Medication-Assisted Treatment
For more severe withdrawal symptoms, medications will be prescribed to help reduce side effects and make withdrawal easier. This report from the National Institute on Drug Use explains that “Someone in recovery can also use medications that reduce the negative effects of withdrawal and cravings without producing the euphoria that the original drug of abuse caused.”
These medications are typically used in an inpatient setting as they require close monitoring. If they are used in an outpatient setting, regular and very close monitoring would be needed. The dosage for each medication will vary depending on the individual situation.
Clonidine
Clonidine’s original purpose was to treat high blood pressure but in recent years it’s been used to ease withdrawal effects from opioids. It works with specific receptors in the brain to calm the nervous system, which creates a sense of relaxation and pain relief.
Clonidine is one of the most commonly used medications to aid with withdrawal: it can help reduce withdrawal symptoms by 50%-75%. Clonidine can help to reduce anxiety and restlessness and enable patients to better regulate their emotions, all of which can make the withdrawal experience more manageable. It’s also very effective at reducing cramping, muscle aches, sweating, and a runny nose.
Lofexidine
Like Clonidine, Lofexidine’s original purpose was to treat high blood pressure. It can relieve the side effects of withdrawal in the same way as Clonidine. Although it’s less commonly used, it can be safer for use than Clonidine. This article from Harvard Medical School explains that “clonidine can cause low blood pressure, which can be a limiting side effect, whereas lofexidine has less of an impact on blood pressure.”
Buprenorphine
Buprenorphine is an opioid replacement. It’s what is known as a partial opioid agonist: it binds to opioid receptors in the brain but doesn’t activate them as strongly as other opioids. It produces fewer side effects than some other opioids and doesn’t produce a sense of euphoria. It’s often used to make withdrawal more manageable and to shorten the length of time it takes for withdrawal.
Suboxone
Suboxone is a combination of buprenorphine and an opioid blocker called naloxone. The combination does not produce addictive side effects like other opioids. It can aid in reducing withdrawal symptoms and reduce the length of time it takes to withdraw from other higher-strength opioids.
Methadone
Methadone is what is known as an opioid agonist: it’s another opioid that binds to the opioid receptors in the brain. It produces fewer side effects than many other opioids. It’s also much easier to withdraw from as it produces less intense withdrawal symptoms and eliminates the sense of euphoria. Therefore, it’s sometimes used in the longer term to help reduce other opioids, before eventually withdrawing from methadone.
Naltrexone
Naltrexone is an opioid antagonist, meaning it blocks the opioid receptors in your brain. This reduces the desire for opioids and can help to make the withdrawal process easier. However, it can also block the effects of opioids, so it’s important it’s used correctly to prevent withdrawing too quickly and causing more side effects.
Naloxone
Naloxone is a very quick-acting opioid antagonist: it quickly gets rid of the effects of opioids within the body and brain. This is only used in the case of opioid overdose when quick withdrawal is needed, as it can produce a lot of side effects and be dangerous if not used appropriately.
Diazepam
Diazepam is a benzodiazepine: it’s a sedative that can help to alleviate withdrawal symptoms such as anxiety, restlessness, distress, and problems sleeping. It’s also useful in relieving muscle spasms. Diazepam works by calming the brain and nerve pathways. It is often used during alcohol withdrawal along with other drug withdrawals. Diazepam will only be used short term, as in the long term it can become addictive.
Over The Counter Medications
For mild withdrawal symptoms, over-the-counter medications may be useful to reduce symptoms and make you feel more comfortable. This is more common if you are withdrawing in an outpatient setting. It’s important to follow guidance from your doctor about what might be suitable for you.
Painkillers
Over-the-counter painkillers may help to reduce joint and muscle pain which comes as a side effect of withdrawal, along with reducing any chronic pain you might be feeling as you reduce your opioid dose. These might include paracetamol, aspirin, and co-codamol.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are also available, which help to reduce inflammation as well as pain. NSAIDS can also be useful in fighting fever, chills, and sweating.
Anti-nausea
Anti-nausea medications can reduce both the feeling of nausea to make you more comfortable, and the likelihood of vomiting. These may include medications such as meclizine (Antivert or Bonine) or dimenhydrinate (Dramamine).
Sometimes nausea and vomiting can make you feel like you don’t want to eat or stop you from keeping food and drink down, which can make you weak. Taking anti-nausea medication can help you to tackle this.
Anti-diarrhea
Anti-diarrhea medications like loperamide (Imodium) can help to settle your stomach and reduce diarrhea to make you more comfortable. Diarrhea can make you very dehydrated, which can be dangerous, so these medications can be particularly useful.
Antihistamines
Antihistamines may be able to help reduce itching, watery eyes, and skin irritation. As well as making withdrawal less distressing, this can increase your chances of being comfortable enough to sleep during withdrawal.
Rapid And Accelerated Detoxification
What is rapid detoxification?
Rapid detoxification refers to withdrawal done under anesthesia, using opioid-blocking drugs. This enables doctors to get opioids out of the patient system more quickly. However, this method is not used very often, as the risks outweigh the potential benefits.
What are the risks?
Although the opioids may leave the patient's system more quickly, the length of time spent experiencing withdrawal effects is not necessarily shortened. Aside from this, the procedure can be dangerous. This article explains that “vomiting often occurs during withdrawal, and the potential of vomiting under anesthesia greatly increases the risk of death.”
The National Institute for Health & Clinical Excellence (NICE) guidelines which are used to regulate health treatment in England state that, “Ultra-rapid detoxification under general anesthesia or heavy sedation (where the airway needs to be supported) must not be offered. This is because of the risk of serious adverse events, including death.”
The procedure is typically only offered in exceptional circumstances, or where the individual specifically requests it. In this case, very close monitoring would take place during the procedure to make it as safe as possible.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens, and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888 or (516) 419-4480 for the Long Island office to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.
