Treatment Options for Withdrawal from Opioids

Repeat exposures to opioids can cause physical dependence regardless of the reasons for taking the drugs. Dependence is characterized by a series of symptoms that have predictable long-term implications; one of which is withdrawal upon cessation of use. According to the World Health Organization,” In practice, most patients resume opioid use within six months of commencing opioid withdrawal; the implication being that a single detoxification episode should not be promoted as effective treatment.”

When a person experiences withdrawal from opioids, their first response is to take more of the drugs, increasing their tolerance and dependency levels and subsequently, the severity of future withdrawal episodes. It becomes more difficult to stop using the opioids, despite the willpower to quit because the rewarding effects of opioids give them a special propensity to reinforce continued use, while the negative reinforcement of withdrawals works in concert to keep the abuse cycle going.

Withdrawal from opioids is likened to severe flu infection with intense cravings for more opioid drugs, and dysphoria. The varying degrees of intensity, severity, duration, and symptom logy differ by individuals, and the treatment options for withdrawal from opioids should be matched to the individual’s needs and treatment goals.

Symptoms of Opioid Withdrawal

Symptoms of opioid withdrawal include insomnia and anxiety.

Opioid withdrawal symptoms ensue when a person develops tolerance to opioids and typically emerge within 6-12 hours for short acting opioids such as heroin, morphine, and codeine; and within 24-36 hours for long-acting opioid such as methadone and buprenorphine. Altered brain functions and systems have accumulative effects on neurotransmissions and the residual effects of the opioids drugs can have lasting impacts in the person’s health for a long time.

Symptoms of opioid withdrawal can include:

• Craving
• Pupil dilation
• Diarrhea, vomiting, and nausea
• Anxiety
• Insomnia
• Irritability
• Muscular and abdominal pains
• Tachycardia
• Low or dysphoric moods
• Restlessness
• Tremors
• Weakness and fatigue
• Runny nose
• Teary eyes
• Excessive sweating, chills, and goose-bumps
• Fluctuations in breathing

Matching Patient Needs

Matching patient needs with levels of care necessary to ensure safety and effectiveness involves assessing “the extent, nature, and duration of patients’ opioid and other substance use and their treatment histories, as well as their medical, psychiatric, and psychosocial needs and functional status” according to the SAMHSA.

There are many different types of settings where treatment for opiate withdrawal can be delivered in a safe, comfortable, and controlled manner. Inpatient services are generally reserved as a matter of choice or for those with anticipated complications such as compromised health or other co-occurring conditions such as pregnancy. Traditionally, inpatient settings have longer duration requirements and are more expensive and restrictive in nature than an outpatient setting.

Intensive outpatient services may involve a brief stay in an inpatient setting with follow-ups through an outpatient provider and a great deal of outpatient services can be highly efficient in treating withdrawal from opiates with various levels of care.

Opioid Treatment Programs (OTPs) are recommended settings where the dispensing of methadone or buprenorphine is accompanied by the most up-to-date and accredited practices by the SAMHSA. Whether delivered in methadone clinics or office based treatment settings, these programs provide the long-term detox options that so many opiate dependents require.

Medically Supervised Withdrawal

Although opioid withdrawals are not considered life threatening, some conditions can become severe enough to warrant interventions. Medically supervised withdrawal helps to ensure the safety and comfort of the individual to get them through acute phase using pharmacological agents to provide relief for the withdrawal symptoms in a controlled manner while monitoring the patient’s progress.

Integrating counseling, education, medical, and psychiatric support with adjunct medications to relieve nausea, vomiting, pain, diarrhea, insomnia, and anxiety may be an appropriate treatment options for withdrawal from opioids in those who have a relatively low tolerance. More often than not, however, this proves insufficient in keeping a chronic or long-term opioid dependent engaged in the treatment process.

Long-term Detox Using Methadone or Buprenorphine

According to the University of California, “Over the long term, the mortality rate of opioid addicts (overdose being the most common cause) is about 6 to 20 times greater than that of the general population; among those who remain alive, the prevalence of stable abstinence from opioid use is low (less than 30% after 10-30 years of observation), and many continue to use alcohol and other drugs after ceasing to use opioids.”

According to the SAMHSA, opioid relapse rates are at their highest during the first 3 – 6 months after cessation of use and those “who are opioid addicted have been found to respond best to treatment that combines pharmacological and behavioral interventions.” While there are a wide range of treatment options for withdrawal from opioids, research shows that the integration of methadone or buprenorphine into the opiate detox treatments increases outcome measures including:

• Treatment retention
• Opioid-free urine drug testing
• Decreased opioid craving, intensity, and withdrawal
• Pain reduction
• Adverse effects
• HIV and other risk behaviors
• Decreased overdose and mortality risks
• Improvements in health and social functioning

Some people have been successful using rapid detox methods with naloxone or naltrexone to speed up the withdrawal process, but, these options are not recommended as a first line of treatment. Antagonist drugs precipitate withdrawals which can be severe and as a detox treatment option, are usually administered under anesthesia which has its own levels of danger.