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Opiate withdrawal

• Overview
• Symptoms
• Treatment

Alternative Names:

Withdrawal from opioids; Dopesickness

Treatment:

Treatment of withdrawal includes supportive care and medications. The most commonly used medication, clonidine, primarily reduces physical symptoms.

Another detox method is to use a slowly tapered (reduced overtime) dose of methadone to reduce the intensity of withdrawal symptoms. Methadone maintenance involves ongoing use of methadone.

A new medication called buprenorphine has been shown to be more effective 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.

Some drug treatment programs have widely advertised treatments for opiate withdrawal called detox under anesthesia or rapid opiate detox. This involves anesthetizing the patient and injecting large doses of opiate-blocking drugs, with hopes that this will speed up the transition to normal opioid system function.

There is no evidence that these programs actually reduce the time spent suffering withdrawal. In some cases, they may reduce the intensity of symptoms. However, there have been several deaths associated with the procedure, particularly when it is performed outside a hospital.

Because opiate withdrawal produces vomiting, and vomiting during anesthesia significantly increases death risk, many specialists think the risks of this procedure significantly outweigh the potential (and unproven) benefits.

Support Groups:

Support groups, such as Narcotics Anonymous and SMART Recovery can be enormously helpful to people suffering opiate addiction.

Expectations (prognosis):

Withdrawal from opiates is painful, but not life-threatening.

Complications:

The biggest complication is return to drug use. Most opiate overdose deaths occur in people who have just withdrawn or detoxed. Because withdrawal reduces a previously-developed tolerance, recently withdrawn addicts can overdose on a much smaller dose than they used to take daily. Addicts should be warned about this possibility.

Longer term treatment is recommended for most addicts following withdrawal. This can include self-help groups, like Narcotics Anonymous or SMART Recovery, outpatient counseling, intensive outpatient treatment (day hospitalization), or in-patient treatment.

Addicts withdrawing from opiates should be assessed for depression and other mental illnesses. Appropriate treatment of such disorders can reduce the risk of relapse. Antidepressant medications should NOT be withheld under the assumption that the depression is only related to withdrawal, and not a pre-existing condition.

Treatment goals should be discussed with the patient and recommendations for care made accordingly. If an opiate addict has withdrawn repeatedly only to relapse repeatedly, methadone maintenance is strongly recommended.

Calling your health care provider:

Call your doctor if you are using or withdrawing from opiates.

• Review Date: 5/17/2006
• Reviewed By: Paul Ballas, D.O., Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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