<prompt> Treatment of opiod dependence includes:NaloxoneNaltrexoneAcamprostateAll  <response>: B i.e. Naltrexone Management of Opioid related Disorders - Opiate eg heroin toxicity and overdose intoxication management requires IMIV naloxone drug of choiceQ, or nalmefene, suppo of vital functions 02, positive pressure breathing, IV fluids, pressor agents for hypotension cardiac monitoring for QT prolongation and intubation -. In opioid dependent intoxicated patients administration of opioid antagonists eg naloxone nalmefene; both approved for overdoseintoxication may produce signs of opioid withdrawl precipitated opioid withdrawl as well as reversal of overdose. A relative advantage of naloxone is that withdrawl effects are of sho duration ti2 60-90 min in comparison to nalmefene t12 10 hours Opioid related disorder Drugs Used OverdoseIntoxication Naloxone 1st, Nalmefene 2ndQ Withdrawl Symptoms Methadone 1st, Buprenorphine symptomatic relief 2nd, LAAM no longer used, Clonidine Lofexidine 3rd, Benzodiazepines Tramadol Withdrawl Treatment All above Naltrexone for rapid Detoxification detoxifiation; however it cant be used alone Opioid Dependence Methadone , Buprenorphine, Maintenance LAAM no longer used treatment available recommended, Naltrexone to prevent relapseQ Opioid withdrawl syndrome symptoms can be treated by weak or paial opioid agonist such as methadone drug of 1 choiceQ, buprenorphine drug of 2 choiceQ, LAAM not recommended as it prolongs QT interval and a2 adrenergic agonist drugs such as clonidine drug of 3rd choiceQ and lofexidineQ clonidine analogue with less hypotensive effect. Weak or paial opioid agonists act by stabilizing the patient on an equivalent drug with less additionabuse potential, and then the substituted drug is gradually withdrawn. Whereas, a-2 adrenergic agonist drugs are centrally acting sympatholytic agents with no addiction and no narcotic action and relieve opioid withdrawl symptoms by reducing central sympathetic outflow noradrenergic hyperactivity. Opiate withdrawl treatment or detoxification is done by methadone 1st choice, buprenorphine 2nd, LAAM not recommended, clonidine 3rd and lofexidineQ. Opioid antagonist naltrexone combined with az adrenergic agonist is used to shoen the duration of withdrawl with out significantly increasing patient discomfo i.e. rapid ultra rapid opiate detoxification ROD. Another benefit of ROD is reduced time between opioid use and commencement of sustained naltrexone treatment for prevention of relapseQ. Ultrarapid opiate detoxification is an extension of ROD using anesthetics. Alpha 2 adrenergic agonists are primarily used for detoxification treatment of withdrawl symptoms. Weak agonist and paial opioid agonist medications are commonly used for detoxifiation treatment of withdrawl symptoms and maintenance treatment for opioid dependence. Opioid antagonists eg naltrexone are used to accelerate detoxification used in withdrawl treatment but does not treat withdrawl symptoms and then continued post detoxification to prevent relapseQ. Opioid antagonist naltrexone must be staed after detoxification or with a2 agonist, to prevent withdrawl symptoms. For opioid dependence chronic use, FDA approved maintenance treatment include opioid agonists methadone, buprenorphinQ and LAAM not preferred; but theoritically can be given and opioid antagonist naltrexoneQ. Cognitive behavior therapy, psychodynamic interpersonal therapies, self help and 12-step group therapy, behavioral therapies and therapeutic communities help to achieve opioid abstinence. 