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Opiate withdrawal

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 dose of methadone to reduce the intensity of withdrawal symptoms. This can be effective in inpatient programs, but outpatient methadone detox programs are ineffective.

Methadone maintenance involves ongoing use of methadone. This is the most effective treatment for opiate addiction, according to the Institutes of Medicine.

The FDA is expected to approve a new medication for use in the treatment of opiate withdrawal very soon. This medication, called buprenorphine, may help both physical and mental withdrawal symptoms. It may also be used for long-term maintenance like methadone.

This will have significant advantages over methadone because it will be obtainable from general practitioners, not just specialized clinics with rigid attendance requirements.

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 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 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 Most opiate overdose deaths occur in people who have just withdrawn or detoxed. Because withdrawal reduces a previously-developed tolerance, recently withdrawn addicts can overdose on a much smaller dose than they used to take daily.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, and 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: 5/4/2004
Reviewed By: Ram Chandran Kalyanam, M.D., Department of Psychiatry, Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center, Pittsburgh, PA. Review provided by VeriMed Healthcare Network.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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