Opioid Withdrawal Treatment Options

Opioid withdrawal is a group of symptoms that can happen if you have been taking opioids and then stop taking them. Opioid withdrawal can also happen:

• When the dosage is decreased.
• After stopping a prescription opioid as directed. Physical dependence can develop after taking opioids regularly for just a few days.
• After taking a prescription opioid incorrectly, such as taking more than recommended or taking it for a different purpose (opioid misuse).
• Taking the opioid illegally and then stopping.

Opioid withdrawal is not usually life-threatening, but it can be very uncomfortable and severe. Opioid withdrawal treatment makes managing withdrawal easier.

What are the signs and symptoms of opioid withdrawal?

Symptoms of this condition can be both physical and emotional. Physical symptoms include:

• Nausea and vomiting.
• Muscle aches or spasms.
• Watery eyes and runny nose.
• Widening of the dark centers of the eyes (dilated pupils).
• Hair standing on end.
• Fever and sweating.
• Flushing and itching of the skin.
• Stomach cramping and diarrhea.
• Trouble sleeping.

Emotional symptoms include:

• Depression.
• Anxiety and nervousness.
• Restlessness, irritability, and severe mood swings.

When symptoms start and how long they last depend on the kind of opioid you have been taking.

• Short-acting opioids, such as heroin or oxycodone, work fast and then lose their effect quickly. Symptoms occur within hours of stopping or reducing the amount you take. The worst symptoms (peak withdrawal) occur in 2–3 days. Overall, symptoms should lessen in 7–10 days.
• Long-acting opioids, such as methadone, work for a longer period of time. Symptoms can occur within 1–3 days of stopping or reducing the amount you take. The worst symptoms occur in 3–8 days. Symptoms may continue for several weeks but will be milder.

There are also medicines that block the effects of opioids (opioid antagonists), such as naloxone. Naloxone is given to restore a person’s breathing if it has slowed down or stopped due to an opioid overdose. The effect includes withdrawal symptoms that begin within minutes and last for about an hour. It is important to get medical help in this situation.

How is this treated?

Treatment for opioid withdrawal usually happens:

• In an emergency department.
• In a clinic or drug treatment facility.
• At home.
• In a combination of different settings.

Treatment for this condition depends on the type of opioids that are causing your symptoms.

Medicines

• Opioid or opioid-like medicine. This is the most effective treatment. It is used to block withdrawal symptoms, and then the dose is lowered over time.
• If you have been taking prescription opioid medicine, your health care provider may lower the dose over several days.
• If you have opioid use disorder, your health care provider may give you the following medicines to block withdrawals:
  • Methadone. It is given at a certain dose. The dose is then slowly lowered over 6–10 days.
  • Buprenorphine. It is given at a certain dose. The dose is then lowered over 3–5 days. In some cases, it may be lowered very slowly over 30 days.
• Other medicines may also be used as a stand-alone treatment or in combination with other treatments. These include:
  • Alpha-2 adrenergic agonists. These medicines block a brain chemical (norepinephrine) that causes some withdrawal symptoms. They can reduce and lessen the severity of symptoms but do not stop them. The medicines can cause side effects such as drowsiness, dizziness, and low blood pressure.
  • Other medicines to reduce anxiety, relieve muscle aches, promote sleep, and decrease digestive symptoms like nausea and diarrhea.

Other treatments

• Counseling. This treatment is also called talk therapy. It is provided by treatment counselors and is used in addition to medicines.
• Support groups. These groups provide emotional support, advice, and guidance during recovery. They offer a safe environment in which you can talk to present and past opioid users and those who have gone through treatment.

Follow these instructions at home:

• Always check with your health care provider before starting any new medicines. Many of the medicines used to treat opioid withdrawal can have dangerous side effects and should only be taken as prescribed by your health care provider.
• Do not start using an opioid medicine again without talking to a health care provider. You may be at an increased risk for problems, including opioid overdose.
• If you have chronic pain, ask your health care provider about an intensive pain rehabilitation program or a referral to a chronic pain specialist. You may need to work with a pain specialist to come up with a treatment plan to help manage pain.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You need help stopping use of an opioid medicine.
• You have been on long-term opioids and are planning to stop, and you would like to prepare for any withdrawal symptoms.
• You have been treated at home, but you are still having symptoms of withdrawal.
• You have been treated for withdrawal, but you have started using opioids again (relapsed).

Get help right away if you:

• Have chest pain and shortness of breath.
• Are drowsy and have difficulty staying awake.
• Feel weak or dizzy, or feel like you are going to pass out.
• Have nausea or vomiting that does not go away, or you begin to vomit blood.
• Have diarrhea that does not stop, or you begin to feel weak and light-headed.
• Feel severely depressed and anxious.
• Feel you may be a harm to yourself or others.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• Opioid withdrawal is a group of symptoms that can happen if you have been taking opioids and then stop taking them.
• Opioid withdrawal symptoms are treated using medicines, counseling, and support groups.
• The most effective treatment is to use an opioid or opioid-like drug to block withdrawal symptoms and gradually lower the dose over time.