Withdrawal from opioids; Dopesickness
Treatment involves supportive care and medications. The most commonly used medication, clonidine, primarily reduces anxiety, agitation, muscle aches, sweating, runny nose and cramping.
Other medications are used to treat vomiting and diarrhea.
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.
People withdrawing from methadone may be placed on long-term maintenance. This involves slowly decreasing the dosage of methadone over time. This helps reduce the intensity of withdrawal symptoms.
Some drug treatment programs have widely advertised treatments for opiate withdrawal called detox under anesthesia or rapid opiate detox. Such programs involve placing you under anesthesia and injecting large doses of opiate-blocking drugs, with hopes that this will speed up the return to normal opioid system function.
There is no evidence that these programs actually reduce the time spent in withdrawal. In some cases, they may reduce the intensity of symptoms. However, there have been several deaths associated with the procedures, particularly when it is done 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, such as Narcotics Anonymous and SMART Recovery, can be enormously helpful to people addicted to opiates.
Withdrawal from opiates is painful, but not life threatening.
Complications include vomiting and breathing in stomach contents into the lungs. This is called aspiration, and can cause lung infection. Vomiting and diarrhea can cause dehydration and body chemical and mineral (electrolyte) disturbances.
The biggest complication is return to drug use. Most opiate overdose deaths occur in people who have just withdrawn or detoxed. Because withdrawal reduces your tolerance to the drug, those who have just gone through withdrawal can overdose on a much smaller dose than they used to take.
Longer-term treatment is recommended for most people following withdrawal. This can include self-help groups, like Narcotics Anonymous or SMART Recovery, outpatient counseling, intensive outpatient treatment (day hospitalization), or inpatient treatment.
Those withdrawing from opiates should be checked 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 a person continues to withdraw repeatedly, methadone maintenance is strongly recommended.
Call your doctor if you are using or withdrawing from opiates.
Doyon S. Opiods. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 167.
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