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What Are Effective Treatments for Opiate Withdrawal?

The opiate epidemic is a public health crisis. The National Institute on Drug Abuse (NIDA) reports that about 115 people die from an opioid overdose in the United States every day.

For every person who dies, there are many more who seek medical treatment for opioid-related issues. The Healthcare Cost and Utilization Project (H CUP) publishes that the rates of emergency department (ED) visits for opioid-related concerns has been steadily rising over the past several years.

The most effective treatment for opiate withdrawal is medical detox. In these programs, clients are supervised by medical professionals, and they receive medications, therapy, and support during withdrawal. Various self-care methods can support the withdrawal process, but medical detox is the most important treatment.

How Dependence Forms

Opioids make up a drug class that includes heroin and fentanyl as well as prescription pain relievers. These drugs bind to the opioid receptors in the brain, which causes a spike in dopamine levels — the neurotransmitter involved in mood regulation and feelings of happiness as well as movement and sleep functions.

Opiates are considered central nervous system depressants. They act as sedatives and slow down respiration, blood pressure, and heart rate. 

Tolerance to opioids can build quickly and with relatively few uses. The person will need to take higher doses for the drug to continue being effective.
Higher doses more often rapidly increase the rate of physical dependence on opiates. One of the side effects of opiate dependence is withdrawal symptoms when the drug wears off. The higher the rate of opiate dependence, the more significant the withdrawal symptoms can be.
Opiate withdrawal symptoms range from physical flu-like symptoms to intense drug cravings and mood swings.
Opiate withdrawal is best treated with medical detox, which allows the drug to safely and slowly process out of the body, often with the use of medications to manage withdrawal side effects. Individuals are then tapered off these replacement medications slowly to avoid uncomfortable symptoms.

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Symptoms of Opiate Withdrawal

The National Survey on Drug Use and Health (NSDUH) reports that in 2016, more than 2 million adults in the United States struggled with opioid addiction. Physical dependence and withdrawal symptoms are signs of addiction.
Addiction is a behavioral disorder and brain disease, in part related to a lack of control over drug use. Physical dependence and withdrawal symptoms can occur separately from addiction and may set in with the regular, medical use of any opiate drug.
Opiate withdrawal can be significant. The longer and more opioid drugs that are taken at a time, the higher the level of dependence is likely to be; therefore, withdrawal symptoms will be more intense. Nonmedical use of an opioid drug or mixing opioids with other drugs can also increase the rate of dependence and complicate withdrawal.
Opiate withdrawal symptoms can include physical symptoms, such as nausea, vomiting, tremors, dizziness, blurred vision, loss of appetite, insomnia, headaches, runny nose and watery eyes, chills and goosebumps, racing heart rate and high blood pressure, yawning, dilated pupils, muscle aches, joint and back pain, diarrhea, and stomach cramps.
Emotional symptoms can be equally intense. They may include depression, anxiety, irritability, agitation, trouble concentrating or thinking straight, memory problems, cravings, and significant mood swings.
The U.S. National Library of Medicine (NLM) publishes that opiate withdrawal typically begins within 12 to 30 hours of the last opioid dose. The exact timeline depends on a variety of factors, including the half-life of the specific drug taken.

Medications to Manage the Process

To manage opiate withdrawal, it is not recommended to stop taking these drugs suddenly, or cold turkey. Instead, the dosage should be slowly lowered, or tapered, over time.
Fast-acting opiates like heroin or OxyContin (oxycodone) can be replaced or substituted with long-acting ones that stay in the system longer. Users are then weaned off these long-acting drugs safely in a controlled manner.
Buprenorphine and methadone are the U.S. Food and Drug Administration-approved for the treatment of opioid dependence. Both are long-acting opioids that can be given during detox to ease withdrawal.
Buprenorphine is a partial opioid agonist drug, which means that it has a weaker affinity for opioid receptors in the brain. While it does still activate them, it does so to a lesser degree. It doesn’t result in a euphoric high, but it still controls withdrawal symptoms and cravings.
Methadone is a full agonist drug, but it has a longer half-life than many traditional opiates. It can, therefore, be taken less frequently to control cravings and withdrawal symptoms.
In addition to opioid substitution medications, the FDA has approved Lucemyra (lofexidine), the first non-opioid drug officially approved to manage opioid withdrawal. Lofexidine is an alpha-2-adrenergic receptor agonist drug that was initially designed to treat hypertension (high blood pressure). It helps to regulate and slow the release of norepinephrine, which may play a role in the hyperactive functions of the central nervous system functions that can make opiate withdrawal so physically uncomfortable.

Additional medications, such as antidepressants, anti-anxiety medications, nonsteroidal anti-inflammatory drugs (NSAIDs), sleep aids, and gastrointestinal relief medications, can all be helpful during opiate withdrawal to manage specific symptoms, such as pain, stomach upset, sleep difficulties, and emotional disturbances.

Medical Detox Benefits

Medications are only part of the puzzle when it comes to opiate withdrawal, as the side effects are not merely physical but also psychological. Due to drug cravings and the intensity of opiate withdrawal symptoms, both physical and emotional, medical detox is the ideal environment to manage all aspects of opiate withdrawal.
A medical detox program offers around-the-clock care and supervision in an environment where safety and security are primary concerns. The difficulties of withdrawal and associated drug cravings make it seem easier to return to drug use and relapse. Medical detox can provide stability and support while the drug processes out of the body.

Medical detox programs are staffed by trained professionals who monitor vital signs and dispense medications as needed to control withdrawal symptoms. Therapeutic methods during medical detox can help with drug cravings, triggers, stress, and emotional lows. Behavioral therapies can provide coping strategies and tools for minimizing relapse.
Supportive care is provided during medical detox. A stable and encouraging environment during the first several days to a week after stopping an opioid drug is essential. It allows the brain and body time to stabilize and regulate before continuing with the intensive work of therapy.

Nurse giving a patient a prescription in a bottle

Self-Care 

Opiate withdrawal can range in severity, duration, and intensity greatly related to the level of dependence.

Significant opioid dependence should always be managed through a medical detox program for optimal safety. Underlying medical conditions or co-occurring mental health issues can also exacerbate and complicate opiate withdrawal, and they need to be managed simultaneously through an integrated treatment program. Milder opiate dependence may be managed on an outpatient basis.

While it is best to enlist the help of a professional when detoxing from an opiate drug, there are ways to ease opiate withdrawal. They include:

  • Taking a hot bath to alleviate stress and provide some physical relief
  • Eating balanced and healthy meals while avoiding caffeine, processed foods, refined sugars, and unhealthy fats
  • Drinking enough water to stay fully hydrated
  • Regulating sleep as much as possible by sticking to a set sleep schedule
  • Engaging in mind-clearing activities, such as breathing exercises, meditation, or yoga
  • Participating in physical activities, such as going for a walk or run to reduce stress and increase natural endorphins
  • Finding a hobby to keep the mind occupied
  • Talking to friends and family and get support when needed
  • Trying body manipulation techniques, such as chiropractic care and massage therapy; both can help pain relief and reduce stress

Before attempting to manage opiate withdrawal at home, know that it can be unpredictable. Again, it is optimally managed through a medical detox program that can offer medical and psychological support.

Opiate drugs should almost never be stopped suddenly. A medical professional is the only person who should set up a controlled taper to wean the drug safely out of the body.

Opiate withdrawal symptoms are typically most intense in the first week or so after stopping an opiate drug and will then start to ease with time. The first few days to two weeks are vital to a sustained recovery.

Opiate cravings, sleep issues, and emotional withdrawal symptoms may continue for a few weeks to even months after detox from an opiate drug. It is essential to have a strong support system in place as well as tools for managing stress and potential triggers.

Sources

(May 2018). FDA Approves the First Non-Opioid Treatment for Management of Opioid Withdrawal Symptoms in Adults. U.S. Food and Drug Administration. Retrieved January 2019 from https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm607884.htm

(March 2018). Opioid Overdose Crisis. National Institute on Drug Abuse. Retrieved January 2019 from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

(October 2018). H CUP Fast Stats – Opioid-Related Hospital Use. Healthcare Cost and Utilization Project. Retrieved January 2019 from https://www.hcup-us.ahrq.gov/faststats/OpioidUseServlet?radio-3=on&location1=US&characteristic1=01&setting1=ED&location2=&characteristic2=01&setting2=IP&expansionInfoState=hide&dataTablesState=hide&definitionsState=hide&exportState=hide

(September 2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved January 2019 from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm

(May 2018). Opiate and Opioid Withdrawal. U.S. National Library of Medicine. Retrieved January 2019 from https://medlineplus.gov/ency/article/000949.htm

(October 2018) Information About Medication-Assisted Treatment (MAT). U.S. Food and Drug Administration. Retrieved January 2019 from https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm600092.htm

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