Wednesday December 19th 2018

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Detox From Opiates


ARTICLE OVERVIEW: Opiates are a highly addictive drugs that trigger intense withdrawal. This article describes what you need to know if you want to detox from an opiate…and where to get medical help.


TABLE OF CONTENTS:


What Happens To Your Brain?

Opiates are chemical compounds that are extracted or refined from natural poppy plants. Examples of opiates are:

  • Codeine
  • Heroin
  • Morphine
  • Opium

Opiates act by attaching to specific proteins called opioid receptors, which are found on nerve cells in the brain, spinal cord, gastrointestinal tract, and other organs in the body. When opiates attach to their receptors, they reduce the perception of pain and can produce a sense of well-being.

With repeated administration of these drugs, the production of endogenous opioids is inhibited, which accounts in part for the discomfort that ensues when the drugs are discontinued. Repeated exposure to opiates alters the brain so that it functions normally when the drugs are present and abnormally when they are not.


Opiates physically change the brain. 


Opiate drugs cause physical dependence. This means that a person relies on the drug to prevent withdrawal symptoms. Over time, more of the drug is needed for the same effect. This is called “drug tolerance”. When the person stops taking the drugs, the body needs time to recover, and withdrawal symptoms result.

Withdrawal from opiates can occur any time long-term use is stopped or cut back.

Read on for more on what to expect as the body goes through withdrawal.

What Happens To Your Body?

If you are thinking about quitting opiates, you probably don’t want to go through withdrawal. Withdrawal is like a really bad flue. But, there are medications that can help!

Early symptoms of opiates withdrawal include:

  • Agitation
  • Anxiety
  • Muscle aches
  • Increased tearing
  • Insomnia
  • Runny nose
  • Sweating
  • Yawning

Later symptoms of opiates withdrawal include:

  • Abdominal cramping
  • Diarrhea
  • Dilated pupils
  • Goose bumps
  • Nausea.
  • Vomiting

Call us to learn more about your detox options.


These symptoms are very uncomfortable, but are not life-threatening, and usually start within 12 hours of your last opiate dose. Physical symptoms will dissipate within the first couple of weeks, but a psychological need for drugs might remain. In fact, these “cravings” can be present long after you’ve stopped using.

Mood and sleep disorders can also continue in the weeks and months after you quit an opiate. As situations arise in your day-to-day life, stress can trigger potential cravings. So, even months or years after you finish acute withdrawal, protracted symptoms can persist.

The most commonly reported protracted symptoms include:

  • Anxiety.
  • Cravings.
  • Disturbed sleep.
  • Irritability.
  • Mood swings.
  • Tiredness, variable energy, low enthusias.
  • Variable concentration.

Duration

You can expect to start to feel opiate withdrawal 12 hours after your last dose. The severity of withdrawal peaks around Day 2 and can last between 5-7 days. The degree and time you spend in opiate withdrawal will varies by person and is based on drug use history, how much were in the system, your age, gender, weight, and metabolism factors.

Timeline

The physical symptoms of withdrawal start 6 to 24 hours after last use, peak in severity during days two to four, and generally subside by day seven. However, psychological features of dysphoria, anxiety, sleep disturbances and increased cravings may continue for weeks or even months.

Day 1: Early Withdrawal

Onset is within 6-12 hours for short-acting opiates and can include:

  • Agitation
  • Anxiety
  • Excesive yawning
  • Fever
  • Hypertension
  • Muscle aches
  • Nose running
  • Racing heart
  • Sweats
  • Tearing up

Days 2-3: Middle Withdrawal

During this time, the peak of severe symptoms begin and can include:

  • Abdominal cramping
  • Blurry vision
  • Diarrhea
  • Dilated pupils
  • Goose bumps
  • High blood pressure
  • Nausea and vomiting
  • Rapid heartbeat

Day 3-7: Late Withdrawal

Late withdrawal symptoms peak and usually last week or so, and include:

  • Depression
  • Diarrhea
  • Drug cravings
  • Goosebumps
  • Nausea and vomiting
  • Stomach cramps

Dangers

While it’s rare to die from withdrawal or detox, death is a possible side effect. Suicidal ideation, possible violence, and even hallucinations can occur. For this reason, it’s recommended that anyone who’s planning a opiate withdrawal detox at a medical facility.

“The major drawback of opiate use is the potential for abuse and addiction.”

Opiate abuse, addiction, and overdoses are serious public health problems in the United States. In 2016, more Americans died due to opiates overdoses than car crashes. And the risk of overdose increases if you try to detox from opiates on your own. During detox, you lower tolerance for opiates…and this can result in problems if you relapse.

More below on why you need to seek help anytime you want to come off an opiate.

Can You Do It Yourself?

Withdrawal from these drugs on your own can be very hard and may be risky and very dangerous. If you try to go through withdrawal on your own, you’ll need to be prepared. Always seek medical supervision during an opiate detox.

You can try to slowly taper off before you go off completely, but you’ll need some suggested guidelines from a prescribing doctor or pharmacist first. This might limit the intensity of your withdrawal. However, given the compulsive nature of addiction, most people find self-regulated tapering to be impossible. It often leads to a full relapse into addiction.

Plus, if you relapse…you also risk overdose. When you lower your tolerance, you increase the risk of overdose during a relapse. Users who do not realize they may have lost their tolerance during a period of abstinence may initially take the high dosage that they previously had used before quitting, a dosage that produces an overdose in the person who no longer has tolerance.

Medical treatment of opiate withdrawal most often involves medicines, counseling, and support. This is the safest way to get off the drugs. Together, you can discuss your care and treatment goals with a doctor. Why risk it? Be safe!

Where To Detox?

Withdrawal can take place in a number of settings:

  1. In a detox clinic.
  2. In a regular hospital, if symptoms are severe.
  3. At home with medical supervision (in rare cases).

It’s possible to withdraw at home when you do not have access to a detox clinic. In these cases, you might consider managing the withdrawal on an outpatient basis with a supervising physician.

Detoxing from opiates is best done at a medical detox clinic and inpatient rehab center. This is the safest option, for both one’s mental and physical health. Medically assisted detox also has higher rates of success than other methods; alternatives can be risky at best and even life-threatening at worst.

Medications That Can Help

While opiates dependence has more treatment agents available than other abused drugs, none are curative. They can, however, markedly diminish withdrawal symptoms and craving, and block opiates effects due to lapses.

Withdrawal Agents

Buprenorphine is long-acting, safe, and effective by the sublingual route, but may precipitate withdrawal symptoms if given too soon after an opiates agonist. Buprenorphine may be combined with Naloxone (Bunavail, Suboxone, Zubsolv), which helps prevent dependence and misuse.

Methadone  allows people to recover from their addiction and to reclaim active and meaningful lives. For optimal results, persons should also participate in a comprehensive medication-assisted treatment (MAT) program that includes counseling and social support.

Methadone therapy achieves this by preventing opiate withdrawal symptoms, blocking the euphoric effects, and minimizing the craving. Methadone maintenance has been shown to reduce illicit opiates use, decrease the incidence of infectious disease (such as HIV and hepatitis) commonly contracted through needle sharing, reduce criminal activity, improve social outcome, and reduce mortality.

Naltrexone blocks the euphoric and sedative effects of drugs such as opiates. It works differently in the body than buprenorphine and methadone, which activate opioid receptors in the body that suppress cravings. Naltrexone binds and blocks opioid receptors, decreases reactivity to drug-conditioned cues, and decreases craving.

Other Detoxification Agents And Methods

Clonidine is an antihypertensive. Clonidine is used to help reduce anxiety, agitation, muscle aches, sweating, runny nose, and cramping. It does not help reduce cravings. Since clonidine has mild analgesic effects, added analgesia may not be needed during the withdrawal period for medical opiates addicts. Compared with methadone-aided withdrawal clonidine has more side effects, especially hypotension, but is lessnlikely to lead to post-withdrawal rebound.

Lofexidine. The U.S. Food and Drug Administration approved Lucemyra (lofexidine hydrochloride) for the mitigation of withdrawal symptoms to facilitate abrupt discontinuation of opiatess in adults. While Lucemyra may lessen the severity of withdrawal symptoms, it may not completely prevent them and is only approved for treatment for up to 14 days. Lucemyra is not a treatment for opiate use disorder, but can be used as part of a broader, long-term treatment plan for managing opiate use disorder.

 

Treating Common Symptoms:

There are symptomatic medications that may be helpful for treat uncomfortable symptoms like nausea, vomiting, insomnia, diarrhea, muscle pain and depression. If you are in the process of detoxification of opiates, and present any of these symptoms, consult your treating physician to assess whether any of the treatment options presented here may work for you.

Q: What to do for nausea and vomiting?

A: Prochlorperazine or ondansetron are recommended for nausea and vomiting related to opiate withdrawal.

Q: What to do for insomnia?

A: Insomnia is both common and debilitating. Clonazepam, trazodone, and zolpidem have all been used for withdrawal-related insomnia, but the decision to use a benzodiazepine needs to be made carefully, especially for outpatient detoxification.

Q; What to do for diarrhea?

A; With your doctor’s supervision, several over-the-counter medications can help with acute withdrawal-related diarrhea if your symptoms are not severe. Common over-the-counter medications include Bismuth subsalicylate (Pepto-Bismol and Kaopectate) and Loperamide (Imodium).

Q: What to do for muscle pain?

A: Muscle aches often respond well to home treatment, like:

  • Applying ice to the affected area relieve pain and improve inflammation.
  • Resting the area of the body where you are experiencing aches and pains.
  • Taking an over-the-counter pain reliever, such as nonsteroidal anti-inflammatory drugs (ibuprofen or ketorolac tromethamine).

Q: What to do for depression?

A: The relationship between opiates abuse and depression is bi-directional, meaning that suffering from one increases the risk of the other. When seeking treatment for opiates abuse and depression, you first may need to seek immediate medical attention to address the withdrawal symptoms of opiates and also, talk to your doctor about programs that address the dual diagnosis simultaneously.

Effective inpatient or outpatient treatment programs typically include:

  • A treatment plan tailored to your individual needs.
  • Family psychoeducation and counseling.
  • Follow up support.
  • Intensive individual counseling.
  • Medication options for both opiates replacement and depression.
  • Onsite medical assistance and support.
  • Peer group support for addiction and depression.

Do You Have Questions?

Do you still have questions about opiates detox? Please share your questions and experiences with opiates in the comments section below. We’ll try to respond to you personally and promptly.

Additional Reference Sources:
MEDLINE PLUS: Opioid and opioid withdrawal
NCBI: Maintenance medication for opiate addiction
NCBI: Medicines used in alcohol and opioid dependence
NCBI: Pharmacologic treatment for opioid dependence: Detoxification and maintenance options
NCBI: The neurobiology of opioid dependence
NCBI: Withdrawal management
NIDA: America’s addiction to opioids
NIDA: Effective treatments for opioid addiction
NIDA: FDA approves first medication to reduce opioid withdrawal symptoms
NIDA: Opioids
SA HEALTH: Opioid withdrawal management
SAMHSA: Medication-Assisted Treatment (MAT)
SAMHSA: Opioids

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