Levorphanol Withdrawal

Definition

Medical professionals define opioid withdrawal as a normal, predictable consequence of a sudden drop in the level of opioids in the body of a person who is physically dependent on this type of drugs. Opioid drugs include heroin, codeine, morphine, OxyContin, Dilaudid and methadone.

Withdrawal from levorphanol can cause a variety of overpowering physical and psychological symptoms that can drive the individual back to opioid abuse. Physical symptoms of levorphanol withdrawal may last five or more days; psychological symptoms of withdrawal may last much longer and be more difficult to detect.

Causes

The human body adjusts to the presence of certain foreign substances such as levorphanol or other opioids. The body sometimes becomes tolerant of those substances, which means it takes an ever-increasing amount of levorphanol to cause the intended euphoric or pain-relieving effect.

With continued use over the course of weeks, the body may become dependent on levorphanol; this means the individual must maintain a certain level of opioids for the body to feel "normal." If the level of opioids drops below this level rapidly, the body struggles to maintain chemical balance. The individual feels this struggle through physical and psychological withdrawal symptoms.

Facts

According to the CDC, about 9 percent of people abuse opioids such as levorphanol at some point in their lives, either to get high or to treat an illness for which it was not prescribed.

Withdrawal symptoms are painful and demoralizing, but usually not life threatening. The severity and duration of withdrawal symptoms depends largely on the how long the individual has abused drugs and his average dosages.

Patients who take levorphanol for less than one week to reduce post-operative pain should not expect withdrawal symptoms when they stop taking this medication. Those who use levorphanol for longer than a week should wean themselves from levorphanol by taking successively smaller doses further apart.

Symptoms

Withdrawal from opioids is typically associated with physical symptoms similar to the flu. These physical symptoms are extremely uncomfortable and last for five or more days, with the worst symptoms occurring on or about the fourth day. Taking another dose of levorphanol would stop these withdrawal symptoms, and this promise of relief causes many individuals to relapse back to drug abuse

Withdrawal also causes psychological symptoms whose demoralizing affects can interfere with recovery. These psychological symptoms lead the individual to believe that she is incapable or unworthy of recovery.

Physical levorphanol withdrawal symptoms last five or more days, with the worst symptoms occurring on or about the fourth day. Psychological symptoms of levorphanol withdrawal can last much longer and frequently go undetected and untreated.

Physical

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

Psychological symptoms of withdrawal include:

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

Possible Complications

As with other opioids, complications of levorphanol withdrawal include vomiting and then breathing the stomach contents into the lungs, a condition known as aspiration. Aspiration may result in fluid in the lungs or lung infections. Extreme vomiting and diarrhea cause dangerous dehydration, which may result in a dangerous electrolyte imbalance, seizures, coma or death.

The primary complication associated with levorphanol withdrawal is the return to opioid abuse. There is a greater risk of overdose for those who have recently gone through detoxification. This is because detox reduces the individual's tolerance to opioids; a person who has just completed detox can overdose on a much smaller dose of levorphanol than they used to take.

Treatment options

Opioid abuse and physical dependence is a growing epidemic among American adults and youth. 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 facility. Just over 5 percent of admissions to publicly funded substance abuse programs were for treatment of opioid abuse. These treatment facilities assist individuals in overcoming physical dependence, withdrawal symptoms during detoxification and rehabilitation.

Treatment Options

Treatment for levorphanol abuse consists of two parts: detoxification and rehabilitation. Detoxification is the process of lowering the level of levorphanol in the body. Levorphanol detoxification typically includes five or more days of intense withdrawal symptoms as the body adjusts to the lack of opioids.

Rehabilitation includes behavior modification and counseling which helps the individual learn how to live without levorphanol.

Detoxification

A person may try to break their levorphanol addiction by himself, without the help of medicine to reduce withdrawal symptoms or experts to establish a safe treatment plan or watch for complications. During self-detoxification, the individual will experience several days of flu-like symptoms, including diarrhea and muscle aches, along with insomnia, malaise and anxiety. During the self-detoxification process, withdrawal symptoms can only fade with time or by taking another dose of levorphanol.

A person trying self-detoxification risks dangerous complications, such as dehydration from excessive diarrhea. He may also vomit and inhale the stomach contents, a condition known as aspiration, which may cause fluid in the lungs and lung infections. The primary complication to levorphanol detoxification is the return to opioid abuse. When going through the long, grueling process of self-detoxification, many are tempted to stop the symptoms by taking another dose of levorphanol.

The Thomas Recipe

Others try to ease symptoms of levorphanol withdrawal with a homemade treatment plan including prescription drugs and over-the-counter medicines. One such remedy is the Thomas Recipe, which includes valium or some other benzodiazepine to help the addicted individual sleep. Imodium relieves his diarrhea while mineral supplements ease muscle aches. On or about the fourth day, the person awakens with profound malaise and lack of energy. The Thomas Recipe suggests supplements such as L-Tyrosine with B6, which gives the patient a surge of energy.

While the Thomas Recipe reduces physical symptoms of levorphanol withdrawal a bit, the patient is still at risk for complications such as aspiration, dehydration and relapse. Relapse to levorphanol abuse can result in life threatening overdose. The detoxification process lowers tolerance to levorphanol; a person can overdose on a smaller amount of levorphanol than he used to take before attempting detoxification. Experiencing even a small amount of levorphanol withdrawal can reduce tolerance.

Overdose

Levorphanol remains in body tissues long after it stops relieving pain or causing euphoria. Levorphanol users must take care not to exceed the recommended dose, as this may result in dangerous overdose. Symptoms of levorphanol overdose include:

  • Breathing that Stops
  • Cold, Clammy Skin
  • Confusion
  • Extreme Drowsiness
  • Fainting
  • Pinpoint Pupils
  • Shallow Breathing
  • Weak Pulse

Levorphanol overdose is a serious, life threatening medical emergency that requires immediate professional care in an emergency room or urgent care clinic. Emergency department doctors administer naloxone and other medications to bring levorphanol down to safe levels. Nurses establish an airway to help the patient breathe, monitor his vital signs and watch for complications. Nurses may empty the patient's stomach or administer charcoal to absorb excess levorphanol. If necessary, nurses and doctors perform life-saving CPR or other emergency measures.

Drug Replacement Therapy

Those without toxic levels of levorphanol can participate in drug replacement therapy, or DRT, which allows the individual to put off the detoxification process until after he has gone through behavioral modification. Doctors prescribe methadone, Suboxone or other drugs that mimic the effects of levorphanol but do not get the patient high. Once he learns how to live without levorphanol, the patient weans himself from the replacement drug by taking increasingly smaller doses further apart.

Some levorphanol-dependent individuals have a difficult time weaning themselves from the replacement drug. Harvard Medical School says that about a quarter of methadone DRT patients eventually quit using DRT altogether, while another 25 percent continues to take the drug and 50 percent go on and off methadone the rest of their lives.

DRT is just one type of MAT, or medically-assisted treatment. Rehabilitation experts agree that MAT helps people overcome dependence on levorphanol or other opioids for several reasons, including:

  • Improved Survival Rates
  • Increased Retention in Treatment
  • Decreased Illicit Opioid Use
  • Decreased Risk for Hepatitis and HIV
  • Decreased Participation in Criminal Activities
  • Increased Employment Rates and Performance
  • Improved Birth Outcomes for Pregnant Women Dependent on Levorphanol

Another type of MAT is inpatient detoxification. During standard detoxification, doctors give the patient naloxone and other medications to reduce his levorphanol levels, and still other drugs to relieve the resulting withdrawal symptoms. Nurses monitor patients for complications and take appropriate action whenever necessary. While standard detoxification reduces the severity and duration of physical withdrawal symptoms as compared to self-detoxification, the patient still battles the demoralizing psychological withdrawal symptoms, which can make him feel incapable or unworthy of a successful recovery.

Rehabilitation and detoxification experts agree that rapid detox is the most humane and efficient way to detoxify the body from the effects of levorphanol dependence. During rapid detox, board certified anesthesiologists administer sedatives and anesthesia alongside the standard detoxification medications so that the patient dozes in a comfortable "twilight sleep" during the detoxification process. When she awakens a few hours later, she will not remember the demeaning and uncomfortable symptoms of withdrawal. As a result, she will be in better position for effective rehabilitation for her addiction to levorphanol.

Rehabilitation

Medically assisted detoxification addresses only the individual's physical dependence upon levorphanol. MAT by itself does little to change long-term drug abuse. While detoxification addresses the physical aspects of levorphanol addiction, rehabilitation focuses on the behavioral aspects of this destructive disease.

There are many levorphanol treatment options available, including outpatient therapy, inpatient rehabilitation and long-term residential treatment. No one treatment is appropriate for everyone, but whatever treatment the individual chooses needs to be readily available so that he can engage in therapy regularly. It is important that the patient remain in treatment for an adequate amount of time.

Effective treatment for levorphanol addiction attends to multiple needs of the individual, not just his withdrawal from levorphanol. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. Many people struggling with levorphanol withdrawal have other issues, such as mental disorders that may compromise the individual's attempts to overcome levorphanol withdrawal.

Counselors should assess and modify treatment plans continually to ensure it meets the patient's changing needs. Counselors should require drug testing frequently, as relapses to levorphanol use do occur.

Counselors should test patients for infectious diseases such as HIV/ AIDS, hepatitis B and C, tuberculosis. She should also help patients find ways to reduce the risk of contracting or spreading infectious diseases.

Facts

Programs

Risks