Going Through Opioid Use Disorder Withdrawal With Medication
Opioid use disorder (OUD) is estimated to affect 3 million Americans and 16 million people worldwide. One of the biggest challenges to overcoming opioid addiction and dependence is the fear of withdrawal symptoms. In fact, a study of individuals taking prescription opioids for pain found that avoiding withdrawal was the most common reason for continued use.
To combat this, medication-assisted treatment is often used to reduce opioid withdrawal and support recovery, and it can make the whole process a lot easier. If you’re trying to overcome opioid use disorder, medication could be a crucial boost to your recovery. You don’t have to do it alone.
Opioids are pain-relieving drugs. They include prescription medications such as hydrocodone (Vicodin) and oxycodone (Oxycontin), synthetic opioids such as fentanyl, and illegal drugs such as heroin. Misuse of opioids can lead to addiction and physical dependence in a short period of time. As a result, when opioids are stopped suddenly, significant withdrawal symptoms can occur, including anxiety or stress, body aches, sweating, goosebumps, nausea and vomiting, diarrhea, stomach cramps, racing heart rate, shaking, and difficulty sleeping.
Depending on the type of opioid being used, withdrawal can start within several hours of last taking the drug and, in some cases, can persist for up to two weeks. Many people find opioid withdrawal to be too uncomfortable to go through on their own, and without proper help, they can return to abusing opioids or stay dependent on them. Fortunately, there are several medications available to help ease withdrawal symptoms so you can move past opioids.
Getting help managing withdrawal symptoms is an important first step on the road to recovery from opioid use disorder. For moderate to severe withdrawal, opioid-replacement medications can be extremely helpful. As opioids themselves, these medications act on the same receptors in the brain, lessening cravings and the experience of withdrawal–but they’re administered in particular doses in controlled environments so they aren’t abused. They are beneficial during the initial drug detoxification process when opioid withdrawal is often strongest, and they are also used for maintenance therapy to keep symptoms at bay long-term.
Common opioid-replacement medications include:
Methadone: Methadone has been used to treat opioid addiction for decades. It’s dispensed as a pill, liquid, or wafer through an opioid treatment program, often requiring daily visits to a clinic to receive the medication. By carefully regulating the amount of methadone given, your withdrawal symptoms can be minimized, but you won’t feel the same euphoric high as with other opioids. Methadone dosage can be slowly decreased over time, eliminating opioid dependence. It’s a good choice for individuals who are dependent on high doses of opioids.
Buprenorphine: Buprenorphine works similarly to methadone, but it has what’s known as a “ceiling effect.” That means at a certain point, increasing the dose won’t produce a stronger effect. This makes it safer, lowering the risk of overdose. It’s often combined with a medication called naloxone to decrease the likelihood of it being misused. Buprenorphine can be prescribed by a physician or given as part of an opioid treatment program. It’s taken as a dissolvable tablet or film when used in the early stages of withdrawal. Later on, for maintenance, an extended-release buprenorphine injection (Sublocade) can provide longer-lasting coverage.
Non-opioid medications may also be administered to help ease withdrawal. While they don’t affect opioid cravings, they can be used to treat acute withdrawal symptoms. These medications include:
Lofexidine (Lucemyra): If opioids are abruptly stopped, this newer medication can help ease (though not completely prevent) most of the common withdrawal symptoms. Lofexidine provides some relief by balancing a hormone in the brain called norepinephrine. It’s usually given as three pills taken four times a day for about a week, and then the dose is gradually reduced. It can be given for up to 14 days if needed.
Clonidine: Originally prescribed as a blood pressure medication, clonidine is sometimes prescribed for opioid withdrawal. It’s in the same family of drugs as lofexidine and helps reduce uncomfortable symptoms caused by the detox process. Clonidine may be administered as a pill or as a patch applied to the skin. The dose may be weaned after approximately a week once withdrawal symptoms begin to subside.
Other medications that treat specific symptoms may also be helpful during the withdrawal process. For example, anti-nausea or anti-diarrheal medications can treat stomach upset, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for pain management, and sleep aids may be prescribed to relieve insomnia.
Though medications play an important role in treating opioid use disorder, they should be just one part of a more robust treatment plan. Treatment should be ongoing and individualized, incorporating elements like inpatient or outpatient therapy, self-help programs like Narcotic Anonymous, and support from family or friends as needed.