Propoxyphene Withdrawal

Definition

Propoxyphene withdrawal is a normal, predictable event that occurs when propoxyphene levels drop suddenly in a person who is physically dependent on this type of drug. Propoxyphene withdrawal appears as a set of physical and psychological symptoms. Physical symptoms of propoxyphene withdrawal can incapacitate you for five or more days; psychological symptoms of withdrawal may last much longer.

Causes

Your body adjusts to the substances you put into it, such as food, alcohol or propoxyphene, by altering its own chemistry. With continued use, your body begins to depend on propoxyphene to maintain chemical balance. When you are dependent on propoxyphene, you need to take a certain amount of propoxyphene each day for your body to feel normal.

If you allow the level of propoxyphene to drop suddenly, your body will struggle to regain chemical balance. You will feel this struggle through withdrawal symptoms. Medical professionals refer to this as detoxification or abstinence syndrome.

Long-term use of propoxyphene may cause your body to grow tolerant of it, which means you have to take a larger dose of propoxyphene to get high or relieve your pain. The severity and duration of withdrawal symptoms often depends on the amount of time you have been taking propoxyphene and the dose.

Widespread substance abuse in the United States is causing high numbers of drug dependence and subsequent withdrawal symptoms. Anyone who takes high doses of propoxyphene or uses this drug for a long time can become dependent on propoxyphene, addicted to it, or both. Drug dependence and propoxyphene withdrawal are serious medical conditions that require professional treatment.

Facts

Doctors prescribe propoxyphene to relieve moderate to severe pain. Recreational users target propoxyphene because of its euphoric effect.

Americans take more painkillers like propoxyphene 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.

Withdrawal symptoms are painful and demoralizing, but usually not life threatening.

Abuse, Dependence and Propoxyphene Withdrawal

The U.S. Drug Enforcement Agency, or DEA, classifies substances according to their potential for abuse and dependence. The DEA classifies propoxyphene as a schedule II drug, meaning it poses a relatively high risk for abuse.

To decrease the incidence of abuse, the DEA prohibits refills on propoxyphene. The doctor must write a new prescription each time she determines a patient needs pain relief. A person who is dependent on propoxyphene may try to get around the DEA restriction through various forms of diversion. Someone might present bogus prescriptions at pharmacies or tamper with prescriptions to get more propoxyphene in each bottle. Doctor shopping is another tactic, where the dependent individual requests propoxyphene prescriptions from several physicians.

Many individuals say they get prescription drugs free from family members or friends. It is common for people to save prescription painkillers in case they have pain later, leaving excess narcotics in the medicine cabinet. Opioids are also widely available from drug dealers on the black market.

Symptoms

Propoxyphene withdrawal causes physical symptoms similar to the flu, but propoxyphene withdrawal also causes psychological symptoms. The psychological aspects of propoxyphene can be just as overpowering as the physical symptoms of withdrawal.

Physical symptoms of propoxyphene withdrawal include:

  • Abdominal Cramps
  • Anorexia
  • Backache
  • Body Aches
  • Chills
  • Diarrhea
  • Increased Blood Pressure, Respiratory Rate or Heart Rate
  • Insomnia
  • Joint Pain
  • Muscle Aches
  • Nausea
  • Perspiration
  • Runny Nose
  • Vomiting
  • Watery Eyes
  • Weakness
  • Yawning

Physical symptoms last five or more days, with the worst symptoms occurring on or about the fourth day. Psychological symptoms of propoxyphene may last longer, especially if left undiagnosed or untreated.

Left untreated or poorly treated, the psychological withdrawal symptoms can interfere with detoxification efforts. Psychological complications associated with propoxyphene can leave you feeling unworthy or incapable of recovery.

Psychological symptoms of withdrawal include:

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

Possible Complications

Complications of opioid withdrawal include vomiting and then breathing the stomach contents into the lungs, a dangerous complication known as aspiration. Aspiration may cause fluid in your lungs or lung infection. Extreme vomiting and diarrhea may result in dehydration.

Relapse is the greatest complication of propoxyphene withdrawal. Many people cycle between relapse and remission, struggling with propoxyphene each time.

You face a greater risk for toxic overdose if you take propoxyphene shortly after experiencing withdrawal symptoms. Detoxification reduces your tolerance to propoxyphene, so it is possible for you to overdose on a smaller dose than you used to take before you experienced even modest withdrawal symptoms.

Treatment options

There is widespread dependence on drugs such as propoxyphene 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 facility.

Just over 5 percent of admissions to publicly funded substance abuse programs were for treatment of the abuse of opioids such as propoxyphene. Treatment facilities help you overcome propoxyphene withdrawal and provide counseling to reduce your risk for relapse.

Proper treatment is critical to your recovery. Treatment includes two phases: detoxification and rehabilitation. Detoxification deals specifically with the process of propoxyphene withdrawal. Rehabilitation includes behavior modification that helps you avoid relapses and reduce the number of times you will need to endure propoxyphene withdrawal.

Detoxification is the medical process of lowering propoxyphene to safe levels. Most detoxification procedures require inpatient treatment to reduce of intense propoxyphene withdrawal symptoms.

Detoxification

Many people struggling with drug dependence try to overcome propoxyphene by themselves, in a process known as self-detoxification, or "going cold turkey." Cold turkey refers to the way the way your skin will look during self-detoxification: pale, cold and clammy with goose bumps, much like a plucked turkey's skin.

Self-detoxification offers no protection from the intense physical and psychological symptoms associated with propoxyphene withdrawal. Without medicine to ease your propoxyphene withdrawal symptoms or professional guidance to help with psychological trauma, you stand a grave risk for relapse to drug abuse.

Some people use homemade treatment plans to reduce individual propoxyphene withdrawal symptoms during self-detoxification. One well-known remedy is The Thomas Recipe, which includes valium or some other benzodiazepine to calm your nerves and help you sleep. Imodium eases your diarrhea while mineral supplements and hot baths relieve your achy muscles and other body aches. The Thomas Recipe includes L-Tyrosine with B6 for a boost of energy to overcome malaise.

The Thomas Recipe relieves symptoms associated with propoxyphene withdrawal but it offers no protection against complications such as aspiration, dehydration and relapse. Without professional counseling, psychological propoxyphene withdrawal symptoms increase your risk for relapse and potential overdose from lowered tolerance levels.

Overdose

High doses of propoxyphene, or taking propoxyphene after experiencing withdrawal symptoms, increases your risk for toxic overdose. Overdose is a serious, sometimes fatal medical emergency. If you think you or someone you know is suffering from a toxic level of propoxyphene, 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 propoxyphene overdose include:

  • Blue Lips
  • Breathing That Stops
  • Cold, Clammy Skin
  • Confusion
  • Extreme Drowsiness
  • Fainting
  • Pinpoint or Dilated Pupils
  • Shallow Breathing
  • Slow or Uneven Heart Rate
  • Weak Pulse

Propoxyphene overdose may cause death - prescription painkiller overdoses killed nearly 15,000 people in the United States in 2008, according to the CDC. Prescription painkiller abuse is responsible for nearly half a million emergency room visits every year.

To combat toxic overdose, doctors administer naloxone and other medications that lower propoxyphene to safe levels. Nurses monitor your vital signs, watch for complications and establish an airway to help your breathe. Nurses might pump your stomach or administer charcoal to absorb the excess propoxyphene in your digestive tract. Emergency personnel may perform CPR or other measures to save your life.

Drug Replacement Therapy

If you are not in immediate danger of overdose, you may benefit from Drug Replacement Therapy, or DRT. This therapy includes replacement medications that mimic the effects of propoxyphene. DRT drugs include methadone, Suboxone and buprenorphine.

DRT medications act similarly to propoxyphene to reduce withdrawal symptoms, but DRT drugs do not get you high. DRT enables you to participate in rehabilitation before going through the detoxification stage.

After some rehabilitation, you will wean yourself from the replacement drug by taking smaller doses increasingly further apart. You may 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.

Medication-Assisted Treatment

DRT is just one kind of Medication-Assisted Treatment, or MAT. Medications reduce your propoxyphene withdrawal symptoms during the detoxification phase. MAT helps you tolerate the procedure longer than if you tried self-detoxification.

Rehabilitation professionals recognize MAT as 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

Standard detoxification requires that you stay in a hospital for several days. During inpatient care, doctors give you naloxone and other medications to lower your propoxyphene levels. They also administer other drugs to ease your propoxyphene withdrawal symptoms.

While standard inpatient detoxification procedures will reduce the severity and duration of propoxyphene withdrawal symptoms somewhat, you must still endure a long, uncomfortable and demoralizing battle.

Rapid detox is the most humane form of detoxification available today. Rapid detox quickly places you in a prime position to deal with the behavioral aspects of your dependence on propoxyphene.

During rapid detox, board certified anesthesiologists administer the standard detoxification and anti-withdrawal drugs alongside sedatives and anesthesia, so you rest in a pleasant "twilight sleep" instead of throwing up and not sleeping for days on end. When you awaken from rapid detox, you will not remember the challenging detoxification process. Instead of a few days, you are ready for meaningful rehabilitation in a few hours.

Rehabilitation

Each episode of propoxyphene withdrawal is a traumatic and significant event. Without meaningful rehabilitation, you are likely to remain in an endless cycle of drug use and withdrawal, traumatizing yourself each time you endure propoxyphene withdrawal. Rehabilitation helps you stop the cycle and end the propoxyphene withdrawal symptoms permanently.

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 your dependence on propoxyphene and your other significant 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 you remain in treatment long enough to change the behavioral patterns that initially led to your dependence on propoxyphene.

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

Your rehabilitation counselor may create an individualized treatment plan that includes individual, family or group counseling and other behavioral therapies. Your therapy may also include medication, an important element of treatment for many patients. Many people who are dependent on opioids such as propoxyphene 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 your chances for recovery from propoxyphene withdrawal.

A rehabilitation professional will continually assess your progress and modify your treatment plan so that it always fits your 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.