Opioid Withdrawal: A New Look At Medication Options

opioid therapy often results in uncomfortable signs and symptoms of withdrawal. The severity of these symptoms can fluctuate among patients, even among those with similar body mass index, gender, and dosage. Several theories have been proposed regarding the contribution of noradrenergic pathways in the expression of opioid withdrawal.1 In the central nervous system, the major clustering of norepinephrine-producing neurons is in the locus coeruleus (LC). Levels of norepinephrine and its metabolites are altered during opioid dependence, resulting in somatic opioid withdrawal symptoms.1 Other studies have suggested that alterations in the density and sensitivity of alpha and beta adrenergic receptors plays a role.1 Still, others suggest that a mesolimbic dopaminergic system contributes to opioid withdrawal symptomatology.2 In October, Practical Pain Management featured an article by Hymes et al on the use of percutaneous electrical neurostimulation to treat withdrawal symptoms.3 In this article, the authors examine pharmaceutical ways to attenuate withdrawal symptoms. By taking advantage of alphaand betaagonists and antagonist, clincians can provide faster tapers and less withdrawal symptoms—without adding a new medication to patients polytherapy.