Brief Answer:
buprenorphine can be tried, please contact AIIMS

Detailed Answer:
Dear XXXXXXX

Thank you for your query.

Opium or Morphine is a class of drugs called opiods. Once a person develops an addiction to a substance (nowadays, the term used is 'dependence'), it becomes very difficult to stop taking it. On stopping, some symptoms appear, like lacrimation, yawning, vomiting, pupilary dilation, goose skin, sweating, fluctuating blood pressure, irritability, agitation, irritability, low mood etc. which are known as withdrawal symptoms appear. Your fried seems to have developed withdrawal symptoms.

Patients who come to me with this condition, I usually prefer to admit and treat him with a gradually decreasing schedule of low potency opioid drugs like buprenorphine (methadone is used in some centres). First the drug is uptitrated to alleviate the withdrawal symptoms, then gradually reduced at every 1- 2 week interval depending upon clinical picture of patient. Most patients will need a very low dose drug for very long durations, may be life long (called Oral substitution therapy-OST).

Accordingly in my opinion, it would be difficult to manage his symptoms without a visit to a psychiatric / deaddiction centre and the aforementioned drugs. Therefore I suggest that your friend visit one such centre at the earliest. NIMHANS Bangalore and AIIMS Delhi are the very best centres in our country.

Besides the aforementioned treatment, he will also need supportive psychotherapy, behavior therapy and motivation enhancement therapy. An attempt is to be made to find out the roots and consequences of drug taking behavior (like familial or marital discord, underlying psychiatric disorders like anxiety, attention deficit etc) and rectify them as much as possible with the help of medical, family and social interventions.

I would also encourage you to harbour a positive outlook about the entire matter. This is definitely going to be difficult. But with support from friends and family like you, your friend has chance to be relieved of his drug taking behavior. However the chances of positive treatment is unlikely without visiting deaddiction centre.

Hope I have been able to satisfy your query. please feel free to contact me further for any clarifications.

Best of luck
Dr. Sourav.

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Brief Answer:
2- 8mg per day under medical supervision

Detailed Answer:
Dear XXXXXXX
The starting dose ranges from 2 to 8 mg per day in divided doses. But the exact dose has to be decided by a qualified expert after thorough examination of the patient's condition.
The drug partially blocks the opium receptors in brain, to prevent the withdrawal symptoms from occurring.
I would advice you to consult a deaddiction specialist for the needful. Self medication May be XXXXXXX in this case, besides being useless.
Best of luck.
Dr. Sourav.

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Brief Answer:
urgent referral needed,sedative for time being

Detailed Answer:
I can understand your problem completely. But unfortunately, this kind of a situation may become a medical emergency, and needs professional intervention urgently, and can't be managed at home. Since your patient is from a village in Haryana, I would suggest you to ask the family members/ friends of the patient to accompany him to any of GMC Chandigarh or PGI Chandigarh or PGIMS Rohtak (whichever is nearer to you) for admission and management of the condition.All these institutes offer very good management of these cases.

If a patient would have come to me with these issues,I would have suggested a sedative injection(like inj. Lorazepam) to be given for the time being to manage the irritability and dysphoria while the patient is transported urgently to any of the above facilities. If a visit to the nearest centre is not feasible, he can visit his family physician who can prescribe the above mentioned therapy.

Hope I've been able to satisfy your query. Best of luck.
Dr. Sourav.

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