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Opiate treatment for opiate withdrawal in newborn infants

An opiate such as morphine or dilute tincture of opium should probably be used as initial treatment to ameliorate withdrawal symptoms in newborn infants with an opiate withdrawal due to maternal opiate use in pregnancy. Use of opiates (commonly prescribed methadone or illicit heroin) by pregnant women may result in a withdrawal syndrome in their newborn infants. This may result in disruption of the mother‐infant relationship, sleeping and feeding difficulties, weight loss and seizures. Treatments for newborn infants used to ameliorate these symptoms and reduce complications include opiates, sedatives (phenobarbitone or diazepam) and supportive treatments (swaddling, settling, massage, relaxation baths, pacifiers or waterbeds). Trials of opiates compared to sedatives or other non‐pharmacological treatments have generally been of poor quality. Individual trials have reported that using an opiate compared to phenobarbitone may reduce the incidence of seizures, duration of treatment and nursery admission rate. However, no overall effect was found on treatment failure rate. When compared to diazepam, opiates reduced the incidence of treatment failure. Opiates such as morphine or dilute tincture of opium should probably be used as initial treatment for opiate withdrawal in newborn infants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Sedatives for opiate withdrawal in newborn infants

When a sedative is needed to ameliorate symptoms in newborn infants with opiate withdrawal due to maternal opiate use in pregnancy, phenobarbitone is preferred. Use of opiates (commonly prescribed methadone or illicit heroin) by pregnant women may result in a withdrawal syndrome in their newborn infants. This may result in disruption of the mother‐infant relationship, sleeping and feeding difficulties, weight loss and seizures. Treatments for newborn infants used to ameliorate these symptoms and reduce complications include opiates, sedatives (phenobarbitone or diazepam) and supportive treatments (swaddling, settling, massage, relaxation baths, pacifiers or waterbeds). Trials of sedatives have generally been of poor quality. Individual studies have reported that use of phenobarbitone compared to supportive care alone reduces the amount time an infant needs supportive care, is better than diazepam at preventing treatment failure and reduces the severity of withdrawal in infants treated with a opiate. In infants treated with an opiate, the addition of a sedative (phenobarbitone or clonidine) may reduce withdrawal severity, although safety and efficacy need confirming. The long term effects of use of phenobarbitone on an infant's development have not been determined.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Detoxification treatments for opiate dependent adolescents

We reviewed the evidence on the effect of detoxification treatment compared with pharmacological maintenance treatment or psychosocial intervention in achieving abstinence on adolescents heroin dependents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Maintenance treatments for opiate‐dependent pregnant women

Some women continue to use opiates when they are pregnant, yet heroin readily crosses the placenta. Opiate‐dependent women experience a six‐fold increase in maternal obstetric complications and give birth to low‐weight babies. The newborn may experience narcotic withdrawal (neonatal abstinence syndrome) and have development problems. There is also increased neonatal mortality and a 74‐fold increase in the risk of sudden infant death syndrome. Maintenance treatment with methadone provides a steady concentration of opiate in the pregnant woman's blood and so prevents the adverse effects on the fetus of repeated withdrawals. Buprenorphine is also used. These treatments reduce illicit drug use, improve compliance with obstetric care and improve neonatal birth weight but they are still associated with neonatal abstinence syndrome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Methadone at tapered doses for the management of opioid withdrawal

Abuse of opioid drugs and dependence on them causes major health and social issues that include transmission of HIV and hepatitis C with injection, increased crime and costs for health care and law enforcement, family disruption and lost productivity. Addicts, particularly those aged 15 to 34 years, are also at higher risk of death. Managed withdrawal (or detoxification) is used as the first step in treatment. Withdrawal symptoms include anxiety, chills, muscle pain (myalgia) and weakness, tremor, lethargy and drowsiness, restlessness and irritability, nausea and vomiting and diarrhoea. Persisting sleep disturbances and drug craving can continue for weeks and months after detoxification and often lead to a return to opioid use. The number of addicts who complete detoxification tends to be low, and rates of relapse are high.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification

People who abuse opioid drugs and become dependent on them experience social issues and health risks. Medications such as methadone and buprenorphine are substituted to help dependent drug users detoxify and return to living drug free, by reducing physiological withdrawal symptoms (pharmacological detoxification). Yet psychological symptoms can occur during detoxification and may be distressing. It is often a personal crisis that led to a drug user deciding to detoxify. Furthermore the psychological reasons why a person became addicted are important. They may not be able to cope with stress and have come to expect that using mood modifying illicit substances helps. Even after successful return to a drug‐free state, many people return to heroin use and re‐addiction is a substantial problem in rehabilitation. The physiological, behavioural and social conditions in an individual's life that made them an opiate addict may still be present when physical dependence on the drug has been eliminated, which makes psychosocial therapy important. Psychosocial treatments include behavioural treatments, counselling and family therapy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Inpatient versus other settings for detoxification for opioid dependence

Dependence on opioid drugs, such as heroin, morphine, and codeine, is a serious problem in many societies. Opioids are very difficult to quit using. The first step to quitting is detoxification, which can cause a number of painful symptoms as the drug withdraws from the body. Many people choose an inpatient detoxification program rather than trying to stop using opioids on their own. In an inpatient program, medications such as methadone can ease the symptoms of withdrawal and patients are in a secure, supportive environment with no access to opiates. However, inpatient programs are expensive and can disrupt patients' lives. An increasing number of outpatient programs are available, providing medication and some support while keeping the drug user in the community. In addition to drop‐in programs, there are day centres and even residential facilities which are not staffed 24 hours, unlike inpatient programs. The authors of this review looked for research comparing inpatient and other types of opiate withdrawal programs to see which is more effective. They found only one study from 1975, which had 40 participants. The study suggested inpatient therapy might be more effective than outpatient therapy in the short‐term, but all of the inpatients relapsed within three months after detoxification. Since they found only one outdated study which included very few patients, the Cochrane review authors could not conclude whether inpatient treatment is more effective than outpatient or other settings. More research must be done to measure the benefits and costs of inpatient detoxification, especially for more severely dependent users.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Pharmacological therapies for maintenance treatments of opium dependence

Opium is obtained from the unripe seed capsules of the poppy plant. Opium is usually used by smoking or by swallowing to create a feeling of euphoria, to provide pleasure or as an analgesic or hypnotic. Cultural attitudes affect the patterns of opioid use among different countries. In the Middle East and south east Asia, opium is used in many cases in social settings and the users do not suffer from considerable social dysfunction. It is used occasionally and mainly in male gatherings but regular use can cause dependence. Opium users have a more stable life style than heroin users and, of those who come for treatment, a higher proportion are married and live with their family.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Psychosocial interventions to reduce sedative use, abuse and dependence

In this Cochrane review we aimed to measure the effectiveness of psychosocial interventions for treating people who harmfully use, abuse or are dependent on benzodiazepines (BZDs). BZDs are a type of drug that can be used to treat people who have anxiety, panic disorder, insomnia and a range of other conditions. Long term use of BZDs is not generally recommended and can lead to physical and psychological dependence and withdrawal symptoms when patients reduce or stop using them. Previous systematic reviews, examining other drugs like heroin, cocaine or alcohol, have suggested some benefits of psychosocial interventions to reduce these substances. There has been no Cochrane review of psychosocial interventions to reduce BZD use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Use of slow‐release oral morphine for the treatment of people with opioid dependence

Opioid dependence is associated with public health and social problems. People injecting opioids are particularly at risk, not only because they become dependent faster than with other routes of administration but also because they are exposed to consequences such as an increased risk of overdose mortality, infective diseases and health issues. At least three‐quarters of global opiate users consume heroin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Tramadol for neuropathic pain

Neuropathic pain is frequently caused by damage to the peripheral nerves. Symptoms may include burning or shooting sensations, and abnormal sensitivity to normally non‐painful stimuli. Neuropathic pain is difficult to treat. Anticonvulsants and antidepressants are frequently used but their use is limited by side effects. Tramadol is a unique pain killing drug with mild opiate properties.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

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