The Opioid Detoxification Process
Opioids have been long prescribed for pain management. Traditionally, they have been used for both acute (short-term) and chronic (long-term) pain. The epidemic of opioid abuse in our country has encouraged exploring non-opioid therapy chronic pain. This would require an individual to stop taking opioids to participate in a non-opioid pain management treatment. An opioid detoxification program can help.
Even if a person takes opioids as prescribed, over time, the person is at an increased risk for developing an opioid use disorder (OUD). Physical dependence can occur in a short amount of time, or as little as two weeks. Long-term opioid users may struggle with more intense withdrawal symptoms, but an opioid detoxification program can reduce and, in some cases, eliminate these symptoms.
Individuals who want to stop taking opioids for any reason are encouraged to explore options for detoxification. In an inpatient setting, medical professionals find medication that is best-suited for the person in treatment. There are many options available, and a detox program can help determine what may work best.
Medications Used In An Opioid Detoxification Program
There are several medication options used in an opioid detox program that can help relieve withdrawal symptoms. Some of these medications ease withdrawal symptoms by affecting the opioid receptors in the brain (methadone, buprenorphine, and naloxone) and some treat specific withdrawal symptoms (clonidine, anti-diarrheals, anti-nausea meds, and sleeping medications).
Providing as much comfort as possible during the detox process may help lower the potential of relapse. Some of the medications used during an opioid detoxification program are as follows:
Medications To Ease Opioid Withdrawal Symptoms
Methadone: This medication is an opioid, and is often prescribed during detox to relieve withdrawal symptoms. It can also be used as medication-assisted treatment (MAT) for long-term opioid abstinence. Methadone can be tapered down over time and eventually the individual can be completely opioid-free.
Buprenorphine: This medication works on the same opioid receptors in the brain as other opioids, but with a significant difference. It is what is called a partial agonist, which means that it limits the amount of activation in the receptors. This helps to alleviate withdrawal symptoms while not allowing the receptors to activate to levels that would give the person complete euphoric effects.
Naloxone: Usually sold under the brand name Narcan, this medication is typically used to reverse opioid overdose. In an opioid detoxification setting, this medication has been combined with buprenorphine (Suboxone) to help relieve withdrawal symptoms and may help prevent dependence and decrease likelihood of abuse.
Lofexidine Hydrochloride: On May 16th, 2018, the Food and Drug Administration (FDA) approved lofexidine hydrochloride (Lucemyra) to help manage opioid withdrawal symptoms. This medication affects a receptor in the brain that controls norepinephrine release, something that has been thought to affect the severity of opioid withdrawal syndrome. There have been studies to support this as a viable option for treatment for opioid withdrawal syndrome.
Clonidine: In a detox setting, clonidine (Catapres) is used to relieve a number of opioid withdrawal symptoms, such as runny nose, sweating, cramping, muscle aches, anxiety, and agitation. Clonidine can be used as part of an opioid-free detoxification process when appropriate.
Benzodiazepines: Some long-acting benzodiazepines, like diazepam (Valium) and clonazepam (Klonopin), are prescribed to relieve opioid withdrawal symptoms. Benzos can help with symptoms of anxiety, agitation, muscle spasms, and sleep.
Medications To Treat Specific Opioid Withdrawal Symptoms
Symptom-Specific Medications: Medications (both over-the-counter and prescription) to treat specific symptoms of opioid withdrawal symptoms include:
- non-steroidal, anti-inflammatory drugs (NSAIDs)
Many of these medications can help alleviate opioid withdrawal symptoms, but several of these medications have interactions with other medications that a patient may be taking. For example, ondansetron (Zofran) has interactions with 200 other medications, ranging from severe to mild complications.
It is important to maintain communication with the physicians and nurses who are supervising an opioid detox program to ensure patient safety and avoid potential drug interactions.
Opioid Detoxification Timeline
An opioid detoxification timeline can depend on many factors, such as the type of opioid a patient is currently taking, the method used to ingest the opioid, if any other medications are being taken, or if any other substances are being abused.
A short-acting opioid, like heroin, has a shorter half-life, so withdrawal symptoms could start a few hours after the last dose is taken, where a long-acting opioid, like methadone, can take 30 or more hours before withdrawal begins.
After the onset of symptoms, physical symptoms typically peak within 72 hours. The physical symptoms can last up to a week, and the psychological symptoms can vary from two weeks to two years.
Opioid Withdrawal Syndrome Symptoms
The symptoms of opioid withdrawal tend to be the same, regardless of which opioid is taken. However, the length of withdrawal is different depending on the opioid taken, how long it has been taken, and the method of ingestion.
For example, heroin withdrawal symptoms typically appear six to 12 hours after the last dose and can last approximately five days. Methadone withdrawal symptoms can start within 30 hours, and can take over two weeks before they begin to subside. These symptoms can also be more severe if the individual has been misusing opioids for six months or more.
Symptoms of opioid withdrawal syndrome can include:
- hot and cold flashes
- runny nose and sneezing
- watery eyes
- trouble sleeping and restlessness
- anxiety and irritability
- body aches and cramping (muscle, joint, and bone)
- gastrointestinal issues (nausea, abdominal pain, diarrhea, and vomiting)
These symptoms can be worsened or there may be additional withdrawal symptoms if a person is misusing additional substances or narcotics, such as alcohol, benzodiazepines, or cocaine. When a person is having withdrawal from more than one substance at the same time, it is referred to co-current withdrawal, and should be managed in a setting that is supervised by medical staff.
This co-current withdrawal is likely to affect the medications that can be prescribed, so maintaining open communication with those who are supervising the detoxification process is very important.
Finding The Right Opioid Detoxification Program
When a person is participating in an opioid detox program, there are ways to decrease the severity of withdrawal symptoms. Detoxification interventions using medications have proven to be quite helpful.
Opioid use disorder can be different for everyone, which is why individualized care plans are important. Developing a care plan with a medical professional can help treatment outcomes and decrease possibility of relapse. Reach out to us today, and let us help you find a treatment plan that can work for you or your loved one.
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- U.S. Food and Drug Administration (FDA) — FDA approves the first non-opioid treatment for management of opioid withdrawal symptoms in adults
- U.S. National Library of Medicine: MedlinePlus — Opiate and opioid withdrawal