In order to experience the symptoms of withdrawal, one must have first developed a form of drug dependence, which may occur as physical dependence, psychological dependence, or both. Drug dependence develops from consuming one or more substances over a period of time. Dependence arises in a dose-dependent manner and produces withdrawal symptoms that vary with the type of drug that is consumed. For example, prolonged use of an antidepressant medication is likely to cause a much different reaction when discontinued compared to discontinuation of an opioid, such as heroin. Withdrawal symptoms from opiates include anxiety, sweating, vomiting, and diarrhea. Alcohol withdrawal symptoms include irritability, fatigue, shaking, sweating, and nausea. Withdrawal from nicotine can cause irritability, fatigue, insomnia, headache, and difficulty concentrating. Many prescription and legal nonprescription substances can also cause withdrawal symptoms when individuals stop consuming them, even if they were taken as directed by a physician.
The route of administration, whether intravenous, intramuscular, oral or otherwise, can also play a role in determining the severity of withdrawal symptoms. There are different stages of withdrawal as well; generally, a person will start to feel bad (crash or come down), progress to feeling worse, hit a plateau, and then the symptoms begin to dissipate. However, withdrawal from certain drugs (benzodiazepines, alcohol, glucocorticoids) can be fatal. While it is seldom fatal to the user, withdrawal from opiates (and some other drugs) can cause miscarriage, due to fetal withdrawal. The term "cold turkey" is used to describe the sudden cessation use of a substance and the ensuing physiologic manifestations.
The symptoms from withdrawal may be even more dramatic when the drug has masked prolonged malnutrition, disease, chronic pain, infections (common in intravenous drug use), or sleep deprivation, conditions that drug abusers often suffer as a secondary consequence of the drug. When the drug is removed, these conditions may resurface and be confused with withdrawal symptoms.
As noted above, many drugs should not be stopped abruptly[5] without the advice and supervision of a physician, especially if the medication induces dependence or if the condition they are being used to treat is potentially dangerous and likely to return once medication is stopped, such as diabetes, asthma, heart conditions and many psychological or neurological conditions, like epilepsy, hypertension, schizophrenia and psychosis. With careful physician attention, however, medication prioritization and discontinuation can decrease costs, simplify prescription regimens, decrease risks of adverse drug events and polypharmacy, focus therapies where they are most effective, and prevent cost-related underuse of medications.[6]
Evidence of the nation’s opioid addiction problem is not only being found in emergency rooms.
It’s also being noticed in maternity wards, especially those in rural areas in the United States.
A study published today in JAMA Pediatrics reports that the number of babies born with drug withdrawal symptoms from opioids has increased substantially more in rural areas than in cities.
The research coincides with a report last week from the U.S. Centers for Disease Control and Prevention (CDC) that unveiled overdose deaths from prescription and illegal opioids increased once again last year.
That addictive trend, researchers say, is affecting pregnant woman and their unborn babies, especially those in lower income households.
“The opioid epidemic has hit rural communities especially hard, and we found that these geographical disparities also affect pregnant women and infants,” Dr. Nicole Villapiano, a lead author of the study, and a pediatrician at the University of Michigan’s C.S. Mott Children’s Hospital, said in a press release.
Read more: Treating pain inside the
opioid epidemic »
That surge was 80 percent higher than the increase in urban areas.
In addition, the researchers reported infants born in rural areas now account for more than 21 percent of NAS cases nationwide compared to nearly 13 percent in 2003.
They also found that in 2012 opiate use by pregnant women in rural counties was 70 percent higher — 8 per 1,000 childbirth hospitalizations compared to 4.8 hospitalizations in urban counties.
Researchers noted that people in urban areas tend to have better access to treatment and addiction services.
Babies born with NAS are more likely to have seizures and low birth weight as well as breathing, sleeping, and feeding problems.
Dr. Larissa Mooney, an assistant clinical professor of psychiatry at the University of California Los Angeles (UCLA), and director of the UCLA Addiction Medicine Clinic, told Healthline the new study “highlights an important aspect of the opioid epidemic.”
She said the rise in withdrawal symptoms in infants is almost certainly tied to the increase in opioid and heroin use in rural areas.
Mooney added that access to treatment needs to be expanded in rural areas. This includes both preventative education to expectant mothers on opioid use, as well as treatment for pregnant women who are already addicted to prescription drugs.
Impact on babies
The study’s researchers reported that the rate of newborns diagnosed with neonatal abstinence syndrome (NAS) increased in rural areas from about 1 case per 1,000 in 2003-2004 to more than 7 cases per 1,000 in 2012-2013.That surge was 80 percent higher than the increase in urban areas.
In addition, the researchers reported infants born in rural areas now account for more than 21 percent of NAS cases nationwide compared to nearly 13 percent in 2003.
They also found that in 2012 opiate use by pregnant women in rural counties was 70 percent higher — 8 per 1,000 childbirth hospitalizations compared to 4.8 hospitalizations in urban counties.
Researchers noted that people in urban areas tend to have better access to treatment and addiction services.
Babies born with NAS are more likely to have seizures and low birth weight as well as breathing, sleeping, and feeding problems.
Dr. Larissa Mooney, an assistant clinical professor of psychiatry at the University of California Los Angeles (UCLA), and director of the UCLA Addiction Medicine Clinic, told Healthline the new study “highlights an important aspect of the opioid epidemic.”
She said the rise in withdrawal symptoms in infants is almost certainly tied to the increase in opioid and heroin use in rural areas.
Mooney added that access to treatment needs to be expanded in rural areas. This includes both preventative education to expectant mothers on opioid use, as well as treatment for pregnant women who are already addicted to prescription drugs.
Mooney, a board certified addiction psychiatrist, said women
who receive treatment and education are also more likely to engage in other
healthy prenatal practices.
“We need to be proactive,” she said.
Read more: Prescription drugs lead to heroin addictions »
That report noted that more than 33,000 people in the United States died from opioid painkillers in 2015. That’s almost 100 a day.
In particular, the death rate for illegally obtained opioids such as fentanyl — the drug involved in the death of the singer Prince – jumped by 73 percent last year.
By comparison, the death rate involving legal prescription opioids rose by 4 percent.
Federal officials said the lower mortality rate for prescription pills suggests recent efforts to reduce opioid addiction are making progress.
Mooney agreed with that assessment.
She said there has been more media attention and patient education about the potential dangers of opioids.
She added new CDC guidelines on painkiller prescriptions
have helped physicians better understand the problem.“We need to be proactive,” she said.
Read more: Prescription drugs lead to heroin addictions »
Opioid overdose deaths
Mooney said there is a correlation between the increase in NAS cases and the CDC report on opioid overdose deaths.That report noted that more than 33,000 people in the United States died from opioid painkillers in 2015. That’s almost 100 a day.
In particular, the death rate for illegally obtained opioids such as fentanyl — the drug involved in the death of the singer Prince – jumped by 73 percent last year.
By comparison, the death rate involving legal prescription opioids rose by 4 percent.
Federal officials said the lower mortality rate for prescription pills suggests recent efforts to reduce opioid addiction are making progress.
Mooney agreed with that assessment.
She said there has been more media attention and patient education about the potential dangers of opioids.
Mooney said views are changing on prescribing opioids for less serious pain as well as prescribing them for long-term chronic pain.
She said there is now a trend to use opioids only for short-term acute pain.
“The message is becoming more clear,” she said. “We really need to change our approach to treating pain.”
She added when opioids are required, physicians should be careful when prescribing.
“You should start low and go slow,” Mooney said.
She said the overall strategy should be similar to the one for mothers in rural areas.
Access to treatment should be increased as should education for patients and physicians.
The “gold standard” for addiction treatment, she noted, is the use of other, less harmful drugs such as methadone.
Mooney added the $1 billion for opioid addiction programs included in the 21st Century Cures Act approved last week by Congress is a step in the right direction.
“Our approach should be similar to other epidemics,” she said.
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