Hydromorphone Withdrawal

Definition

Hydromorphone withdrawal is the normal, predictable consequence of a sudden drop in the level of hydromorphone in the body of a person who is physically dependent upon the drug. Withdrawal causes a variety of overpowering physical symptoms that can last five or more days; psychological symptoms of withdrawal from hydromorphone may last much longer and contribute to relapse.

Causes

The human body adapts to the presence of some substances introduced into the body, including hydromorphone or other opioids. The body becomes tolerant of certain chemicals, which means it takes an ever-increasing amount of the substance to achieve the desired effect. A person can develop tolerance to a drug through legal, prescribed use or by abusing a drug. In this case, tolerance means an individual must take increasingly larger doses of hydromorphone to relieve pain or to get high.

With prolonged use, the body may become dependent on hydromorphone; this means the individual must maintain a certain level of opioids for the body to feel normal. If the level of opioids drops rapidly, the body struggles to maintain its chemical balance. This chemical battle causes uncomfortable withdrawal symptoms.

Facts

According to the Drug Enforcement Agency, or DEA, the number of hydromorphone prescriptions rose 93 percent between the years 2005 and 2009, increasing dramatically from 1.5 million prescriptions to 2.9 million in just four years. Until the recent surge in popularity of illicit use of hydrocodone and Oxycontin, immediate-release formulations of hydromorphone were the most frequently diverted and abused drugs. Hydromorphone abuse is most prevalent in rural and suburban populations.

Symptoms

Withdrawal from opioids such as hydromorphone is typically associated with physical symptoms similar to the flu. Withdrawal also causes psychological symptoms whose demoralizing affects can be just as debilitating as the physical symptoms of withdrawal.

Physical

Physical withdrawal symptoms can last five or more days, with the worst symptoms appearing on or about the fourth day. Physical symptoms of withdrawal are debilitating; individuals are frequently bedridden for several days or weeks. Overpowering physical symptoms force many people back to hydrocodone abuse, especially those who try to quit without the help of a medical professional.

Physical symptoms of withdrawal include:

  • Abdominal Cramping
  • Diarrhea
  • Fever, Runny Nose or Sneezing
  • Goose Bumps and Abnormal Skin Sensations
  • Hot Sweats and Cold Sweats
  • Insomnia
  • Low Energy Level
  • Muscle Aches or Pains
  • Nausea or Vomiting
  • Pain
  • Rapid Heartbeat
  • Rigid Muscles
  • Runny Nose
  • Shivering, Tremors
  • Teary Eyes
  • Yawning

Psychological

Frequently overshadowed by the overpowering physical symptoms of hydrocodone withdrawal, the psychological symptoms can be equally as devastating. The withdrawal process is emotionally draining, embarrassing and demoralizing. Without the help of rehabilitation professionals, the psychological aspects of hydrocodone withdrawal cause the individual to lose hope for recovery and return to hydromorphone use.

Psychological symptoms of withdrawal include:

  • Agitation
  • Anxiety
  • Depression
  • Hallucinations
  • Irritability
  • Poor concentration
  • Restlessness
  • Social isolation

Possible Complications

Withdrawal from opioids such as hydromorphone may cause dangerous complications. One such complication is aspiration, which involves vomiting and then breathing the stomach contents into the lungs. Aspiration may result in fluid in the lungs or infection. Extreme vomiting and diarrhea may result in dehydration.

The greatest complication associated with hydromorphone withdrawal is the return to opioid abuse. There is a greater potential for hydromorphone overdose in those who have recently gone through detoxification because detox reduces tolerance to opioids; a person who has just completed detox can overdose on a much smaller dose of hydromorphone than they took before detoxification.

Treatment options

Abuse and physical dependence on opioids such as hydromorphone is a growing epidemic among adults and youth in the United States. According to the National Institute on Drug Abuse, more than 23 million people in the United States over the age of 12-years needed treatment for alcohol or substance abuse in 2010; of these, only about 11 percent received treatment at a specialty clinic. Slightly more than 5 percent of admissions to publicly funded substance abuse programs were for treatment of opioid abuse. These treatment facilities help patients overcome physical dependence and ease withdrawal symptoms during the detoxification and rehabilitation phases of treatment.

Some people try to quit hydromorphone on their own, without the help of medicine to ease overpowering withdrawal symptoms. This is self-detoxification, or "going cold turkey," referring to the cold, clammy, pale and bumpy appearance the skin takes on while the individual struggles with hydromorphone withdrawal. Physically uncomfortable and incapacitating withdrawal symptoms, such as diarrhea, abdominal pain, cold sweats and muscle pain can last for several days to two weeks. Few individuals have the physical strength to endure self-detoxification from hydromorphone long enough to withdraw completely from this powerful opioid.

Without a medical professional to monitor his condition, the addicted individual may suffer dangerous complications such as aspiration or dehydration as he attempts to detoxify himself from hydromorphone. Complications and overpowering symptoms of withdrawal cause many people who attempt self-detox to start using hydromorphone once again.

Occasionally, individuals develop their own treatment plans to reduce the withdrawal symptoms during self-detoxification by using a variety of products. Once such remedy is The Thomas Recipe, in which a person takes Xanax or some other medication to help him reduce anxiety and sleep, along with medication to stop diarrhea plus vitamins and supplements to ease muscle aches and fatigue. Hot baths also help reduce body aches.

While these homemade concoctions may reduce withdrawal symptoms somewhat, the individual still faces dangerous complications. In addition, self-detoxification addresses only the physical dependency of opioid abuse and not the behavioral aspects of opioid addiction. The person never gains the tools she needs to live without hydromorphone, increasing the risk that she will return to substance abuse.

Relapse is the largest complication associated with quitting hydromorphone and other opioids. Someone who has recently gone through detoxification is at a greater risk for overdose, as detoxification lowers the body's tolerance to hydromorphone. He can accidently overdose on a lower dose than he used to take before he went through the detoxification process.

Overdose is a serious, potentially fatal complication of hydromorphone use, requiring emergency, sometimes lifesaving treatment. Doctors quickly reduce hydromorphone to safe levels by administering naloxone and other medications to stabilize the patient's condition. Once the patient has detoxified her body from the physical effects of hydromorphone dependence, she may participate in behavioral therapy as an inpatient or outpatient to address the psychological aspects of dependence.

Some individuals participate in outpatient drug replacement therapy, or DRT, which allows a person to engage in treatment without losing time away from work or family. During DRT, physicians prescribe drugs such as methadone, Suboxone or buprenorphine to reduce withdrawal symptoms associated with hydromorphone withdrawal. These replacement drugs act in a similar way inside the body as does hydromorphone; DRT "tricks" the body into thinking it has received the hydromorphone it needs to feel normal. The replacement drugs last longer than hydromorphone and do not get the individual high, enabling him to participate in therapy, work and family responsibilities with a clear mind as he progresses though rehabilitation

After counselors help the individual changes the behaviors associated with hydromorphone addiction, the individual weans himself from the replacement drug, although a person may remain on methadone for up to ten years. Supporters of DRT recognize the flexibility of outpatient treatment because it helps people go to work and take care of their families while engaging in meaningful rehabilitation, while opponents of DRT say it is merely trading one addiction for another.

Outpatient drug replacement therapy programs are just one type of Medication-Assisted Treatment, or MAT. MAT refers to any substance abuse treatment plan uses medicine to reduce the severity and duration of withdrawal symptoms. According to the Substance Abuse and Mental Health Services Administration, or SAMSA, this medical intervention:

  • Improves Survival
  • Increase Retention in Treatment
  • Decreases Illicit Opiate Use
  • Decreases The Risk for Hepatitis and HIV
  • Decreases Criminal Activities
  • Increases Employment
  • Improves Birth Outcomes for Pregnant Women Battling Addiction

Inpatient MAT programs use medicine to alleviate opioid withdrawal symptoms and facilitate detoxification. During detoxification, specially trained physicians administer a handful of medications to decrease the level of opioids and even more drugs to reduce withdrawal symptoms. Nurses monitor the patient for dangerous complications or side effects, such as dehydration or aspiration, and respond appropriately. While inpatient MAT programs ease the physical aspects of addiction, individuals must still endure the demoralizing process of detoxification.

Rapid detox is the most humane method of detoxification and is considered by many to be the superior MAT program. During rapid detox, board-certified anesthesiologists administer standard detoxification and anti-withdrawal medications, but also administer anesthesia and sedatives so that the patient rests in a comfortable "twilight sleep." When the patient awakens, he will have no memories of the grueling and demoralizing detoxification and withdrawal process. He can now move onto the rehabilitation process with far fewer psychological burdens associated with hydromorphone withdrawal.

Rehabilitation

Long-term recovery from physical dependence upon hydromorphone relies on a combination of medical treatment and rehabilitation. A significant number of individuals suffer relapse, especially those who engage in self-detoxification or do not participate in rehabilitation.Both medical treatments and counseling work to restore normalcy to those brain function and behavior affected by hydromorphone. Although MAT and behavioral modification are each independently useful in the treatment of withdrawal hydromorphone, addressing both the physical and behavioral aspects of physical dependence to opioids such as hydromorphone offer the best hope for recovery.

Rehabilitation aims at reducing the risk for relapse by changing the behaviors and environmental factors that caused the dependence on hydromorphone in the first place. Professional treatment focuses on improving employment rates, reducing relapse and lessening side effects associated with physical dependence to hydromorphone. Behavioral therapy can occur at an inpatient facility or in an outpatient setting. For the best chance of success, it is important to match the type of facility to the individual's particular needs.

After successful hydromorphone detoxification or drug replacement therapy, patients can increase the chances for recovery by participating in rehabilitation. Treatments include techniques designed to change the behaviors that caused physical dependence or improve the environmental factors that led to the initial dependence on drugs and reduce the risk for relapse. Rehabilitation may be inpatient or outpatient, and programs can be as short as 28 days or as long as 6 months or a year.

New behavioral therapies show particular promise in the treatment of physical dependence and withdrawal from hydromorphone. One such program, contingency management therapy, is a voucher system in which a patient earns points for negative drug tests. He then redeems these points for items that enhance a healthy lifestyle; this allows him to "rewire" his brain so that he associates healthy activities with rewards. Another program known as cognitive-behavioral interventions modifies a patient's expectations and behaviors related to opioid addiction and give him new tools to deal with stresses that may cause relapse.