Opioids and opiates are a type of medication used to treat pain. If a person uses these drugs for longer than a few weeks, their body will eventually get used to the effects. They may become physically dependent on the medication, requiring regular doses to feel normal. If they then suddenly stop taking the medication, they may experience several symptoms. This is called withdrawal.
Opioid withdrawal is not a pleasant experience. Fortunately, there are a variety of medications and treatments available to help treat opioid withdrawal. The safest and most effective treatment being Accelerated Neuro-Regulation (ANR). Learn more about the advantages of ANR opioid withdrawal treatment.
What Are Opioids & Opiates?
Opioids are drugs primarily used to relieve severe or chronic pain. Opiates like morphine are derived from natural plants, and opioids are either semi-synthetic (such as oxycodone), or synthetic (methadone, fentanyl, and similar).
Once taken, both opioids and opiates travel through the bloodstream to the central nervous system, where they bind to opioid receptors. These receptors are found in two locations in the brain:
- The pain pathway. When opioids stick to and activate the opioid receptors in the pain pathway, they stop the brain from receiving pain signals. This way, opioids reduce the perception of pain.
- The mesolimbic reward pathway. When opioids affect the opioid receptors in the reward pathway, they activate dopamine production, which results in pleasure and euphoria.
It’s important to understand that the brain is naturally wired to repeat actions that affect the reward pathway and trigger dopamine release. As such, the risk of opioid dependence is high because opioids alleviate pain and induce a desire to take them again.
How Do People Get Addicted to Opioids?
Opioids are highly addictive not only because they activate dopamine release but also because of decreased endorphin production and opioid tolerance.
Simply put, opioids produce similar effects to endorphins, the natural chemicals that your body releases to decrease pain and increase positive feelings. However, opioids inhibit the production of endorphins while also stimulating the production of opioid receptors. This means that the more you take opioids, the more of them you need for the same effect.
Unfortunately, this can lead to opioid misuse. Medical professionals are often reluctant to increase the preset opioid dosage, as they know how addictive these medications are. In turn, some people decide to take more opioids than prescribed or take them more frequently than instructed without medical supervision. Such misuse of opioids can result in physical dependency, cravings, and addiction.
Causes and Effects of Opioid Withdrawal
In a 2018 survey of the US population, an estimated 808,000 people over the age of 12 reported using heroin during the past year. The same survey found that about 11.4 million people had used narcotic pain relievers without a prescription.
Narcotic pain relievers include, but are not limited to:
- Codeine
- Fentanyl
- Heroin
- Hydrocodone (Vicodin)
- Methadone
- Morphine
- Oxycodone (Percocet or Oxycontin)
- Tramadol
These opioid drugs often cause physical dependence in their users. Dependence means that the individual needs to keep taking the drug, or they will experience opioid withdrawal symptoms. In the long term, an increased dosage of the opioid is needed to create the desired effect. This development is defined as opioid tolerance.
The time it takes to become physically dependent on an opioid varies person to person. When someone stops taking opioids, their body needs time to recover. This detoxification period is called withdrawal. Opioid withdrawal can occur any time long-term opioid use stops or if the regular dosage is lowered.
Symptoms of Opioid Withdrawal
Opioid withdrawal symptoms are often uncomfortable and distressing and in rare cases can be life-threatening. The timeframe for experiencing withdrawal symptoms depends on the individual and the type of opioid they are withdrawing from.
Early symptoms of opioid withdrawal can start as soon as the previous dose wears off and may include:
- Stomach ache
- Agitation and anxiety
- Muscle aches or spasms
- Constricted pupils and watery eyes
- High blood pressure
- Nausea and vomiting
- Insomnia and yawning
- Runny nose
- Sweating
- Elevated blood sugar levels
Late symptoms of opioid withdrawal begin 2-4 days after the last dose and may include:
- Abdominal cramping
- Diarrhea
- Dilated pupils
- Goosebumps
- Nausea and vomiting
- Fluctuating blood pressure
- Depression
Physical Exams and Tests for Opioid Withdrawal Treatment
If you visit a healthcare provider for opioid withdrawal treatment, they will most likely perform a physical exam as well as ask questions about your medical history and drug use. Opioid use can be verified through urine or blood test screening.
Although there is no specific test for opioid withdrawal, a medical practitioner will usually measure opioid withdrawal symptoms using the Clinical Opiate Withdrawal Scale (COWS). Urine might also be tested to rule out withdrawal from any other drugs or combination of drugs. Urine tests can detect the following opioids within 12 to 36 hours after use:
- Morphine
- Heroin
- Codeine
- Oxycodone
- Propoxyphene
Specific tests would need to be performed to detect:
- Methadone
- Buprenorphine
- LAAM (L-alpha-acetylmethadol)
Other drugs are also commonly detected in opiate users, including:
- Marijuana
- Cocaine
- Alcohol
- Benzodiazepine
- Amphetamines
Clinical Opiate Withdrawal Scale (COWS) is used to determine the severity of opioid withdrawal. The COWS assessment is made up of 11 common signs and symptoms of opioid withdrawal.
The scores range from 0 to 47:
- No opioid withdrawal (0–5)
- Mild opioid withdrawal (5–12)
- Moderate opioid withdrawal (13–24)
- Moderately severe opioid withdrawal (25–36)
- Severe opioid withdrawal (37+)
Depending on the healthcare provider, other tests may include:
- Blood chemistries and liver function tests such as CHEM-20
- CBC (complete blood count)
- Chest X-ray
- ECG (electrocardiogram, or heart tracing)
- Testing for hepatitis C, HIV, and tuberculosis (diseases common in opioid addicts)
Opioid Withdrawal Help
Withdrawing from opioids on your own can be very difficult and potentially dangerous. Opioid withdrawal treatment often involves medications, counseling, and support. Withdrawal can take place in a number of settings:
- At-home, using remedies and a strong support system (this method is difficult, and withdrawal should be done very slowly, in compliance with the opioid withdrawal treatment guidelines set by a qualified medical practitioner)
- Detox facility
- Hospital
If you need help overcoming opioid withdrawal, contact the ANR clinic today.
Opioid Withdrawal Treatment
Opioid withdrawal is often very uncomfortable, and many people continue taking opioids just to avoid these unpleasant symptoms. Sometimes those dependent on opioids try to manage the symptoms of withdrawal on their own. This often ends in relapse.
Medical opioid withdrawal treatment in a controlled environment or professional facility, however, can make you more comfortable and lead to a greater chance of success.
Mild opioid withdrawal symptoms can be treated with over-the-counter medications such as:
- Acetaminophen (Tylenol)
- Aspirin
- Ibuprofen
- Imodium
- Hydroxyzine
It’s also crucial to rest and stay hydrated.
A commonly used opioid withdrawal treatment method is substitution and tapering. The opioid on which the patient is dependent is replaced with a similar (but safer) medication. Over a long period, the dosage is gradually reduced until the patient is no longer physically dependent on opioids.
Other medicines can be used during opioid withdrawal treatment to alleviate common symptoms, such as vomiting, diarrhea, and help with sleep.
Most patients need long-term treatment after the initial detox. This can include:
- Groups, such as Narcotics Anonymous or SMART Recovery
- Outpatient counseling
- Intensive outpatient treatment (day hospitalization)
- Inpatient treatment
Any patient going through opioid withdrawal should also be checked for depression and other mental illnesses. Effective treatment of mental disorders reduces the risk of relapse.
Serious opioid withdrawal can be treated with the following prescription opioid withdrawal treatment medications:
- Methadone
- Buprenorphine
- Clonidine
- Lofexidine
- Suboxone
- Codeine phosphate
ANR Treatment for Opioid Withdrawal
If you are suffering through opioid withdrawal or have gone through rapid detox only to relapse, please know it is not your fault. Opioid dependence is not a matter of character or willpower but of a biological imbalance. Accelerated Neuro-Regulation (ANR) is the only treatment that aims to restore your brain’s chemical balance, giving you hope for a future free from drugs.
ANR approaches opioid dependence from a science-based medical perspective. Each opioid withdrawal treatment is tailored to the patient’s individual condition, which ensures the best outcome and diminishes the risk of relapse.
Learn more about how ANR works and how we can help by contacting ANR Clinic today.
Methadone Opioid Withdrawal Treatment
Methadone is a common opioid withdrawal treatment medication which helps relieve opioid withdrawal symptoms. It is often used as a long-term medicine for opioid addiction and dependence.
After a period of using methadone instead of the target opioid (like heroin, for example), the dose is decreased slowly over time. This helps reduce the ferocity of opioid withdrawal symptoms. Some patients unfortunately stay on methadone for years before finally getting clean.
Methadone is taken orally, and the long-lasting effects produce a smoother withdrawal. Methadone is generally safe if care is taken with initial dosing, but doses of 40mg have been fatal to some non-tolerant individuals. As such, the initial dosage of methadone for opioid withdrawal treatment should be less than 40 mg (around 10–20 mg).
If withdrawal symptoms do not ease within 1 hour, more methadone can be taken. Still, the initial dose shouldn’t be more than 30 mg, and the dosage within 24 hours should not exceed 40 mg.
The clinician administering the opioid withdrawal treatment should keep an eye out for signs of drowsiness or motor function impairment. After the patient has stabilized on methadone, the dosage is gradually reduced until they are free from opioid dependence.
Methadone helps alleviate opioid withdrawal symptoms and reduce cravings. It’s useful for detoxification from longer-acting opioids such as morphine. Methadone should be used with caution if the patient has:
- Respiratory deficiency
- Acute alcohol dependence
- Head injury
- Treatment with monoamine oxidase inhibitors (MAOIs)
- Ulcerating colitis or Crohn’s disease
- Severe hepatic impairment
Buprenorphine Opioid Withdrawal Treatment
Buprenorphine (Subutex) is an opioid withdrawal treatment medication that can shorten the length of detox. Like methadone, it is also used for long-term maintenance therapy.
Combined with naloxone (brand names: Bunavail, Suboxone, Zubsolv), it can help prevent opioid dependence and misuse. Buprenorphine quickly alleviates withdrawal symptoms and reduces opioid cravings.
The Food and Drug Administration (FDA) approved sublingual (placed under the tongue) buprenorphine in 2002 for opioid withdrawal treatment. Buprenorphine is safe and long-acting when taken sublingually.
However, it may bring on early withdrawal symptoms if taken too soon after an opioid agonist. The patient should wait at least 12 hours after short-acting opioids and 36 hours after methadone. Buprenorphine can then serve to effectively relieve opioid withdrawal symptoms.
Buprenorphine can also be useful in emergency department environments. Heroin detox, for example, can be managed by administering 2–4 mg of buprenorphine after mild-to-moderate withdrawal. A second dose of the same amount can then be taken 1 to 2 hours later, depending on the patient and their comfort level. Usually, a total of 8–12 mg of buprenorphine is enough in the first 24 hours.
For most people going through opioid withdrawal, slowly reducing the buprenorphine dosage over a week or two is a safe opioid withdrawal treatment strategy. If the withdrawal symptoms worsen, then the dose of buprenorphine is too high for the level of withdrawal.
Symptoms can then be treated with clonidine and other buprenorphine doses stopped for at least 6–8 hours. Patients with severe opioid habits may not experience withdrawal relief from buprenorphine, even at doses of 16 mg, but most will respond to the addition of 0.1 mg of clonidine every 4–6 hours.
A recent systematic review compared buprenorphine to other opioid withdrawal treatment medications. When compared with clonidine, buprenorphine was more effective in treating withdrawal symptoms. Patients stayed in treatment longer and were more likely to complete a full withdrawal. When compared to methadone opioid withdrawal treatment, buprenorphine produced similar results, but withdrawal symptoms were resolved faster.
Because it is a partial opiate agonist, buprenorphine should only be taken after withdrawal symptoms have presented themselves (e.g., at least eight hours after the last heroin dose).
Furthermore, buprenorphine must be used with caution in patients with:
- Respiratory deficiency
- Urethral obstruction
- Diabetes
Buprenorphine dosage must be reviewed on a daily basis and adjusted based on symptoms and side effects. The higher the patient’s dependency dosage, the more buprenorphine is required to manage opioid withdrawal symptoms.
Suboxone Opioid Withdrawal Treatment
Suboxone is a combination of buprenorphine and naloxone used for opioid withdrawal treatment. The blocker does not produce many of the other effects of opioids, and naloxone is added to prevent misuse and people injecting the drug.
If injected, suboxone will cause immediate withdrawal. This makes the combination less likely to be abused. When taken orally, suboxone can be used to treat opioid withdrawal symptoms and shortens the detox period caused by more dangerous opioids.
Codeine Phosphate Opioid Withdrawal Treatment
As an opiate itself, codeine phosphate alleviates opioid withdrawal symptoms and reduces cravings.
Use codeine phosphate with caution if the patient has:
- Pulmonary insufficiency in the lungs
- Impaired liver function
- History of addiction to codeine
Pregnancy and Opioid Withdrawal Management
Abusing opioids during pregnancy can have several harmful effects on the mother and fetus, or neonate. Abstinence treatment for pregnant mothers is usually not available, so methadone maintenance is the standard approach to opioid withdrawal treatment.
A baby may be dependent on methadone at birth and may sometimes need to go through withdrawal. If withdrawal from methadone opioid withdrawal treatment is carried out during pregnancy, it should be done slowly within the second trimester.
Pregnancy increases the metabolization of methadone and decreases the half-life of plasma. Clinicians must balance the risk of relapse if the dose is too low for the mother and the risks surrounding neonatal abstinence syndrome (NAS) for the baby if the dose is too high. Splitting the dosages is one method used in an attempt to combat these problems.
Pregnant methadone-maintained women have been found to decrease narcotic use and experience improved health and prenatal care. Continued use of alcohol, tobacco, cocaine, marijuana, and other illegal substances only served to diminish the results.
Buprenorphine maintenance is a more recent development, with over 300 pregnancies studied. Buprenorphine appears comparable to methadone-maintenance therapy.
One study showed that babies born to buprenorphine-maintained mothers had shorter hospital stays compared to mothers on methadone. The long-term effects of buprenorphine maintenance for pregnant women are yet to be determined.
Rapid Detoxification for Opioid Withdrawal
Rapid detox is rarely done these days because it only manages withdrawal symptoms and does not treat the actual root cause of drug addiction. Opioid-blocking drugs, such as naloxone, are administered under anesthesia.
Some evidence states that this opioid withdrawal treatment method decreases symptoms, but rapid detox doesn’t always impact the time spent suffering opioid withdrawal. Most doctors hesitate to use the rapid detox method, as vomiting often occurs during withdrawal, greatly increasing the risk of death. More often than not, the risks outweigh the potential benefits.
Rapid Opioid Detoxification Under General Anesthesia
A variety of medications have been used to treat opioid withdrawal under general anesthesia, including:
- Nalmefene
- Propofol anesthesia
- Midazolam
- Ondansetron
- Octreotide
- Clonidine
- Benzodiazepines
The opioid withdrawal treatments involving general anesthesia were carried out on an inpatient or even outpatient basis in an attempt to further decrease the time needed for withdrawal. Post-procedure treatment was different for every patient. Claims were made about low relapse rates, but no solid evidence exists.
Significant withdrawal symptoms were shown to persist for days or even weeks, and there was no longer-term improvement three months later. Fluid in the lungs was common during the procedure, and over a dozen deaths have been reported as a result—often within 72 hours.
FAQ About Opioid Withdrawal Treatment
ANR treatment is the safest and most effective treatment for opioid use disorder. Unlike other methods, ANR treatment focuses on the root cause of opioid dependence and restores your brain to its pre-addiction state by repairing the endorphin receptor balance.
Most commonly, the medication used in opioid withdrawal treatment includes opioid agonists (e.g., methadone), partial agonists (for example, buprenorphine or naloxone), and alpha-2 adrenergic agonists (such as clonidine).
Typically, opioid withdrawal symptoms begin between 8 and 24 hours after the last use and last from 4 to 10 days. The exact timing depends on the type of opioids used, the usage method (e.g., snorting, injecting, etc.), the amount of opioids taken during each use, your medical history, and other similar factors.
You should never consume alcohol when taking morphine. Both of these substances are depressants, and mixing them intensifies their effects.
Consumed together, alcohol and morphine can affect your central nervous system, respiratory system, heart rate, and more, leading to an increased risk of overdose and severe side effects. These may include dizziness, panic, difficulty breathing, kidney failure, coma, and death, among others.
Key Takeaways
If you or your loved one is experiencing opioid withdrawal symptoms, seeking opioid withdrawal treatment can help manage these symptoms and lead to successful lifelong recovery.
Before you go, let’s reiterate the key points mentioned in this article:
- Opioid withdrawal, characterized by symptoms such as nausea, sweating, and diarrhea, happens when the body is detoxing after long-term opioid use or after reducing the regular opioid dose.
- Medication-Assisted Treatment (MAT) using drugs like methadone, buprenorphine etc. is often used to alleviate opioid withdrawal symptoms
- Methadone maintenance treatment is the most common opioid withdrawal treatment for pregnant women.
- Rapid detox isn’t an effective opioid withdrawal treatment because it only treats the symptoms—it doesn’t address the cause of opioid dependence.
Dr. Waismann identified the biological roots of opioid dependency, Since then he has successfully treated more than 24,000 patients worldwide that are struggling with opioid addiction.
Throughout his career, he has lectured and educated health professionals in dozens of countries around the world to this day.
