Oxymorphone Withdrawal

Definition

Rehabilitation specialists define oxymorphone withdrawal as the consequence of a sudden drop in the level of oxymorphone in an opioid-dependent person. Doctors diagnose someone as being dependent on oxymorphone if the patient experiences flu-like symptoms when opioid levels go down. Withdrawal causes unpleasant physical symptoms that can last five or more days. Oxymorphone withdrawal may also cause psychological withdrawal symptoms that can last much longer, especially if left untreated or undertreated.

Causes

The human body adjusts to foreign substances in the body, including oxymorphone, by adjusting its own chemistry to maintain a safe chemical balance. The body can become tolerant of certain chemicals, which means it takes an ever-increasing amount of oxymorphone to cause the intended euphoric or pain-relieving effect. With prolonged use, the body may become dependent on the chemical; an opioid-dependent person must maintain a certain level of oxymorphone in order to feel normal.

If the level of opioids drops dramatically, the body struggles to maintain its chemical balance. This struggle manifests itself through withdrawal symptoms. Doctors call this "detoxification." You can cause detoxification by missing a dose, taking an insufficient dose or using a medicine such as naloxone that drops opioid levels.

Chronic abuse of certain prescription drugs, especially opioids such as oxymorphone, is leading to a high number of people suffering from physical dependence and withdrawal symptoms. Anyone who takes oxymorphone can develop an addiction to or dependence on opioids. Physical dependence and oxymorphone withdrawal are serious conditions, requiring the help of a qualified professional.

Facts

Doctors prescribe oxymorphone to treat moderate to severe pain. Recreational users target powerful painkillers such as oxymorphone to get high. According to the U.S. Drug Enforcement Agency, or DEA, pharmacists filled more than a million oxymorphone prescriptions in 2007, making this drug widely available for recreational users.

Americans take more opioid painkillers like oxymorphone than anyone on earth does. Even though Americans account for about 5 percent of global population, they consume 80 percent of the world's supply of opioids, according to the Institute of Addiction Medicine.

Oxymorphone withdrawal is uncomfortable and demoralizing but usually not life threatening. The severity and duration of withdrawal symptoms depends on dosage and duration of oxymorphone use.

Abuse, Dependence and oxymorphone Withdrawal

Oxymorphone is associated with abuse, physical dependence and addiction. The U.S. Drug Enforcement Agency, or DEA, classifies substances according to the potential for abuse, and classifies as a Schedule II narcotic. This means oxymorphone poses a relatively high potential for abuse and mental or physical dependence.

To decrease the risk for abuse, the DEA prohibits refills on schedule II narcotics such as oxymorphone. Many opioid-dependent people try to overcome these restrictions by placing an emergency call after hours or showing up at the doctor's office just as it is closing up for the day. Another tactic is "doctor shopping" to get as many written prescriptions from as many different doctors as possible.

Some oxymorphone abusers present phony prescriptions at pharmacies. An opioid-dependent individual may seem to lose prescriptions frequently, or tamper with written prescription to get more pills in each bottle.

Many recreational users say they get oxymorphone and other prescription opioids free from friends or family members. Some purchase drugs on the street.

Symptoms

Oxymorphone usually causes symptoms similar to the flu, but withdrawal also causes psychological symptoms whose demoralizing affects can interfere with recovery efforts.

Physical symptoms of oxymorphone withdrawal last five or more days, with the worst symptoms occurring on or about the fourth day. A person can relieve oxymorphone withdrawal symptoms by taking several medications that address each symptom, drugs that mimic oxymorphone's effects or by taking more oxymorphone. Without medical attention and professional support, the promise of relief from withdrawal symptoms tempts many into taking more oxymorphone.

Physical

Oxymorphone withdrawal symptoms 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

The physical symptoms associated with oxymorphone withdrawal often overshadow the psychological aspects of detoxification. Oxymorphone withdrawal frequently causes an individual to believe he is unworthy or incapable of recovery. Left untreated or undertreated, psychological symptoms increase the risk for relapse.

Psychological symptoms of oxymorphone withdrawal include:

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

Possible Complications

Relapse is the greatest complication associated with oxymorphone withdrawal. Many individuals suffer countless cycles of relapse and remission, especially when attempting detoxification without the help of trained professionals. Every instance relapse puts recovery further out of reach.

Detoxification increases the risk for overdose in those who return to oxymorphone abuse immediately. Any amount of detoxification reduces the body's tolerance to opioids. Even after feeling moderate withdrawal symptoms, a person can potentially overdose on a smaller dose of oxymorphone than he used to take.

Another complication of oxymorphone withdrawal is vomiting and then breathing the stomach contents into the lungs, a condition known as aspiration, which may result in fluid in the lungs or lung infections. Extreme vomiting and diarrhea might cause dehydration which, left untreated, could cause electrolyte imbalances and other serious medical conditions.

Treatment options

Proper treatment is essential for recovery. Effective treatment includes two phases: detoxification and rehabilitation. While detoxification deals specifically with the process of oxymorphone withdrawal, rehabilitation helps you avoid relapses and therefore reduce the number of times you will need to endure oxymorphone withdrawal.

Detoxification is the medical process of lowering oxymorphone levels. Most detoxification procedures entail several days of intense withdrawal symptoms.

The rehabilitation phase includes behavior modification and counseling. Trained professionals reduce the chance for relapse by helping patients change behaviors associated with drug abuse.

Detoxification

Self-detoxification, or "going cold turkey," offers no protection against brutal physical and psychological withdrawal symptoms. Cold turkey refers to the way the skin looks during detoxification: pale, cold and clammy with goose bumps, much like a plucked turkey's skin. Without medicine to ease oxymorphone withdrawal symptoms or professional guidance to help with psychological trauma, many individuals relapse to oxymorphone abuse.

Some homemade treatment plans reduce individual withdrawal symptoms during self-detoxification. One such concoction is The Thomas Recipe, which includes valium or some other benzodiazepine to calm nerves and encourage sleep. Imodium eases diarrhea while mineral supplements and hot baths relieve muscle aches. L-Tyrosine with B6 gives a boost of energy to overcome malaise.

While the Thomas Recipe addresses some oxymorphone withdrawal symptoms, individuals who attempt self-detoxification face a high risk for complications such as aspiration, dehydration and relapse. Returning to oxymorphone addiction after even a short attempt at detoxification may result in life threatening overdose.

Overdose

High doses of oxymorphone, or taking oxymorphone after experiencing withdrawal symptoms, increases the risk for overdose. Overdose is a serious, sometimes fatal medical emergency. If you think you or someone you know has taken too much oxymorphone, seek emergency assistance immediately by going to the emergency room or calling an ambulance. If you need immediate help, contact your local poison control center at 1-800-222-1222.

Symptoms of oxymorphone overdose include:

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

Oxymorphone overdose can be fatal - prescription painkiller overdoses killed nearly 15,000 people in the United States in 2008, according to the CDC. Prescription painkiller abuse sends nearly half a million people to the emergency room every year.

In the emergency department, doctors administer naloxone and other medications to reduce oxymorphone to safe levels. Nurses monitor vital signs, watch for complications and establish an airway to help the patient breathe. Nurses may pump the stomach or administer charcoal to absorb excess oxymorphone. Emergency personnel may perform CPR or other life-saving measures as necessary.

Individuals who are not under a doctor's care for overdose may benefit from Drug Replacement Therapy, or DRT, which replaces oxymorphone with medications that mimic the effects of opioids. DRT drugs include methadone, Suboxone and buprenorphine. DRT medications act similarly to oxymorphone to reduce withdrawal symptoms, but DRT drugs do not cause euphoria. DRT allows the patient to participate in rehabilitation before attempting detoxification.

After some rehabilitation, the patient must wean himself from the replacement drug by taking smaller doses increasingly further apart. Many people have trouble quitting the replacement drug. Harvard Medical School says that 25 percent of methadone DRT patients eventually quit using drugs altogether, another 25 percent continues to take the replacement drug and 50 percent go on and off methadone.

DRT is just one kind of Medication-Assisted Treatment, or MAT. Medications reduce the overpowering symptoms of withdrawal, helping you tolerate the process long enough to successfully detoxify your body from oxymorphone.

Rehabilitation professionals say that MAT is an important and effective treatment approach because it:

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

Standard detoxification involves a hospital stay of five or more days. During inpatient care, doctors administer naloxone and other medications to reduce oxymorphone levels along with other drugs to control the ensuing withdrawal symptoms. While standard inpatient detoxification procedures relieve the severity and duration of symptoms somewhat, the patient still endures a lengthy, uncomfortable and demoralizing battle that acts as a psychological barrier to recovery.

Rapid detox is the most humane form of detoxification available today. Rapid detox quickly puts the patient in a prime position to deal with oxymorphone dependence. During rapid detox, board certified anesthesiologists administer the standard detoxification and anti-withdrawal drugs alongside sedatives and anesthesia, so the patient dozes in a restful "twilight sleep" instead of throwing up and not sleeping for days on end. When she awakens from rapid detox, the patient will have no memory of the grueling detoxification process. Instead of a few days, she is ready for meaningful behavior modification in a few hours.

Rehabilitation

Oxymorphone withdrawal is a traumatic and significant event. Without rehabilitation, the opioid-dependent individual is likely to return to substance abuse and potentially face repeated bouts of oxymorphone withdrawal as she cycles between relapse and remission.

There is a wide variety of rehabilitation options available, from long-term residential facilities to monthly meetings with a trained counselor. Treatment largely depends on the severity of dependence to oxymorphone and other personal needs, such as childcare or time away from work.

No single treatment is appropriate for everyone, but treatment does need to be readily available for all who need it. It is critical that the patient remain in treatment long enough to change the behavioral patterns that led to dependence on oxymorphone.

Effective treatment attends to the multiple needs of the individual, such as physical and mental health issues, legal or social problems and other aspects of drug abuse. Treatment should not just focus on easing symptoms associated with oxymorphone withdrawal. Overcoming oxymorphone withdrawal symptoms is only the first stage of treatment and by itself does little to change long-term drug abuse.

An individualized treatment plan may include individual, family or group counseling and other behavioral therapies. Therapy may also include medication, an important element of treatment for many patients. Many people who are dependent on opioids such as oxymorphone have other physical and mental disorders that interfere with recovery efforts. Many of these conditions are responsive to medication or other forms of treatment, which improves the individual's chances for recovery from oxymorphone withdrawal.

The rehabilitation professional will continually assess the patient's progress and modify the treatment plan so that it always fits the patient's changing needs. The counselor will also monitor for drug use, as relapses do occur. The counselor may request testing for certain illnesses, such as HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases and provide information on how to reduce the risk for contracting or spreading these diseases.

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.