Opioid Withdrawal Medication & Side Effects
Opioids or opiates or 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 is through Accelerated Neuro-Regulation (ANR). Discover the advantages of ANR opioid withdrawal treatment.
Causes and Effects of Opioid Withdrawal
In a 2018 survey of people in the USA, 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:
- Hydrocodone (Vicodin)
- Oxycodone (Percocet or Oxycontin)
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 withdrawal symptoms. In the long term, a higher dosage of the opioid is needed to create the desired effect. This is called opioid tolerance.
The time it takes to become physically dependent on an opioid varies between subjects. When someone stops taking opioids, their body needs time to recover. This recovery period is called ‘withdrawal’. Withdrawal can occur any time long-term opioid use stops, or if the regular dosage is lowered.
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Symptoms of Opioid Withdrawal
Opioid withdrawal symptoms are often uncomfortable and distressing, but unlikely to 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
- Elevated blood sugar levels
Late symptoms of withdrawal begin 2-4 days after the last dose and may include:
- Abdominal cramping
- Dilated pupils
- Nausea and vomiting
- Fluctuating blood pressure
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, urine is almost always 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:
Specific tests would need to be performed to detect:
- LAAM (L-alpha-acetylmethadol)
Other drugs are also commonly detected in opiate users, including:
COWS (Clinical Opioid Withdrawal Scale) is often used to determine the severity of opioid withdrawal. The COWS test 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 medicines, counseling, and support. Withdrawal can take place in a number of settings:
- At-home, using medicines and a strong support system. (This method is difficult, and withdrawal should be done very slowly.)
- Detox facilities
- Regular hospitals
If you need help with opioid withdrawal, contact the ANR clinic today.
Medications for Opioid Withdrawal
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 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)
Resting and staying hydrated are also very important.
A commonly effective opioid withdrawal 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 to treat common symptoms such as vomiting and diarrhea, and also help with sleep.
Most patients need long-term treatment after the initial detox. This can include:
- Groups, like 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 and antidepressant medication should be taken as guided by your doctor.
Serious opioid withdrawal can be treated with the following medications:
- Codeine phosphate
Methadone is a common medication proven to help 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 stay on methadone for years before finally getting clean.
Methadone is effective when 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 to treat opioid withdrawal should be less than 40mg (around 10 – 20mg). If withdrawal symptoms do not ease within 1 hour, more methadone can be taken, but the initial dose shouldn’t be more than 30mg. Methadone dosage within 24 hours should not exceed 40mg. The clinician administering the 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 to alleviate opioid withdrawal symptoms and reduce cravings. It’s especially 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 (Subutex) is used to treat opioid withdrawal and 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 is one of the best opiate withdrawal medications, quickly alleviating withdrawal symptoms and reducing opioid cravings.
The Food and Drug Administration (FDA) approved sublingual (placed under the tongue) buprenorphine in 2002 for opioid withdrawal treatment. Buprenorphine is effective, safe, and long-acting when taken sublingually, but 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 – 4mg 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 strategy. If the opioid 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 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 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 latest heroin dose).
Buprenorphine must be used with caution in patients with:
- Respiratory deficiency
- Urethral obstruction
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.
Naltrexone is often prescribed to treat opioid dependence. It works by blocking the negative effects opioids have on the brain and prevents the user from feeling ‘high’. By blocking the pleasurable effects of opioids, naltrexone reduces the cravings usually caused by opioids. It should only be used alongside a comprehensive recovery program including counseling, support groups, and other withdrawal treatment methods recommended by your doctor or healthcare provider.
Naltrexone can trigger withdrawal symptoms if the patient is currently dependent on opioids. To reduce the risk of severe withdrawal symptoms, it’s important to stop taking opioids for a minimum of 7-10 days before taking naltrexone. The length of time will vary between patients depending on the type of opioid addiction, the level of dose/tolerance, and the length of their addiction.
Naltrexone works differently to medication like buprenorphine and methadone that help reduce cravings. Naltrexone blocks the opioid receptors, eliminating any desire to take opioids. Naltrexone users do not get ‘high’, and will not feel the euphoric sedating effects of opioid usage.
Naltrexone is used in three main ways:
- Oral tablet (ReVia, Depade)
- Injectable shot (Vivitrol)
- Implant device
The naltrexone tablet is most common, but the injectable shot and implant device options are becoming more popular.
Naltrexone oral tablet
Required naltrexone tablet dosage will vary from patient to patient and the amount of medicine they require each day. It can be taken at a treatment center, or at home. If taken at home, it is to be done with a supervisor present to administer the doses as scheduled. The dosage should not be adjusted unless your doctor has recommended it.
Naltrexone injection shot
The extended-release naltrexone shot is injected into a muscle each month. A doctor or nurse will administer the medication in a clinical setting. It is common to experience side effects at the injection site. Be sure to see a doctor if the following do not go away or they get worse within 14 days:
Naltrexone abdominal implant
The abdominal implants are small pellets, shaped in the same way as animal feed. A local anesthetic makes insertion less painful. Over time, the implant will release a steady amount of naltrexone into the body for 3 – 6 months. An inpatient treatment setting is necessary to monitor the results.
Clonidine does not help reduce cravings for opioids. It is specifically used to reduce the symptoms of opioid withdrawal, such as:
- Anxiety, agitation, and tremors
- Runny nose and weepy eyes
- Abdominal cramping
Clonidine is less effective in treating symptoms like
- Lethargy and yawning
- Aching muscles
Clonidine is administered in an inpatient setting. Clonidine works by binding to α2 autoreceptors in the locus coeruleus area of the brain, suppressing its hyperactivity as the patient experiences withdrawal. 0.4 to 1.2 mg/day or more, can help reduce the intensity of withdrawal symptoms by 50 to 75 percent.
In comparison to methadone-aided withdrawal, clonidine has more side effects. Low blood pressure, dizziness, and drowsiness are common with clonidine, but methadone is more likely to lead to relapse. In a study of heroin detoxification, buprenorphine had better retention rates and less severe withdrawal symptoms than experienced with clonidine.
Clonidine has mild analgesic effects, meaning extra analgesia may not be needed during the withdrawal period. Clonidine should be used alongside symptomatic treatment as required, but it shouldn’t be used as an opioid substitute.
This method involves high doses of clonidine and benzodiazepines, followed by naltrexone which produces a rapid withdrawal. More clonidine and benzos are then administered to mitigate further opioid withdrawal symptoms. While withdrawal may reduce to 2 – 3 days, there is a lack of evidence around relapse statistics.
Jump to rapid detoxification methods.
A patient with low blood pressure may limit the optimal dose of clonidine for treating opioid withdrawal. Lofexidine is an analog of clonidine and has been approved in the UK. Initial research indicates it may be as effective as clonidine for opioid withdrawal. Combining lofexidine with a low-dose of the opioid blocker naloxone seems to improve symptoms and lowers the chances of relapse.
Suboxone is a combination of buprenorphine and naloxone. The blocker does not produce many of the other effects of opioids. Naloxone works to prevent constipation and 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 Treatment
Pregnancy and Opioid Withdrawal Management
Abusing opioids during pregnancy can have several harmful effects on the mother, fetus, or neonate. Abstinence treatment for pregnant mothers is usually not available and so methadone maintenance is the standard approach.
A baby may be dependent on methadone at birth and 50% of the time will need to go through withdrawal. Fortunately, the risk of birth defects is low as long as healthcare is adequate. If withdrawal from methadone withdrawal treatment is carried out during pregnancy it should be within the second trimester and done slowly.
Pregnancy increases the metabolization of methadone and the half-life of plasma is decreased. 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 out is one method used to combat these problems.
Pregnant methadone-maintained women have been found to decrease narcotic use and experience improved health and prenatal care. Fetuses experienced improved growth and perinatal outcomes. 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 and good fetal outcomes. Buprenorphine appears comparable to methadone-maintenance therapy. One study showed that babies born to buprenorphine-maintained mothers had shorter stays in hospitals 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 or naltrexone, are administered under anesthesia.
Some evidence states that this 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. The risks more often than not 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:
- Propofol anesthesia
The opioid withdrawal treatments involving general anesthesia were carried out on an inpatient or outpatient basis in an attempt to further decrease the time needed for withdrawal. Post-procedure treatment was different for every patient. Claims were made around 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 3 months later. Fluid in the lungs was common during the procedure, and over one dozen deaths have been reported as a result — often within 72 hours.
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 that 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 100% science-based medical perspective. Each treatment is tailored to the patient’s individual condition, and is the safest method to administer opioid withdrawal medication.
Become Opioid Free
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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.