. It was fucking torture and I’m so glad I don’t have those flares anymore that put me in the ER.

[writers-potion]

i was wondering if you could give some points and tips on writing about a character who is suffering from DRUG ABUSE

Writing A Drug Addict Character

Know Your Drugs

Was the drug invented? A scene using insulin set in 1820 is problematic since this treatment wasn’t discovered until the 1900s. Fentanyl shouldn’t be used in a 1930s scene since it wasn’t available for use until the 1960s—opium or morphine would be more accurate choices.

Was the method invented? Since insulin must be given as a shot, that scene is even less authentic as the hypodermic needle wasn’t invented until the mid-1800s. Older historical fiction could involve the use of poultices and mustard packs, while skin drug patches (transdermal patches) are only appropriate in more modern scenes.

The most common drugs abused by gangs are: Marijuana, Methamphetamine, Heroin, Cocaine

Or, it can be prescription drugs

Although many medications can be abused, the following three classes are most commonly abused:

Opioids—usually prescribed to treat pain;

Central nervous system (CNS) depressants—used to treat anxiety and sleep disorders; and

Stimulants—most often prescribed to treat attention deficit hyperactivity disorder (ADHD). (common example? caffeine)

Write In Stages

Stage 1: First Use

Some people use a substance for the first time out of curiosity, while others use substances due to peer pressure. People may also be prescribed medication, such as opioids, by their doctor. Individuals may view their first use as a one-time occurrence, but this opens the door for future use. Some people try a substance one time and never use it again. 

You character will feel:

Angry and/or desperate

Miserable

Lonely

Trying to run away from a certain problem

Persuaded into doing drug

Guilty

Stage 2: Regular Use

If a person uses a substance and enjoys how it makes them feel or believes it will improve their life, they may start to use the substance regularly. They may use drugs or drink alcohol on the weekends while at parties or hanging out with friends. Occasional use may become a regular occurrence. It might become a part of a person’s routine.

Your character:

Will start getting in careless activities while doing drugs

Will probably be violent

Won’t think he has any issue whatsoever and shrug it off

Start associating themselves with harder drug users

Have a false sense of security that they’re able to quit whenever they want.

Stage 3: Risky Use

The next stage after regular use is risky use. A person will continue to use a substance despite the physical, mental, legal or social consequences. Their use likely started as a way to escape or have fun with peers but has now taken priority over other aspects of their life.

Your Character will feel:

uncomfortable around family members/friends who start to notice

Exhibit more reckless behavior

Driving under influence, stealing money to finance substance use, etc.

Underperforming at work or school

Experience tension in personal relationships

Stage 4: Dependence

The next stage is a physical, mental and emotional reliance on the substance. The individual is no longer using the substance for medical or recreational purposes. When a person doesn’t use the substance, their body will exhibit withdrawal symptoms, such as tremors, headaches, nausea, anxiety and muscle cramps.

Your Chracter Will:

Develop a sort of rountine/typical place where they abuse

Believe that the substance is essential for survival

Use substance even when it's unnecessary

Stage 5: Substance Use Disorder

While some people use dependency and substance use disorder interchangeably, they’re very different. Once a person develops a substance use disorder, substance misuse becomes a compulsion rather than a conscious choice. They’ll also experience severe physical and mental side effects, depending on the substance they’re using.

Your Character:

Has noe developed a chronic disease with the risk of relapse

Is now incapable of quitting on their own

Feel like life is impossible to deal with without the substance.

Lose their job, fail out of school, become isolated from friends and family or give up their passions or hobbies.

Research the Trends

Medical knowledge changes over time and with it the drugs prescribed. This then impacts the type of prescription drugs available on the streets.

late 1800s: chloral hydrate used for anxiety and insomnia > bromides > 1920s: barbiturates, barbital > benzodiazepines ("benzos") > early 2000s: opiod drugs > opiod drug bans led to growth of black markets: ilicit fentanyl > and so on...

Different countries/locations will have varying trends of drug abuse (depending on laws, availability, costs, etc.)

Research the Slag

look for "[drug name] trip report" on YouTube, etc. to get first-hand accounts of how drug addicts behave.

The main focus should always be to use the words your characters would use in ways that suit the world you have created.

The slang for certain drugs is a difficult vocabulary to maintain as it is ever-changing and varies based on country, region, town, even by streets. Some writers use what they know or have heard locally, others invent their own.

Resources

FDA (Food and Drug Administration) and DEA online databases and drug resources

Social networking groups focusing on related specialty writing topics, such as trauma or emergency medicine

Newspaper articles and medical journals are great places to find real cases.

The US national poison center 

Helpful Vocab:

Addled - sense of confusion + complete lack of mental awareness

Crazed - emotional anguish experienced by the addict

Desperate

Despondent

Erratic

Fidgety

Hopeless

Impressionable

Struggling

[transmutationisms]

I was reading your porn addiction post, and I just wondering what you consider addiction if not some sort of disease? I also think porn addiction and stuff in that vein is fake but I also can’t think that addiction is just people choosing to be that way even though they hate it. I say this as someone who was actually addicted to substances like I feel like there was something going on there that can’t be explained by the idea that addicts just choose to be like that. (I don’t think you think addicts just choose to be like that I just don’t really know any alternative schools of thought lol) I don’t mean this in an accusatory way I’m sorry if it comes off that way, I am genuinely curious what you think cause your posts are always so enlightening.

first of all you have to keep in mind that 'addiction' has no singular meaning. even if we confine ourselves to talking about psychoactive substances, 'addiction' can range from the 'classic' case of increasing, compulsive, self-destructive use, to cases where a person's usage may actually be stable in the long term but they're chemically dependent on the substance (think: the way doctors talk about chronic pain patients who are dependent on opioid painkillers; then compare to how they talk about psychiatric patients who are dependent on SSRIs. for example). you can get dx'd with a 'substance use disorder' purely on the basis of how much you take/consume, even if you don't feel it's causing impairment in your life, particularly if you let slip that someone else in your life has expressed concern or tried to stop you. race and class contribute to distinctions here as well, where certain people have leeway to be seen (even in a psychiatric setting!) as 'experimenting' with substances, or using them 'recreationally', where the same usage pattern in a person who's otherwise marginalised might be flagged as 'addictive' and in need of intervention. all of this gets even messier when psychiatrists and physicians try to justify applying discourses of 'addiction' to eating, gambling, sex, social media, and so forth. recall that 'addiction' in the roman republic and middle ages had contested legal and augural meanings that could be positive as well as negative, and that by the seventeenth century it was largely used as a reflexive verb with a predominantly positive meaning—as in, "we sincerely addict ourselves to almighty god" (thomas fuller, 1655) or, of plato, "he addicted himself to the discipline of pythagoras" (thomas hearne, 1698). it was not until the twentieth century that "addict" came to be widely used as a noun defining people who were passively suffering on a medical model.

i don't mean to be evasive here but to point out that asking "how do we define addiction besides a disease model?" presumes already that the disease model is the singular and inescapable way of understanding addiction in the first place—this is not true historically or presently. addiction is a muddled concept and has always involved moral discourses; attempts to present it as a 'pure' or 'objective' medico-scientific judgment are in fact recent and still unstable.

to the extent that it is useful to talk about addiction as a disease—that is, as a state of suffering that is imposed upon the sufferer, that is a disruption of a desired state of health and well-being—i think it is critical to keep in mind that such a disease is social as much as biological. you can start here by pointing out that substance use is often precipitated by the necessity of withstanding miserable life conditions (ranging from extreme poverty, domestic abuse, social marginalisation, &c, to the 'standard', inherently alienating and miserable conditions anyone endures in capitalist society). but there are other social factors that contribute to the presentation of substance use as compulsive, escalating, and self-endangering. eg, lack of a safe, steady supply is a huge factor here! when people are forced to rely on inconsistent, unregulated supplies to get high, this contributes greatly to drug 'binge' behaviours and endangers users. there is also the fact that drug users are often already marginalised (esp along lines of race, class, ability, &c) and are then further marginalised on the basis of being drug users. what would substance use look like in a society where using didn't relegate people to the social margins, or render them socially disposable? what if people had social supports, and weren't forced to toil away their entire lives at jobs that make them miserable for pay that's barely enough to live on? what sorts of patterns of substance use would we see then? so then, is it the drugs themselves that are the problem here, purely neurobiologically? or is there a larger story to tell about how people come to exist in such a state where substance use is increasingly hard for them to engage in with safeguards; where being a substance user causes them to lose whatever degree of social connection and support they may have had, which was often insufficient already; where they are often unable to integrate substance use into a full and connected life because they are told they must either give up enjoyment of a substance entirely, or be continually branded 'relapsing', 'non-compliant', 'dangerous', &c &c.....?

at the end of the day i don't think it's helpful or accurate to talk about addiction as a disease because it decontextualises drug use from all of these factors: why people do it, why it becomes harmful for some, why it's assumed we must simply 'stop' and 'resist' in order to 'get better'. disease explanations blame the substances themselves on a reductive bio-mechanical level (& again, this becomes especially untenable philosophically when we think at all about 'behavioural addictions'). the point here isn't to say that addicts are just blithely waltzing into addiction—or, indeed, to say that drug use is intrinsically a bad thing that should be avoided! it's a pretty typical feature of human existence that many of us enjoy consuming substances that alter our mental and physical states, and that's not inherently bad. when i push back against a disease model of addiction, i'm not invoking a model of personal responsibility or individual choice. i'm asking how we can understand drug use within a much broader social and historically contextualised frame, and how that can help people who are in many different states wrt drugs, from 'currently engaging in patterns of usage that feel compulsive and terrible' to 'never done a drug in their life'.

[genderqueerdykes]

I'm so glad to hear your surgery went well, lots of good luck for your recovery <333 i'm chronically ill myself and went through the whole being treated like trash by the ER staff song-and-dance too while looking for a diagnosis (i was also on the verge of death), so i was really scared for you when i saw you liveblogging your experience. But again, really happy that everything went well for you in the end ! :)

hello there! thanks for sending such a kind message!

i'm sorry you've been through it too. i totally understand that working in an ER is a horrific job. i know that the nurses and staff have to put up with an insane amount of stress, even from patients who are "well behaved". i understand that there are many people who come into the ER who expect to be treated right away, treated like they're special, or handed all the best medications right away

i saw many people in there who would literally get pissed off when the nurses would bring them tylenol, aspirin or ibuprofen instead of opioids. i watched an older woman literally start SCOWLING and her tone turned completely bitter and hateful once the nurse brought her some aspirin for her pain. a man sitting next to me started grumbling angrily because he overheard the nurse bringing me oxycodone and got pissed off that he wasn't getting any. it bothered me that so many people in there were clearly just trying to get handed opioids despite not being in a lot of pain. i get that there were a lot of people in here who were upset because they weren't getting high and i get how that could be upsetting to the nurses.

i wasn't getting high- i was in way too much pain and in hysterics. i wasn't having fun. it really upset me to overhear that people near me thought i was having a "good time" or having fun or just there to get high off of pills. like it made me really uncomfortable to hear that people around me were literally getting jealous over me being given oxy for an ungodly amount of pain. i get that many people can be rude and expect special treatment, i'm never going to sit here and say that being an ER staff member is easy by any stretch of the imagination. i DO understand that drug seeking people do exist, and i witnessed a lot of them in that ER, but it doesn't mean that you should treat the drug seeker, or anyone else like shit. drug seeking can still be a sign of a greater problem and people who engage in this type of behavior deserve to be talked to like people instead of treated like absolute shit. even if the behavior was affecting me, personally, i still don't think someone who goes to the ER specifically to seek drugs should be treated in a subhuman manner

but when i told the surgical staff about how i was being treated, they were utterly appalled. one of the nurses told me that she understands that compassion fatigue is a thing, and that burnout happens, but too many ER nurses resort to become so cold and bitter than they're just mean to their patients because they view them as a nuisance, and start viewing everyone as whiny drug seekers or people who are faking for attention. it's not good, i feel like when one gets to that point it's a good idea to switch jobs. being burnt out isn't a sign that you're weak or have bad character, it just means that you're overwhelmed

it really bothers me that ER staff tend to want to look down on patients who are there and assume that they're seeking attention. my best friend told me one of her friends got told it was "faking a stroke" because borderline personality disorders "make us do funny little things for attention." how the hell do you even fake a stroke? you can't fake the entire left side of your body drooping and failing to function

overall i'm sorry that you have received that treatment as well, there's no reason for you to get ignored or treated like garbage for being sick. i didn't want to worry anyone but i wanted to liveblog my experience to show how difficult it can be to be chronically ill, especially in America, and how people do not take health problems seriously-- even certain medical professionals

the fact that a nurse decided to get pissed off at me and berate me for becoming hysterical from pain was just out of this world. i told her that i wasn't sure how much longer i could wait because the ER waiting room was freezing cold and loud as hell (eveveryone either had several people there with them to talk to, were on the phone/facetime or were blasting music or videos from their phones), and that sitting upright in the chairs was making the pressure and pain in my abdomen worse... she decided to snap at me instead of offering even a modicum of comfort

she scoffed and went "well if you leave, and your symptoms come back, WHICH THEY WILL, you're going to have to come right back here and start all over again. we can't make special exceptions just for you, you wouldn't keep your place in line, you'd have to start all over again and wait all over again. you're an adult, you can make your own decisions, but it's just going to be the same thing all over again if you leave."

she could've went "hey, i get it, it's really stressful in here. surgery is busy and we're going to get you in there as soon as we can, it's just very busy right now." or something like that or at least checked to see if i was due for pain medication, but instead she just got mad at me for "whining". i told a member of the surgical staff team about this and her response was "they're completely discompassionate down there- there's no compassion whatsoever, they just don't... care." as much as it was shocking to hear her say that, it was validating, because it was true

i hope you don't have to deal with that again the next time you need help, i hate it when chronically ill people get branded as annoying, drug seekers, fakers, etc. because that's literally what chronic illness is. just because our situations are complicated doesn't mean people should throw their hands up in the air and give up and consider you a burden. you shouldn't have to go through that in the first place

thanks for your kind message i appreciate it! best of luck in your future care as well, it's not right for anyone who's sick to be turned away or treated like garbage. the focus should be on the patient's care, not the ER nurse's feelings or assumptions about that person. yes medical professionals are human and deserve to have their emotions respected, but they should never supersede the safety and well being of someone who is sick, whether or not they're on death's doorstep or not. take care of yourself, thanks for stopping by!

[bethanydelleman]

Trope exploration: Man, usually a war veteran, with PTSD drowns his sorrows in alcohol

I was rewatching one of my favourite shows and I was struck by the fact that the main male character had severe Posttraumatic stress disorder (PTSD)* and yet didn't drink because it seemed like a big trope subversion. This made me wonder about the real world comorbidity** of substance use disorder (SUD) and PTSD, so I could determine if this common association was a reflection of real life or a trope.

PTSD & SUD co-occur at a rate of about 30-55%

(many of these studies are in veterans, source, source, source)

However, this is SUD in general, which means it includes any abuse of a drug, including but not limited to alcohol. The highest rates of PTSD are in cocaine and opiate users. Also, and this is very interesting, the direction of causation is unknown (does the substance or the PTSD come first):

Although PTSD and SUDs appear to be strongly linked, little is known about the nature of their relationship. The most widely held explanation of their frequent co-occurrence is the self-medication hypothesis. This hypothesis is based primarily on clinical observation and posits that traumatized individuals attempt to use substances in order to dampen traumatic memories, or to avoid or “escape” from other painful symptoms of PTSD. A second hypothesis, the high-risk hypothesis, posits that individuals with SUDs, because of high-risk lifestyles, are likely to experience a trauma and are, therefore, more likely than the general population to develop PTSD. Finally, a third hypothesis, known as the susceptibility hypothesis, states that substance use increases an individual's susceptibility to developing PTSD following a trauma. (source)

It was also noted as important that most patients who suffered from PTSD had multiple traumatic events in their lives, beginning in childhood. Also, more men had SUD than women, which holds true in the general population as well.

I think one of the best representations in popular media of PTSD might be The Hunger Games. They have SUD/PTSD Haymitch and the Morphling (opioid abuse) victors, but Katniss and Peeta deal with their experience in other ways, as do the others that we see. Also, it's clear that most of the victors have repeated trauma: Katniss's father dying and nearly starving to death; Peeta's childhood abuse; and Haymitch being forced to have a front row seat to subsequent games.

Conclusion: at most, only about 50% of patients with PTSD abuse a drug of any kind, less of them abuse alcohol. So it would be both interesting and scientifically valid to see more characters with PTSD who are not constantly drinking. Men are more likely to have substance use disorders, so the trope is partially supported.***

*Comorbidity is when two disorders happen in the same person at the same time. There are many conditions that are likely to co-occur, like depression and generalized anxiety disorder or Type 2 diabetes and obesity.

**Symptoms of Posttraumatic Stress Disorder, taken from one of the sources above:

The characteristic symptoms of PTSD can be divided into three clusters: avoidant, intrusive, and arousal symptoms. Examples of intrusive symptoms include unwanted thoughts or flashbacks of the event. Avoidant symptoms include, for example, attempts to avoid any thoughts or stimuli that remind one of the event. These symptoms are particularly relevant to this review because substances of abuse are often used by individuals with PTSD in an attempt to avoid or escape memories. Arousal symptoms generally include exaggerated startle reflex, sleep disturbance, and irritability, and are generally associated with hyperactivity of the autonomic nervous system.

***I'm not saying that this trope is bad or that we shouldn't see any people with PTSD resorting to substance abuse in media. Instead, I'm saying that the amount of people with PTSD who use alcohol as a coping mechanism is lower than most people probably think, and it would be interesting to see other representations of PTSD as well. PTSD & SUD are most likely commonly paired together in media because it's an easily visible sign of internal suffering.

Also, varied displays of different disorders are important, in my opinion. We don't want someone thinking they don't have PTSD or that a loved one doesn't have PTSD because they don't also have a problem with alcohol.

[intheroomblog]

Medication-Assisted Treatment: Pros And Cons Of MAT For Recovery

Medication-Assisted Treatment (MAT) offers a balanced approach to Medication addiction recovery by combining medications with counseling. MAT can reduce withdrawal symptoms and cravings, helping patients stabilize their recovery journey. However, MAT may not suit everyone, as some fear reliance on medications or potential side effects. Understanding MAT’s advantages and challenges is essential for making an informed choice about addiction treatment.

[macgyvermedical]

Reference Guide to Writing Drug Withdrawal

So your character has a substance use disorder (or physical dependence to a substance for another reason). This post will tell you how to write a scene (or story) in which they go through withdrawal.

NOTE: THIS POST DOES NOT INTEND TO COVER ANYTHING EXCEPT WITHDRAWAL, WHICH IS A VERY SMALL PART OF SUBSTANCE USE DISORDER AND PHYSICAL DEPENDENCE.

Substance Use Disorders and Physical Dependence:

Substance use disorders are chronic illnesses in which a person continues to use a substance (commonly nicotine, alcohol, cocaine, opioids like heroin or fentanyl, benzodiazepines, etc...) even when acquiring or using the substance can be dangerous or cause significant problems in their life (such as problems with money, safety, law enforcement, job security, child services involvement, or physical problems like wounds, infections, side effects, hangovers, and withdrawal). Substance use disorders are a common cause of physical dependence.

Physical dependence is also it's own problem and can occur for other reasons too. For example, many people take prescription medications that they would go through withdrawal from if stopped abruptly (say, because the pharmacy couldn't fill it in time and they ran out). Assuming that the medication is being taken as prescribed, physical dependence in itself does not mean someone has a substance use disorder.

So what is withdrawal? Withdrawal (sometimes called "detox") is the process by which a body stops being physically dependent on a substance. Generally speaking, it is unpleasant. This is because when a body is exposed to a substance repeatedly, it changes how it functions to accommodate that substance. When the substance is removed, there is a period of time where the body has to re-adjust to not having the substance.

For example, alcohol is very similar to the neurotransmitter (brain chemical) GABA. If you drink a lot of alcohol (more than about 4 drinks per day) for longer than about a month, the body decreases the amount of GABA it makes naturally to accommodate the "fake" GABA from the alcohol. If the alcohol is suddenly removed, the body doesn't have enough GABA, and the effects of not having enough GABA result in withdrawal symptoms.

The difference being, someone taking a medication they no longer want to take can slowly reduce the dose to minimize withdrawal symptoms. Someone with a substance use disorder usually finds cutting back nearly impossible. Because of this, managing physical dependence in someone with substance use disorder generally means giving them a similar substance which they get from a pharmacy and take continuously (methadone, buprenorphine), or a similar substance they can then taper off of in a controlled way (benzodiazepines, gabapentin).

Specific Withdrawal Syndromes:

Alcohol/Benzodiazepines:

These are the only two substances that result in a potentially life-threatening withdrawal syndrome, and it's essentially the same syndrome. As stated above, when taken for either 2 weeks for benzodiazepines or 4 weeks for alcohol, the body decreases the amount of GABA it produces naturally. GABA is the "brake pedal" in the brain, slowing things down and decreasing the amount of activity. If you don't have enough GABA, you get too much activity, which can result in severe anxiety, insomnia, seizures, hallucinations, high blood pressure, temperature, and pulse rate, heart arrhythmias, and confusion.

6-12 hours after a person's last drink, they will experience insomnia, anxiety, tremors, and headache.

12-24 hours after a person's last drink, if untreated with benzodiazepines or gabapentin, they may start to experience hallucinations (they typically know they are hallucinating at this point).

24-48 hours after a person's last drink, if untreated, they may start to experience seizures.

48-72 hours after a person's last drink, if untreated, they may start to experience a severe symptom known as delerium tremens. This is a state where they are hallucinating severely and they don't know they are hallucinating anymore. This is also a state where the person has heart rhythm problems that could result in death. This is the most dangerous period during withdrawal.

If a person makes it through 72 hours, they are usually in the clear as far as life threatening symptoms go, though they may experience mild symptoms like headaches and insomnia for long periods afterwards.

Note that medication for alcohol or benzodiazepine withdrawal like other benzodiazepines, phenobarbital, and gabapentin are given only for the first 5 days of withdrawal, tapering to lower doses each day. This gets the person through the dangerous part hopefully with no life threatening symptoms. It does not mean all symptoms are controlled, but they are hopefully kept on the milder end while the brain learns to make it's own GABA again.

Opioids:

Opioids include a range of drugs including prescription medications like oxycodone, hydromorphone, and morphine, as well as street drugs like heroin. Today, the street drug supply in many places is heavily adulterated. Many samples of heroin (and even "pressed pills" made to look like prescription opioids) contain the much stronger opioid fentanyl (which increases risk of overdose) and the sedative xylazine (which causes wounds) in addition to the expected heroin or oxycodone.

Opioids work by pretending to be endorphins- another neurotransmitter usually used by the body to reduce pain and stress. Similarly to GABA in alcohol use, the body reacts to having sustained high amounts of fake endorphins by decreasing the amount of endorphins it makes itself. This means, when the opioids are no longer present, the body can't make itself feel good or recover from pain.

There are many parts of the body that endorphins work in, including the brain, gut, nerves, and spine. When they are removed, symptoms include:

Nausea and vomiting.

Diarrhea.

Insomnia.

Anxiety.

Increased body temperature.

Racing heart.

Muscle and bone pain.

Sweating.

Chills.

High blood pressure.

There is not really a universal timeline for these symptoms like there is with alcohol. For someone who primarily uses short-acting opioids, withdrawal begins 8-24 hours after the last use (though anxiety and cravings can start much sooner). For people who primarily use long-acting opioids, withdrawal can take up to 36 hours to begin following the last use. Generally, symptoms peak within 1-3 days after they start, and acute symptoms last 10-14 days.

Unfortunately, someone who has an opioid use disorder will frequently experience cravings for very long periods of time (potentially the rest of their life) after they stop use. For this reason, people do significantly better at reducing or stopping use over the long haul if they are taking an opioid replacement drug like methadone or buprenorphine.

Methadone and buprenorphine are prescription medications that a person goes somewhere each day to get (methadone) or picks up each day from the pharmacy (buprenorphine). The drugs essentially make it so the person won't go into withdrawal and will have significantly fewer cravings for as long as they take the drug.

The management of opioid withdrawal is usually done by switching the person from a street drug to one of these opioid replacement drugs. However, it is important to note that methadone doesn't work immediately (usually it takes about 2-5 days of titrating it up to get it to a high enough dose to work, longer if the person has a very high tolerance). Buprenorphine requires a certain amount of time in withdrawal (usually a day or two) before it can be given, or it can make withdrawal worse instead of better (something called precipitated withdrawal).

Once someone is on one of these medications, they can choose to stay on them (recommended) or taper off (nice to be off meds in theory, but high rates of return-to-use).

Cocaine/Amphetamines:

Instead of pretending to be a neurotransmitter, stimulants like cocaine and amphetamines prevent the body from re-absorbing the neurotransmitter dopamine, leading to a whole bunch of it hanging out in the brain. This increases concentration and energy and boosts mood. However, taken over long periods of time, the brain kind of burns out and fails to respond to the high levels of dopamine.

You may have heard that amphetamines and cocaine don't have withdrawal states. That would be a myth. People who use stimulants repeatedly for long periods frequently have a withdrawal that is essentially the opposite of the effects of stimulants- they feel very tired, have trouble focusing, and feel depressed because their brains can't use dopamine the same way they did before the drug use. This may last for weeks after cessation of stimulants.

Unfortunately, unlike with alcohol and opioids, there's not a ton that can be done for this withdrawal. There have been several studies, including testing medications like the antidepressant mertazapine, the migraine medicine topiramate, as well as naltrexone and buproprion (also an antidepressant).

In Conclusion:

There is so much more to drug use, substance use disorder, and physical dependence than I am covering in this post. I am just covering a small part of physical dependence, however the cause, by discussing the effects and common treatments for withdrawal.

Thank you all for reading this far! I hope you learned something and will use it in your writing!