Samiksha Jaiswal (Editor)

Drug withdrawal

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Covid-19
Specialty  psychiatry
ICD-9-CM  292.0
MeSH  D013375
ICD-10  F10.3-F19.3
eMedicine  article/819502

Drug withdrawal is the group of symptoms that occur upon the abrupt discontinuation or decrease in intake of medications or recreational drugs.

Contents

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.

Substances

Examples (and ICD-10 code) of withdrawal syndrome include:

  • F10.3 alcohol withdrawal syndrome (which can lead to delirium tremens)
  • F11.3 opioids, including methadone withdrawal
  • F12.3 cannabis withdrawal
  • F13.3 benzodiazepine withdrawal syndrome
  • F14.3 cocaine withdrawal
  • F15.3 caffeine withdrawal
  • F17.3 nicotine withdrawal
  • Prescription medicine

    As noted above, many drugs should not be stopped abruptly 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.

    References

    Drug withdrawal Wikipedia


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