May 28, 2018
A Look At Withdrawal
By Michael D. Shaw
These days, addiction is a hot topic. Whether it be heroin, cocaine, alcohol, or prescription drugs, the subject is seldom out of the news cycle for long. Yet, we don’t seem to hear too much about that set of symptoms which occur when people attempt to release themselves from the grip of addiction. It used to be called “withdrawal syndrome,” which Stedman’s Medical Dictionary defines as “the development of a substance-specific syndrome that follows the cessation of, or reduction in, intake of a psychoactive substance that the person previously used regularly.”
In the same reference work, one of the definitions of “withdrawal” is “A psychological and/or physical syndrome caused by the abrupt cessation of the use of a drug in a habituated person.” Interestingly, another definition in Stedman’s of “withdrawal” refers to “The therapeutic process of discontinuing a drug to avoid the symptoms of withdrawal.” We should add that undesirable symptoms that might occur after one abruptly stops taking certain drugs—such as the “rebound effects” that can occur with beta-blockers—can also be called “withdrawal.”
Broadly speaking, drugs and alcohol suppress production of neurotransmitters including norepinephrine—known as a stress hormone. When usage stops, there is a surge of epinephrine (adrenaline), and this is a primary cause of what we call withdrawal syndrome. More detail here.
Withdrawal symptoms vary by drug, and are subject to the reaction in a given individual. Physical withdrawal symptoms tend to be worse with alcohol, opiates, and tranquilizers. In high-risk patients, this can be quite dangerous, with seizures, strokes, or heart attacks a distinct possibility. Other drugs such as cocaine, marijuana, and ecstasy tend to promote emotional withdrawal symptoms.
Symptoms of alcohol withdrawal can include the shakes, insomnia, anxiety, excessive sweating, and gastrointestinal upset. In severe cases, delerium tremens can set in, with its own list of nasty symptoms. This should be considered a medical emergency.
Symptoms of opiate/opioid withdrawal can resemble a flu-like illness, with virtually all the features you might expect. The article cited also cautions that long-term intravenous drug users need to be checked for any number of infectious conditions related to the injection sites.
Drugs.com lists and rates 19 meds used in the treatment of alcohol addiction recovery. The same website lists and rates 14 meds for the treatment of opiate/opioid withdrawal. The last drug listed, Lucemyra (lofexidine hydrochloride), was approved by the FDA on May 16th for the mitigation of withdrawal symptoms to facilitate abrupt discontinuation of opioids in adults. Notably, the drug has been used for more than 20 years in the UK, and is a selective alpha 2-adrenergic receptor agonist that reduces the release of norepinephrine. This class of drugs is typically used as an antihypertensive.
Lucemyra is intended to mitigate the symptoms of opioid withdrawal, rather than an underlying dependency. “Today’s approval represents the first FDA-approved non-opioid treatment for the management of opioid withdrawal symptoms and provides a new option that allows providers to work with patients to select the treatment best suited to an individual’s needs,” said Sharon Hertz, M.D., director of the Division of Anesthesia, Analgesia and Addiction Products in the FDA’s Center for Drug Evaluation and Research.
The FDA granted the manufacturer’s application priority review and fast track designations, and the approval comes after an independent scientific panel voted 11-1 in its favor. The FDA is requiring 15 post-marketing studies, including both animal and human studies.
“It won’t completely eliminate symptoms of withdrawal,” said Dr. Mark Pirner, the senior medical director at US WorldMeds (manufacturer of Lucemyra). “But for places and people where withdrawal is perpetuating higher opioid use, then Lucemyra is an appropriate therapy.”