Dopesickness
Key points
- Opiate withdrawal is caused by stopping, or dramatically reducing, opiate use after heavy and prolonged use (several weeks or more).
- About 5% of the population is believed to misuse opiates, including illegal drugs like heroin and prescribed pain medications such as Oxycontin.
- The symptoms of withdrawal are often the reverse of intoxication.
- A physical exam and clinical history are often sufficient to diagnose opiate withdrawal.
Alternative names
Withdrawal from opioids; Opiate withdrawal
Definition
Opiate withdrawal is caused by stopping, or dramatically reducing, opiate use after heavy and prolonged use (several weeks or more).
Opiates include heroin, morphine, codeine, Oxycontin, Dilaudid, methadone, and others. The reaction frequently includes sweating, shaking, headache, drug craving, nausea, vomiting, abdominal cramping, diarrhea, inability to sleep, confusion, agitation, depression, anxiety, and other behavioral changes.
Causes, incidence, and risk factors
About 5% of the population is believed to misuse opiates, including illegal drugs like heroin and prescribed pain medications such as Oxycontin.
These drugs can cause physical dependence. This means that there is a reliance on the drug to prevent symptoms of withdrawl. Over time, greater amounts of the drug become necessary to produce the same effect.
The time it takes to become physically dependent varies with each individual.
When the drugs are stopped, the body needs time to recover, and withdrawal symptoms result. Withdrawal from opiates can occur whenever any chronic use is discontinued or reduced.
Some people even withdraw from opiates after hospitalization for painful conditions without realizing what is happening to them. They think they have the flu, and because they don't know that opiates would fix the problem, they don't crave the drugs.
Symptoms
The symptoms of withdrawal are often the reverse of intoxication. Withdrawal includes dilated pupils, diarrhea, runny nose, goose bumps, and abdominal pain.
Signs and tests
A physical exam and clinical history are often sufficient to diagnose opiate withdrawal. A urine or serum drug screen can verify the existence of opiates and any other drugs of abuse.
Treatment
Treatment of withdrawal includes supportive care and medications. The most commonly used medication, clonidine, primarily reduces physical symptoms.
Another detox method is to use a slowly tapered dose of methadone to reduce the intensity of withdrawal symptoms. This can be effective in inpatient programs, but outpatient methadone detox programs are ineffective.
Methadone maintenance involves ongoing use of methadone. This is the most effective treatment for opiate addiction, according to the Institutes of Medicine.
The FDA is expected to approve a new medication for use in the treatment of opiate withdrawal very soon. This medication, called buprenorphine, may help both physical and mental withdrawal symptoms. It may also be used for long-term maintenance like methadone.
Written and revised by
Gerald Hurowitz, M.D.
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