CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF OPIOID DEPENDENCE Or. Shiv Gautam 1 , Dr. I.D. Gupta 2 , Dr. Amit Nijhawan 3 , Dr. Vikas Gaur 4 INTRODUCTION The problem of drug abuse is in existence in most of the societies over the world since the time Immemorial. However, the problem has become more complex and alarming in the recent years. (Gautam S et al 2000). Of the various substance use disorders, opioid dependence syndrome has a significantly major impact on mortality and morbidity. Over the past few years, scientific progress has changed our understanding of the nature of opioid dependence and its various possible treatments. Drug dependence is a chronic illness treatable if the treatment is well delivered and tailored to the needs of the particular patient. There is indeed an array of treatments that can effectively reduce drug use, help manage drug cravings, prevent relapses and restore people to productive social functioning. The treatment of drug dependence will be part of long-term, medical, psychological, and social perspectives. (Baltieri et al.2004). There are historical reports on the use of opioid such as those descriptions of Assyrian 'poppy' art dating from 4000 BC and from studies of Egyptian, Greek, and Persian cultures. The term opium derives from the Greek word for 'juice' and refers to juice from the poppy plant Papaver somniferum (Gold MS, 1993). In the nineteenth century, millions of Chinese people became addicted to opium after smoking, eating, drinking, or sniffing it. Purified derivatives of poppy latex, such as morphine, were available. Named after Morpheus, the Greek god of dreams, morphine was isolated from opium in 1806 by Serturner. In rapid succession, many of 20 distinct alkaloids of opium were isolated, including codeine in 1832 and papaverine by Merck in 1848, with many of these alkaloids continuing to be used and abused. With the availability of parenterally administered opiates and the invention of the hypodermic syringe, opiate addiction and opiate withdrawal distress became major worldwide public health problems (Fernandez H. 1998). The recent trends show several changes in habits and behavior, including a frightening increase in the use of drugs throughout the world.This has included an increase in opioids as drugs of abuse (Cangenclam MW et al. 2001). Epidemiology Use of illicit opioids around the world: In 1994 the United States (U.S.) Office of National Drug Control Policy (ONDCP) reported some key trends in heroin use; more teenagers and young adults and more middle-and upper-middle-class people were using purer heroin, and the proportion of people seeking for treatment continued to increase. Around 2000- 2001 the number of opium or heroin abusers was estimated at almost 15 million (0.2%) of the world population). 1 -Professor, 2-Asstt. Professor, 3-Research Associate, 4-Resident Doctor Psychiatric Centre, SMS Medical College, Jaipur (13)