Opioid Withdrawal And Detox

Opioid Withdrawal Symptoms

Opioids are medications used to treat pain, but both prescription and illicit forms are often misused for their euphoric effects. Prolonged opioid abuse can lead to dependence and withdrawal, where the brain and body become reliant on opioids to function normally, making it difficult to stop using without experiencing uncomfortable symptoms.

The symptoms of withdrawal depend on several factors, including the type of opioid being abused, the person’s established tolerance to the drug, the length of their addiction, whether they abused multiple substances, and their mental and medical history. Most symptoms of withdrawal are flu-like, such as fever, sweating, and vomiting.

Opioid withdrawal symptoms include:

How Long Does Opioid Withdrawal Last?

Depending on the type of opioid used (short-acting vs long-acting), the amount used, and the duration of use, acute withdrawal can occur within 8-48 hours after the last use.

For example, acute withdrawal symptoms for heroin, a short-acting opioid, occur within 8-24 hours after last use and usually continue for 4-10 days. In contrast, acute withdrawal for methadone, a long-acting opioid, usually occurs within 12-48 hours after the last use and continues for 10-20 days.

The acute withdrawal period is characterized by flu-like symptoms, including muscle and bone pain, stomach cramps, chills, and vomiting. After the acute withdrawal period ends, the protracted withdrawal period may occur. The protracted withdrawal period can last up to 6 months and is characterized by negative affect, cravings, anxiety, anhedonia, depression, and abnormal stress reactivity. This period is when people in recovery are most vulnerable to triggers that can lead to relapse.

Which Medications Are Used For Opioid Withdrawal Management?

Doctors often prescribe treatment medications during the opioid detox process to help with withdrawal management. These medications help treat the acute withdrawal symptoms and can also help reduce cravings and other long-term issues associated with opioid withdrawal. Some medications may be used during the acute withdrawal period.

In contrast, different medications are geared towards long-term recovery and should only be initiated after the acute withdrawal period is over. Medications can be part of the long-term treatment plan for opioid use disorder (OUD), especially when used in conjunction with psychotherapy and social support.

Methadone

Methadone is a long-acting opioid agonist that can be used in the withdrawal period and continued into long-term treatment for OUD.

Methadone is usually initiated in the early withdrawal period to help alleviate and curb any painful opioid withdrawal effects. Dosage can be decreased over time, especially as the person phases out of the acute withdrawal period.

Methadone can be a short-term or a long-term treatment, not only for opioid withdrawal but also for opioid use disorder.

Buprenorphine

Buprenorphine is a partial opioid agonist, meaning that it binds very strongly to the mu opioid receptor but does not have the full agonist euphoric effects or overdose potential compared to a full opioid agonist. It is a first-line treatment for opioid withdrawal management as well as OUD and is an active ingredient in Suboxone.

If a person takes full opioids like morphine or heroin while on buprenorphine, they may experience precipitated withdrawal because buprenorphine blocks the full opioid from binding to its receptors.

Buprenorphine has a low abuse potential and is a safe medication because of its ceiling effect. Its opioid effect, particularly respiratory depression and euphoria, will increase with each dose until it reaches moderate doses, where it will plateau, even with further dose increases. This “ceiling effect” lowers the risk of misuse and overdose.

Clinical assessments must be done before buprenorphine is started in the withdrawal period, since it is known to cause precipitated withdrawal. In general, buprenorphine is administered after patients experience moderate to severe withdrawal, typically 12 to 48 hours after their last opioid use, depending on the type of opioid they are using. Buprenorphine can be used for long-term maintenance treatment for OUD, as it is known to reduce opioid cravings.

Suboxone

The combination of naloxone (an opioid antagonist) and buprenorphine is considered a first-line medication for opioid use disorder. Patients must already be in the early stages of withdrawal before Suboxone is initiated because Suboxone can cause precipitated withdrawal due to both of its ingredients: naloxone and buprenorphine.

Practitioners will not start Suboxone until there is clear evidence of opioid withdrawal and a Clinical Opiate Withdrawal Scale score of 6 or more. Similar to buprenorphine, Suboxone can also be used as maintenance therapy for opioid use disorder, meaning it can be used over a long time period.

Clonidine

Clonidine is a medication used to lower blood pressure, but it is also used off-label to help reduce symptoms associated with opioid withdrawal.

Clonidine works by blocking chemicals in the brain that trigger sympathetic nervous system activity. This reduces uncomfortable symptoms of opioid detoxification, such as sweating, hot flashes, watery eyes, and restlessness. Clonidine can be used with other opioid withdrawal medications as well.

Lofexidine

Lofexidine (Lucemyra) is an alpha-adrenergic agonist and a structural analogue of clonidine. It acts on the central nervous system, which causes sedation, mild pain relief, and relaxation.

Lofexidine is FDA-approved to help treat opioid withdrawal for up to 14 days in adult patients. Unlike clonidine, Lofexidine does not cause low blood pressure, so it may be used as an alternative to clonidine for individuals who cannot tolerate clonidine due to its hypotensive effects.

Which Medications Are Used For Symptom Relief?

Opioid withdrawal comes with a mix of uncomfortable symptoms, including dehydration, nausea, diarrhea, headache, and muscle aches. Over-the-counter medications can help relieve some of these symptoms. Staying hydrated by drinking plenty of water, electrolyte-rich drinks, or hydration solutions like Pedialyte can also help.

Dehydration often occurs due to diarrhea, vomiting, and inadequate fluid intake. Loperamine (Imodium) can help relieve diarrhea, and medications like meclizine or dimenhydrinate can help curb nausea and vomiting.

You can also try antihistamines such as Benadryl to help induce sleep and prevent nausea. Acetaminophen and NSAIDS can help alleviate muscle and bone pain as well as headaches.

Some medical providers may even prescribe antidepressants or benzodiazepines to help ease the withdrawal of opioids, especially if the individual is struggling with anxiety or panic attacks; however, this should be discussed thoroughly with your medical team.

What Should You Expect When Detoxing From Opioids?

Detoxing from opioids can be an uncomfortable and painful experience. Withdrawal symptoms can last from a few days to a week, and you may have a strong urge to use opioids again, which is why this period has high relapse potential.

You may experience flu-like symptoms, have strong cravings to use again, or become very irritable with intense mood swings. It is important to prepare a calm and comfortable environment. Some tips to help make your detox more comfortable include:

• Keep symptomatic medication on hand, such as acetaminophen, anti-nausea, and anti-diarrhea medication.
• Keep yourself comfortable with blankets, pillows, a comfy chair and bed, a room with cool temperatures, a dark sleeping area, etc.
• Trust in your treatment team and be open with them about how you are feeling.
• Find healthy distractions, such as movies, books, and crafts.
• Lean on your support system.
• Stay hydrated and eat to nourish your body.

While discomfort should be expected during opioid detox, doing things to support your physical and mental health can help make the process easier.

Featured Centers Offering Treatment for Opioid Addiction

How Do You Find A Detox Center?

You can use our rehab directory to easily find a detox center that fits your specific needs. Filter your search by selecting detox, location, accepted insurance, and more to discover licensed treatment centers near you. Our directory makes it simple to compare facilities and take the first step toward recovery.

After successfully completing a medical detox program, it is highly recommended to pursue further opioid addiction treatment at an inpatient rehab center.

Inpatient rehabs are equipped with resources that can help you understand the root cause of your addiction. Some treatments include cognitive behavioral therapy, 12-step programs, one-on-one and group counseling sessions, and creative expression activities such as art therapy and music therapy.

The services that inpatient rehab offers, combined with the high levels of around-the-clock care, will help you stay focused and motivated during treatment and beyond.

For more information on your rehab options, explore our rehab directory or contact a treatment provider today.