Substance Abuse and Abuse Q 72
Which medication is commonly used in treatment programs for heroin abusers to produce a non-euphoric state and to replace heroin use?
A. Diazepam
B. Carbamazepine
C. Clonidine
D. Methadone
Correct Answer: D. Methadone
Methadone maintenance programs are used to provide a heroin-depleted individual with a medically controlled dose of methadone to produce a non euphoric state that will prevent withdrawal symptoms. This method of treatment is advocated to help heroin abusers avoid criminal activities associated with obtaining heroin; it also prevents diseases associated with I.V. use of heroin. Methadone is an alternative in treating patients with opioid-tolerance as they may not respond to traditional analgesic regimens. In such patients, methadone dosages are adjusted, or combined with other opioids as adjuvant treatments to enhance response to analgesic interventions.
Option A: Diazepam is an anxiolytic benzodiazepine, first patented and marketed in the United States in 1963. It is a fast-acting, long-lasting benzodiazepine commonly used in the treatment of anxiety disorders, as well as alcohol detoxification, acute recurrent seizures, severe muscle spasm, and spasticity associated with neurologic disorders. In the setting of acute alcohol withdrawal, diazepam is useful for symptomatic relief of agitation, tremor, alcoholic hallucinosis, and acute delirium tremens.
Option B: Carbamazepine may be used for withdrawal from alcohol, barbiturates, and benzodiazepines. In patients with moderate to severe alcohol withdrawal syndrome, carbamazepine has shown to have clinical efficacy in treatment. Researchers proposed that carbamazepine keeps sodium channels in inactivated states, leading to fewer channels to open, and thus inhibits the generation of action potentials.
Option C: Clonidine can be used in acute withdrawal from heroin to avoid norepinephrine rebound when opiates are stopped. Clonidine has multiple off-label uses such as the management of withdrawal symptoms from opioids, benzodiazepines, and alcohol, and for treatment of anxiety, insomnia, and post-traumatic stress disorder (PTSD). Clonidine hydrochloride is an imidazoline derivative that acts centrally on alpha-2 adrenergic as an agonist. The chemical name for clonidine is 2-((2,6-dichlorophenyl) amino)-2-imidazoline hydrochloride.