Tuesday July 22nd 2014

Medications for opioid withdrawal

Not everyone who goes through opioid withdrawal is an addict. But opioid addiction can occur even in people who take opioids as prescribed, including low risk opioids like tramadol which cause tramadol symptoms of withdrawal. Here we’ll review medications you can take during acute detoxification and over the long term to help control opioids cravings. Please leave your questions in the comments section below. We’ll be happy to answer them!

What is withdrawal?

Opioids are powerful medications that can help relieve pain. But you can also become dependent on opioids as your body adapts to the presence of the drugs. When you are dependent on opioids, you feel sick if there are no opioids in the body. This sickness is called withdrawal.

Medications for different stages of treatment

Detoxification is the necessary first step to getting opioids out of your body. But there is no reason that you should suffer during detox. In fact, painful withdrawal decreases likelihood that you stop taking opioids. So what will you experience during withdrawal? And what kind of medications do doctors use to treat the two different stages of detox?

During the first stage of withdrawal (acute detoxification) withdrawal from opiates is painful, but not life threatening. The second stage of treatment addresses possible opioid addiction, and uses a different set of medications to help opioid addicts manage cravings and stay off drugs.

1. Acute detoxification and withdrawal from opioids

Certain medications and vitamins for drug withdrawal can be prescribed during the acute stages of withdrawal, when discomfort is the greatest. Opioid withdrawal can last from 7-10 days, and can be painful and difficult. The medications listed below can help ease the immediate symptoms of withdrawal, resulting in better chances for staying off opioids in the long run. We review the most common medications and their uses here.

Anti-diarrheal drugs – These drugs are used to treat diarrhea and can include Diphenoxylate and Loperamide

Antiemetic drugs – This class of drugs helps prevent or reduce nausea and vomiting associated with opioid withdrawal. Two drugs used to manage symptoms of nausea and vomiting include Hydroxyzine and Promethazine.

Buprenorphine – Buprenorphine has been shown to work better than other medications for treating withdrawal from opiates, and can shorten the length of detox. It may also be used for long term maintenance treatment of opioid addiction like methadone (see below).

Clonidine – Clonidine is the most commonly prescribed medication for opioid withdrawal and it helps to controls autonomic symptoms of withdrawal such as restlessness, sweating, runny nose and watery eyes. Clonidine also helps ease anxiety and can shorten overall withdrawal duration.

Dicyclomine hydrochloride – Dicyclomine hydrochloride is used to treat abdominal cramps and cramping experienced during opioid withdrawal.

Methadone – Methadone blocks withdrawal symptoms by binding to opioid receptors in the brain. This stabilizes your brain long enough to get through the detoxification process, but may also be continued during long term treatment.

Methocarbamol – Methocarbamol is used to treat muscle cramps and joint pain.

Trazodone – Trazodone may be prescribed to treat depression and anxiety in people coming off of opioids. Opioid euphoria can become

Buprenorphine (Suptex) has been shown to work better than other medications for treating withdrawal from opiates, and can shorten the length of detox. It may also be used for long-term maintenance like methadone.

2. Longer term opioid addiction treatment medications

Most people cannot just walk away from opioid addiction after detox. Today’s doctors can prescribe medicines that make you feel similar to being on an addictive drug. These medications address the long-term issues associated with opioid withdrawal such as cravings and relapse. Over time, doctors gradually reduce doses and eliminate drugs when you are ready. But in general, these medications are often prescribed over long term treatment periods (longer than 6 months) and then gradually reduced under medical supervision.

Buprenorphine – Buprenorphine occupies opiate nerve receptors where opioids used to bind, essentially tricking the brain into thinking it is still getting the problem opioid. You feel normal on buprenorphine (not high), withdrawal does not occur, and this drug also helps reduce cravings.

LAAM – LAMM is the abbreviated name for a chemical called levo-alpha-acetyl-methadol. LAAM blocks the euphoric effects of stronger opioids while also controlling opiate craving and can suppresses opioid withdrawal symptoms for 48-72 hours or longer.

Methadone – Chemically, methadone is the simplest of the opioids. Like buprenorphine, methadone occupies opiate nerve receptors where opioids used to bind. And it is also used to mimic and block the effects of stronger opioids. Methadone suppresses opiate withdrawal symptoms for 24 hours or longer. An opioid itself, at proper dosing, methadone usually reduces the appetite for and need to take stronger opioids.

Naltrexone – Naltrexone is used after acute withdrawal to help prevent relapse. Naltrexone blocks the effect of opioid drugs so that you don’t feel high if you take opioids again.

Opioid addiction can be supplemented with medicine to make your chances for staying off opioids better. Although some people may see this as drug substitution, people on opioid maintenance programs in the care of a supervising physician can lead normal, healthy lives. At some point in recovery from addiction, we all need help to change addictive behavior into nonaddictive, healthful patterns. Learning to cope with cravings is difficult. But opioid maintenance can give you the balance you need to look at other life issues.

Questions about opioid withdrawal

We hope to have answered your questions about opioid withdrawal medication options. Please let us know if you have any other questions by writing to us. We answer all legitimate requests with a personal response!

Reference sources: University of Utah Addiction Treatments Past and Present
Medication-Assisted Treatment for Opioid Addiction
University of Maryland Medical Center medical encyclopedia on opiate withdrawal
LAAM in the Treatment of Opiate Addiction Treatment Improvement Protocol (TIP) Series 22

Photo credit: Toca Boca

Leave a Reply

17 Responses to “Medications for opioid withdrawal
Matt Pennell
5:42 pm September 28th, 2012

I have 15 Methocarbamol 750 tablets and I want to stop using the opiates. I have been taking roxy 30 mg for about 3 months straight now and I’m hurting myself and my family. I take around 3 per day of the Roxy 30. I want to quit but I suffer so bad with withdrawl that every time I get to the peak of withdrawl I give into taking more to feel better. I would like to know the best way to most effectively use these 15 tablets and wonder if their are any over the counter helps such as a specific vitamins or pain relievers that will help while taking the Methocarbamol. Please help I’m so tired of living like this. Thank you for you help and support. Today I have taken 3 of the roxy already tomorrow I will begin the journey in quitting.

2:54 pm October 2nd, 2012

Hi Matt. Yes, relapse to prevent withdrawal is common. So don’t give up hope! There are treatment alternatives. I’d suggest that you seek help from a medical doctor for a tapering regimen, and also ask about possible treatment during withdrawal using clonidine or buprenorphine while you detox. There is no need to go cold turkey off opiates. But the process should be medically supervised. Also, you may benefit from asking about mental health treatments to address the underlying reasons which compel your use.

You can do it! You are not alone!

Carolina_D
7:16 pm October 22nd, 2012

I have been taking oxycodone for 6+ years now, as prescribed by my doctor. I am ready to quit. I took my last tab on Saturday. I have a scrip for Lomotil cos I have IBS, and it’s a great help. I also have a scrip for an anti nausea drug…zofran that I was prescribed a few months ago for the flu. I haven’t needed it yet, but probably will. It’s oral release, so just dissolves on the tongue. Anyway, I do need some support through this. My doctor isn’t a help at all, he doesn’t approve of what I’m doing as I have ‘real’ pain. But, I’ve read all over the net that opioids will make pain even worse in the long run. I just want to rid my system of this stuff and then re-evaluate 6 months or so down the line. Of course, if after a month my pain levels have INCREASED to the point I can’t do anything, I might re-evaluate sooner. But, it’s been so long since I haven’t used this stuff, I just want to see what ‘normal’ feels like. (I haven’t had any ‘bad’ effects, such as mood disorders, nor have I been abusive towards others, ever. My daughter would be the first to tell me if I were exhibiting any sort of ‘bad behaviour’. I just want to do this for myself. Any advice, it would be appreciated.

Carolina_D
7:22 pm October 22nd, 2012

Oh, BTW, I have been taking 15 mgs. My scrip is written for 240 tabs per month, although I rarely ever use them all in a month. I usually take (took) about 6 per day, max. They are pure oxycodone, no tylenol.
Thanks again for any help.

8:49 am October 24th, 2012

Hi Carolina. The first step is to taper oxycodone. If you’ve done this, the withdrawal symptoms will be less intense and severe. Are you looking for advice on how to withdraw, how to stay abstinent, or how to find oxycodone pain relief alternatives? It’s not really clear how we can help…

Jillian L.
1:18 am April 3rd, 2013

I have used Tramadol when I have run too low on my Oxycontin. It has saved my life. Two days can seem like an eternity, especially when you have a job and a family to take care of. My Dr. prescribed 50mg. I can take 7-8 in 24 hours and I don’t feel the horrific withdraw symptoms. Thank God for this substitute. I’ve never had to use it for more than 2-21/2 days, so I don’t know how it would work for longer. All I can share is my personal experience.

Tom
12:34 am April 4th, 2013

this site is great, It answered all my questions perfectly, I would like to thank you for taking the time to make this site, and i hope it will help others with questions, as it has helped me. I now know what, and how to speak with my doctor about this issue. Again, thank you for your help.

cindi
5:19 pm April 9th, 2013

I would appreciate any information about coming off the Fentanyl 100 mcg patch. I have been on this patch about 4-5 years. The reason I am taking Fentanyl patch is spinal stenosis fibromylgia and degenerative disk disease. I someday would like to get off this horrible patch..it controls my life. Thank you greycat

Flagirl
5:37 am June 20th, 2013

I need some help, I am freaking out…I’m going to a suboxone dr on Friday and I’ve been on pills(oxy30mg six a day) for five years…I am terrified of the withdrawls I’m going to have immediately upon waking up…how will I make it until I can take the subs? Can u die in WD? How long do I really have to wait to take the subs? I’m also petrified of precip withdrawl…Please help ASAP….I can’t find anyone to respond online at all…Thanks so much.

1:20 pm July 3rd, 2013

Hello Flagirl. First, seek medical advice from a doctor who prescribes Suboxone. And know that death during withdrawal is very unlikely. While withdrawal can be uncomfortable, opiate withdrawal usually provokes death in those whose bodies are really worn down after years and years of drug use and cannot handle the severity of changes brought on by withdrawal. Instead of cold turkey withdrawal, try tapering your dose to avoid severe withdrawal. And speak with your doctor about all your concerns.

Micky D
6:59 pm January 23rd, 2014

Will lorazapam, valium, or xanex help to withdraw from oxycodone and other narcotics? How long do I take these drugs? Thank you for your advice.

Kay
3:59 am April 22nd, 2014

I’m curious as to whether or not there is a dangerous drug interaction between clonidine and trazadone.

I have clonidine for blood pressure but stopped taking it several months ago with BP under control.now I have trazadone for sleep and it works great.

I want to get off the opiates and I believe that clonidine and trazadone might really help to break my physical dependence. I am not addicted, but AM physically dependent. I want to get off the opiates asap and believe the combination clonidine and trazodone may well help me

Have you read or heard anything that the two are dangerous to combine for opiate withdrawal? I’ve read a lot of the opposite until I checked a drug interaction checker!

Peace

9:31 am April 23rd, 2014

Hello Kay. First, you don’t need to attempt opiate withdrawal alone. Seek medical help. Second, I’d suggest that you consult via phone or in person with a pharmacist about possible contraindications of taking these two meds simultaneously. You’ll need a professional medical opinion about this.

dee arroaga
2:53 am May 21st, 2014

I have a 2 gram a day heroin habit for 10 years. I am ready to kick. I have obtained valium, clonodine, buprenorphine and benadryl. What are the correct dosages of the bupe…..it it injectable IM ,03…………………..greatly appreciate some help. Thank you.

12:31 pm May 21st, 2014

Hello Dee. You’ll need to speak with an opiate substitution or opiate detox professional to get some recommendations that are tailor made for you. Tapering and management of opiate withdrawal can be both an art and a science.

Snobird
5:10 am June 21st, 2014

Thankyou for the information provided for opiate withdrawl, my wife and I are currently detoxing her mother who is 64 yrs old and been on opiates most of her adult life. Her Doc prescribed a half doz Clonadine for her detox but she freaked out on day one ( thought she was already experiecing withdrawal symtoms and started taking her Clonadine ) so we are left with Trazadone, xanax and a few other meds she has prescribed to her on a regular basis. We are checking each one online before considering its use, so thank you again for your posts.

w

LJ
1:12 pm July 2nd, 2014

I’m in day 2 of detoxing. I’ve done this before so I know how much it sucks, and I definitely have some anticipatory anxiety knowing the suffering that is ahead of me. Plus, suffering silently makes it a bit worse this time. Last time some people knew and could support me (they tried at least…) So this time I’m taking a different approach. I’m detoxing my body with an 8 day cleanse at the same time, while taking an abundance of supportive vitamins and supplements. Physically, I can honestly say I feel SO much better than I expected to at this point. (Felt like death on day 2 of subutex withdrawal) but mentally, and psychologically…..that’s where I am weak. I know that with one quick phone call or drive by, I could have what I need to feel “better”. Looking for some encouragement and ideas on how to redirect these thoughts. I don’t want to have to start from scratch again. I’m already half way through day 2!!

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