Opiate Withdrawal

Opiate abuse and subsequent dependence is a growing problem in the United States. Almost 2 million people in the United States were dependent on opiates in 2005 according to the Institute of Addiction Medicine. This rise in opiate abuse is due, in large part, to the fact that Americans take more opiates than another other nation on earth. Even though Americans represent only about 5 percent of global population, they consume 80 percent of the world's supply of opiates.

Opiates work by binding to opiate receptors throughout the individual's digestive and central nervous system to change the way the brain perceives pain.

Opiates are a group of painkillers derived from the poppy plant, which produces natural opium and opiates, such as morphine and codeine. The poppy plant also contains other compounds, such as thebaine, from which pharmacologist produce semi-synthetic opiate drugs. Examples of semi-synthetic opiates include hydrocodone, oxycodone, hydromorphone and oxymorphone. While the semi-synthetic opiates are chemically different from natural opiates, they bind to the same opiate receptors to produce varying levels of analgesia, sedation and euphoria.

Opiates, sometimes called opiates, are a psychoactive medication that physicians and surgeons prescribe to relieve patients' moderate to severe pain. Opiates are appealing to recreational drug users because of the pleasant euphoria and sedative affects these drugs produce.

Definition

Rehabilitation specialists define opiate withdrawal as a normal, predictable consequence of a sudden drop in the level of opiates in the body of a person who is physically dependent on opiates. Withdrawal manifests itself in a variety of overpowering physical symptoms that can last five or more days; psychological symptoms of withdrawal may last much longer.

Causes

The human body adapts to the presence of certain foreign chemicals in the body, including opiates. In fact, the body can become tolerant of those substances, which means it takes an ever-increasing amount of opiates to cause the intended euphoric or pain-relieving effect. With prolonged use, the body may become dependent on that substance; this means the individual must maintain a certain level of opiates for the body to feel "normal." If the level of opiates drops rapidly, a process known as detoxification, the body struggles to maintain its chemical balance. This battle for stability manifests itself through acute physical and emotional withdrawal symptoms.

Facts

While detoxification from opiate dependence is not fatal, the resulting symptoms of withdrawal are profoundly uncomfortable without professional medical assistance.

When used as directed by a physician, opiate use poses a small risk for dependence. People using opiates for non-medical use, either to get high or to treat a condition without a prescription, face a greater risk for dependence. Snorting or injecting opiates intravenously increases the risk for dependence and subsequent withdrawal.

Symptoms

Detoxification from opiate dependence causes withdrawal symptoms that are similar to those caused by the flu. Opiate withdrawal also causes psychological symptoms whose demoralizing affects can be just as overpowering as the physical symptoms of withdrawal.

Physical

Physical symptoms of opiate withdrawal begin a few hours after the last dose or immediately upon the administration of drugs that reduce the level of opiates, such as naloxone. Physical withdrawal symptoms typically last five or more days, with the worst symptoms occurring on or about the fourth day. Potent physical symptoms often prevent the most determined and disciplined individuals from a complete recovery, especially if these individuals attempt self-detoxification, without the help of trained professionals.

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

Individuals attempting self-detoxification often overlook or ignore the potent psychological withdrawal symptoms associated with opiate detoxification. Psychological withdrawal symptoms frequently undermine recovery efforts, especially when left untreated or under treated.

Psychological symptoms of withdrawal include:

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

Possible Complications

Without proper medical supervision, an individual may suffer complications. One such complication is aspiration, which is vomiting and then breathing the stomach contents into the lungs. Aspiration may result in pneumonia or lung infections. Extreme vomiting and diarrhea, left untreated, may result in dangerous dehydration.

The greatest complication associated with opiate withdrawal is relapse.

Treatment options

Opiate 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 qualified to help them overcome opiate withdrawal.

Just over 5 percent of admissions to publicly funded substance abuse programs were for treatment of opiate abuse. There, rehabilitative professionals assist individuals in overcoming physical dependence, withdrawal symptoms during detoxification and rehabilitation.

Many individuals try to resolve their dependence on opiates without the help of experienced and qualified medical professionals by attempting self-detoxification. This is commonly called "going cold turkey" in a reference to the cold, clammy and pale appearance the skin takes on as the individual detoxifies himself. During self-detox, the individual bears the full brunt of acute opiate withdrawal, unaided by medicine and caring medical personnel.

Some individuals try to reduce opiate withdrawal symptoms by developing a homemade treatment plan, using medications to address each symptom. One such concoction is The Thomas Recipe, which calls for Xanax or another psychoactive drug to relieve anxiety and help the individual sleep. He will wean himself from this medication after he successfully detoxifies his body from opiates. The Thomas Recipe also calls for medication to relieve diarrhea, vitamins and other drugs to reduce body aches and overwhelming fatigue.

While The Thomas Recipe or other homemade treatments reduce the physical symptoms of opiate withdrawal, they do not prevent dangerous complications or address the underlying psychological symptoms that increase the risk for relapse.

An individual who relapses after attempting detoxification faces a greater risk for overdose because detox reduces tolerance to opiates. A person who has just overcome withdrawal symptoms can overdose on a much smaller dose than they took before detoxification. There was a 63 percent increase in the number of deaths in the United States associated with opiate use during the 5-year period between 1999 and 2004.

Overdose is a serious, potentially fatal medical emergency requiring the help of medical professionals. In the emergency department, doctors will administer naloxone and other medications to reduce opiates to safe levels. Nurses monitor patients for complications and respond appropriately. Once the patient's condition is stable, she may participate in rehabilitation to address the underlying issues that led to opiate dependence.

Individuals in otherwise stable condition may participate in Drug Replacement Therapy, or DRT, in which patients take medications that mimic opiates but do not produce the euphoric effects. This allows the individual to participate in counseling before weaning his body from these dangerous drugs. Methadone, Suboxone and buprenorphine are common DRT medications. Once he learns how to live without opiates, the person weans himself from the replacement drugs.

Harvard Medical School cites estimates that 25 percent of methadone DRT patients eventually abstain, another 25 percent continues to take the drug and 50 percent go on and off methadone.

Supporters of DRT point out that participants do not spend time in a hospital and can therefore continue working or taking care of their families while they engage in rehabilitation. Opponents feel DRT is merely trading one addiction for another.

Medication-Assisted Treatment, or MAT, refers to any substance abuse treatment plan that includes pharmacological intervention to reduce the severity and duration of withdrawal symptoms. DRT is one type of MAT. 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

The standard alternative to DRT is inpatient detoxification, in which doctors and nurses administer medications to reduce opiate levels and still more drugs to deal with the ensuing withdrawal symptoms. Standard detoxification reduces the severity and duration of withdrawal symptoms somewhat, but the patient still faces the demoralizing stigma of going through detoxification.

Rapid detox is a cutting-edge alternative to standard detoxification. During rapid detox, board certified anesthesiologists administer the standard detoxification and anti-withdrawal medications along with anesthesia and sedatives, so that patients rest in a comfortable "twilight sleep." Patients awaken a few hours later, oblivious to the uncomfortable symptoms of withdrawal that may have prevented recovery. These patients do not suffer the demoralizing psychological damage opiate withdrawal usually inflicts.

Rehabilitation

Opiate withdrawal may be a side effect of opiate addiction, as the individual tries to wean himself from this powerful prescription pain reliever. The American Society of Addictive Medicine recognizes that recovery from opiate addiction is "best achieved through a combination of self-management, mutual support, and professional care provided by trained and certified professionals."

Rehabilitation "rewires" the reward circuit in the dependent patient's brain through behavior modification and counseling. Rehab teaches the individual how to live without opiates. Rehabilitation programs may be inpatient or outpatient, with treatment plans ranging from a few weeks to six months or more.

After many years experience helping individuals deal with opiate withdrawal, rehabilitation professionals have agreed upon several principles of effective treatment. These counselors and researchers agree that opiate addiction is a complex but treatable disease that affects brain function and behavior, and that no single treatment is appropriate for everyone. Treatment needs to be readily available and effective treatment attends to multiple needs of the individual, not just his or her drug abuse.

Remaining in treatment for an adequate length of time is critical to ensure the individual has changed the underlying neurological changes that lead to relapse. Individual or group counseling, coupled with other behavioral therapies are the most commonly used forms of treatment directed at reducing drug abuse. MAT is an important element of these treatments for many patients, especially when combined with counseling and other behavioral therapies.

Doctors and rehabilitation professionals must assess the patient's condition continually and modify treatment as necessary to ensure that it meets the patient's changing needs. Many drug-addicted individuals also have other mental disorders that doctors need to address before meaningful rehabilitation for opiate withdrawal can take place. As such, medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse; treatment of the whole person is necessary for meaningful rehabilitation.

Treatment does not need to be voluntary to be effective. According to NIDA, individuals under legal coercion tend to remain in treatment longer than and do better than those not under pressure.

Doctors must monitor patients continuously, as lapses during treatment frequently occur. Treatment programs should assess patients for the presence of HIV/ AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.