Editing Drug withdrawal

{{Short description|Medical condition caused by drug addiction}}
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'''Drug withdrawal''', '''drug withdrawal syndrome''', or '''substance withdrawal syndrome'''<ref name="MeSH">{{cite web |title=MeSH Browser |url=https://meshb.nlm.nih.gov/record/ui?ui=D013375 |website=meshb.nlm.nih.gov |access-date=7 February 2020 |archive-date=30 July 2020 |archive-url=https://web.archive.org/web/20200730020544/https://meshb.nlm.nih.gov/record/ui?ui=D013375 |url-status=live }}</ref> is the group of [[symptom]]s that occur upon the abrupt discontinuation or decrease in the intake of [[Pharmaceutical drug|pharmaceutical]] or [[Recreational drug use|recreational drugs]].

In order for the symptoms of withdrawal to occur, one must have first developed a form of [[Substance dependence|drug dependence]]. This 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 rather different reaction when [[antidepressant discontinuation syndrome|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 drug use|intravenous]], [[Intramuscular injection|intramuscular]], [[Oral drug|oral]], or otherwise can also play a role in determining the severity of withdrawal symptoms.{{Citation needed|date=May 2023}} There are different stages of withdrawal as well; generally, a person will start to feel bad ([[Comedown (drugs)|crash]] or [[comedown (drugs)|comedown]]), progress to feeling worse, hit a plateau, and then the symptoms begin to dissipate. However, withdrawal from certain drugs ([[barbiturates]], [[benzodiazepines]], [[alcohol (drug)|alcohol]], [[glucocorticoids]]) can be fatal.<ref>{{Cite journal |last1=Leung |first1=Edison |last2=Ngo |first2=Daniel H. |last3=Espinoza |first3=Joe A. Jr |last4=Beal |first4=Lauren L. |last5=Chang |first5=Catherine |last6=Baris |first6=Dalsu A. |last7=Lackey |first7=Blake N. |last8=Lane |first8=Scott D. |last9=Wu |first9=Hanjing E. |date=July 2022 |title=A Retrospective Study of the Adjunctive Use of Gabapentin With Benzodiazepines for the Treatment of Benzodiazepine Withdrawal |url=https://journals.lww.com/practicalpsychiatry/fulltext/2022/07000/a_retrospective_study_of_the_adjunctive_use_of.4.aspx |journal=Journal of Psychiatric Practice |language=en-US |volume=28 |issue=4 |pages=310–318 |doi=10.1097/PRA.0000000000000639 |pmid=35797687 |issn=1527-4160}}</ref><ref>{{cite book|author1=National Clinical Guideline Centre|title=Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications|date=2010|publisher=Royal College of Physicians (UK)|location=London|edition=No. 100|chapter-url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047840/|access-date=9 October 2024|language=en|chapter=2 Acute Alcohol Withdrawal|url-status=live|archive-url=https://web.archive.org/web/20140131202232/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047840/|archive-date=31 January 2014}}</ref> 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 of 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 develop as a secondary consequence of the drug. When the drug is removed, these conditions may resurface and be confused with withdrawal symptoms. Genes that encode for the [[alpha5 nicotinic acetylcholine receptor]] affect nicotine and alcohol withdrawal symptoms.

== Effect on homeostasis ==
[[Homeostasis]] is the body's ability to maintain a certain chemical equilibrium in the brain and throughout the body. For example, the function of [[shivering]] in response to cold is to produce heat maintaining internal temperature at around {{convert|37|°C|°F|sigfig=3}}. Homeostasis is impacted in many ways by drug usage and withdrawal. The internal systems perpetuate homeostasis by using different counter-regulatory methods in order to create a new state of balance based on the presence of the drug in the system.<ref name=":0">{{cite journal | vauthors = Koob GF | title = Drug addiction: the yin and yang of hedonic homeostasis | journal = Neuron | volume = 16 | issue = 5 | pages = 893–6 | date = May 1996 | pmid = 8630244 | doi = 10.1016/S0896-6273(00)80109-9 | s2cid = 7053540 | doi-access = free }}</ref> These methods include adapting the body's levels of neurotransmitters, hormones, and other substances present to adjust for the addition of the drug to the body.<ref name=":1">{{Cite news|url=https://unitedrecoveryproject.com/commonly-abused-drugs/|title=What Causes Drug Withdrawal?|work=Laguna Treatment Hospital|access-date=2018-10-12|language=en-US|archive-date=2018-10-13|archive-url=https://web.archive.org/web/20181013014319/https://unitedrecoveryproject.com/commonly-abused-drugs/|url-status=live}}</ref>

== Substances ==
{{addiction glossary}}
Examples (and [[ICD-10]] code) of withdrawal syndrome include:
* F10.3 [[alcohol withdrawal syndrome]] (which can lead to [[delirium tremens]])
* F11.3 [[Opioid withdrawal]], including [[Methadone#Withdrawal symptoms|methadone withdrawal]]<ref>{{Cite encyclopedia|url=https://medlineplus.gov/ency/article/000949.htm|title=Opiate and opioid withdrawal|encyclopedia=MedlinePlus Medical Encyclopedia|publisher=U.S. National Library of Medicine|language=en|access-date=2019-11-20|archive-date=2019-12-08|archive-url=https://web.archive.org/web/20191208070501/https://medlineplus.gov/ency/article/000949.htm|url-status=live}}</ref>
* F12.3 [[cannabis withdrawal]]
* F13.3 [[benzodiazepine withdrawal syndrome|benzodiazepine withdrawal]]
* F14.3 [[Cocaine dependence#Withdrawal symptoms|cocaine withdrawal]]
* F15.3 [[Caffeine#Dependence and withdrawal|caffeine withdrawal]]
* F17.3 [[nicotine withdrawal]]

== Prescription medicine ==
As noted above, many drugs should not be stopped abruptly<ref>{{cite book | year = 2002 | title = Coming off Psychiatric Drugs | editor = Peter Lehmann | publisher = Peter Lehmann Publishing | location = Germany | isbn = 978-1-891408-98-4 | url = http://www.peter-lehmann-publishing.com | access-date = 2022-05-06 | archive-date = 2019-05-28 | archive-url = https://web.archive.org/web/20190528235308/http://www.peter-lehmann-publishing.com/ | url-status = live }}</ref> 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]], [[cardiovascular disease|heart conditions]] and many psychological or neurological conditions, like  [[epilepsy]], [[depression (mood)|depression]], [[hypertension]], [[schizophrenia]] and [[psychosis]]. The stopping of [[antipsychotic]]s in schizophrenia and psychoses needs [[Antipsychotic#Discontinuation|monitoring]].<ref name=BMJ>{{cite book |editor1-first=BMJ | editor =  Joint Formulary Committee  | title = British National Formulary | edition = 57 | date = March 2009 |publisher=Royal Pharmaceutical Society of Great Britain |location=United Kingdom |isbn=978-0-85369-845-6 |page=192 |chapter=4.2.1 |quote=Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse.}}</ref> The stopping of [[antidepressant]]s for example, can lead to [[antidepressant discontinuation syndrome]]. With careful physician attention, however, medication prioritization and discontinuation can decrease costs, simplify prescription regimens, decrease risks of adverse drug events and poly-pharmacy, focus therapies where they are most effective, and prevent cost-related under-use of medications.<ref name=alexander>{{cite journal | vauthors = Alexander GC, Sayla MA, Holmes HM, Sachs GA | title = Prioritizing and stopping prescription medicines | journal = CMAJ | volume = 174 | issue = 8 | pages = 1083–4 | date = April 2006 | pmid = 16606954 | pmc = 1421477 | doi = 10.1503/cmaj.050837 }}</ref>

Medication Appropriateness Tool for Comorbid Health Conditions in Dementia<ref>{{Cite web|url=http://www.match-d.com.au/|title=MATCH-D Medication Appropriateness Tool for Comorbid Health conditions during Dementia|website=www.match-d.com.au|access-date=2019-06-01|archive-date=2019-05-18|archive-url=https://web.archive.org/web/20190518055626/http://www.match-d.com.au/|url-status=live}}</ref> ([[MATCH-D]]) warns that people with dementia are more likely to experience adverse effects, and to monitor carefully for withdrawal symptoms when ceasing medications for these people as they are both more likely to experience symptoms and less likely to be able to reliably report symptoms.<ref>{{cite journal | vauthors = Page AT, Potter K, Clifford R, McLachlan AJ, Etherton-Beer C | title = Medication appropriateness tool for co-morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel | journal = Internal Medicine Journal | volume = 46 | issue = 10 | pages = 1189–1197 | date = October 2016 | pmid = 27527376 | pmc = 5129475 | doi = 10.1111/imj.13215 }}</ref>

=== Anti-hypertensive drugs ===

The latest evidence does not have evidence of an effect due to discontinuing vs continuing medications used for treating elevated blood pressure or prevention of heart disease in older adults on all-case mortality and incidence of heart attack.<ref name="Reeve_2020">{{cite journal | vauthors = Reeve E, Jordan V, Thompson W, Sawan M, Todd A, Gammie TM, Hopper I, Hilmer SN, Gnjidic D | display-authors = 6 | title = Withdrawal of antihypertensive drugs in older people | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD012572 | date = June 2020 | issue = 6 | pmid = 32519776 | pmc = 7387859 | doi = 10.1002/14651858.cd012572.pub2 }}</ref> The findings are based on low quality evidence suggesting it may be safe to stop anti-hypertensive medications. However, older adults should not stop any of their medications without talking to a healthcare professional.<ref name="Reeve_2020" />

== See also ==<!-- Please respect alphabetical order -->
* [[Chemical dependency]]
* [[Drug detoxification]]
* [[Drug tolerance]]
* [[Hangover]]
* [[Neonatal withdrawal]]
* [[Post-acute withdrawal syndrome]] (PAWS)
* [[Rebound effect]]

== References ==
{{Reflist}}

{{Psychoactive substance use}}
{{Medical resources
|  DiseasesDB     =  
|  ICD10          = {{ICD10|F|10||f|10}}.3-{{ICD10|F|19||f|10}}.3 
|  ICD9           = {{ICD9|292.0}} 
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|  eMedicineSubj  = article 
|  eMedicineTopic = 819502 
|  MeshID         = D013375
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[[Category:Drug rehabilitation]]
[[Category:Substance-related disorders]]
[[Category:Withdrawal syndromes]]