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INNOSC Theranostics and
Pharmacological Sciences Alpha-2A receptor agonist and addiction

by the kidneys. Moreover, the half-life of clonidine varies professionals, who are rarely studied for at least 6 months.
widely, between 6 and 23 h, depending on kidney function. 11 The characterization of OUD treatment outcomes includes
treatment discontinuation, dropouts, relapses, overdoses,
2.1. The off-label use of clonidine to treat opioid and numbers of hospital visits. Return to premorbid
24
withdrawal syndrome functioning socially, jobwise, and in other spheres are not
The off-label use of clonidine to ease symptoms associated investigated as thoroughly as it is for physicians. Physician
25
with abrupt withdrawal from long-term use of opioids, outcomes focus on full recovery and return to work. Thus,
alcohol, benzodiazepines, and nicotine 12,13 is the main topic OUD treatment tends to replace opioids with medications
of this review. Clonidine can alleviate opioid withdrawal such as buprenorphine and methadone.
symptoms by reducing the sympathetic nervous system Physicians and other health professionals are likely
response, including tachycardia, hypertension, sweating, to opt for detoxification from opioids and placement on
hot and cold flashes, anxiety, and general restlessness. long-acting injectable naltrexone. The frequent choice
26
These sedating effects of clonidine may also aid smokers of clonidine may be related to licensure and drug-free
in quitting. However, side effects can include insomnia, job regulations. Clonidine’s choice may also relate to
exacerbating an already common feature of opioid changes in perception and cognitive functioning felt on
withdrawal. Clonidine induces a reduction in blood chronic opioids compared to the effects of detoxification
14
pressure in both normotensive and hypertensive patients and abstinence or detoxification and naltrexone. In the
but may also induce hypotension and postural hypotension highest-risk group of physicians with OUDs, such as
during opioid withdrawal. Notably, clonidine may also anesthesiologists, the decision to treat with naltrexone may
reduce the severity of neonatal abstinence syndrome be directed by the physician health program itself. In this
27
for infants with maternal substance use disorder. 15,16 case, clonidine may be incorporated in post-assessment
Although off-label clonidine has been replaced clinically detoxifications.
by buprenorphine and other treatments, it may improve
16
the Network Neurobehavioral Score in neonatal intensive Clonidine is widely used today as an adjunct treatment
care units for neonatal withdrawal syndrome. 17 for opioid withdrawal, OUD-related craving, and
anxiety, and in the transition to naltrexone for treating
2.2. Better outcomes for impaired health physicians, executives, and other patients with OUDs.
28
professionals: Why? The neurochemical mechanisms of clonidine, especially
Opioid use disorder (OUD) is common and generally related to catecholaminergic activity involving NE and
untreated. Medications and medication-assisted recovery dopamine, provide promising treatments to reverse
have gained support as it is evidence-based, safe, and opioid-induced changes in the locus coeruleus (LC) and
useful. Nevertheless, most adults with OUD do not boost dopaminergic recruitment across this brain region
18
28,29
receive outpatient treatment to address their addiction to attenuate NE hyperactivity.
and remain untreated. At present, outcomes for impaired Although the United States Food and Drug
19
health professionals and others with OUD are markedly Administration (FDA) approved lofexidine, which has
30
20
different, even when receiving the same treatments. Relapse a higher affinity and specificity for alpha-2A adrenergic
to OUD and treatment discontinuation are common receptors, induces less hypotension and other serious
21
among most patients but not among impaired physicians. side effects than clonidine, and does not reinforce opioid
The fear of overdose, slip, or relapse, which can result dependence, the high cost of lofexidine has kept clonidine
in death, may differ due to the fear of losing licensure ahead of lofexidine prescriptions for OUD detoxification. 31
requirements as professional and mandated requirements
to be drug-free. The treatment procedures, follow-up, and 2.3. Opioid withdrawal: Clinical syndrome and
22
case management available to physicians through impaired pathophysiology
health professional programs, including group therapy, Despite effective treatment for opioid addiction, including
caduceus meetings, medication, and particularly random buprenorphine (suboxone) and methadone, most patients
urine testing, contribute to their successful recovery. still relapse into opioid misuse, often resulting in overdoses
22
The usual goal of treatment for OUD is being alive and during these slips and relapses. Acute precipitants, such
taking the opioid agonist or antagonist medication. Urine as stress, exposure to drug-associated cues, or the use of
testing confirmed OUD outcomes for impaired physicians an initially small amount or priming dose of a drug, can
at 80%, with most tested drug-free and functioning at trigger relapses, shorter lapses, and episodes of craving.
premorbid levels at 5-year follow-ups. These outcomes Treatments that buffer the effects of these acute triggers
23
are significantly better than those reported for non-health might improve buprenorphine maintenance outcomes.

Volume 7 Issue 3 (2024) 3 doi: 10.36922/itps.1918