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Opiate withdrawal

Definition

Opiate withdrawal refers to the wide range of symptoms that occur after stopping or dramatically reducing opiate drugs after heavy and prolonged use (several weeks or more).

Opiate drugs include heroin, morphine, codeine, Oxycontin, Dilaudid, methadone, and others.

Alternative Names

Withdrawal from opioids; Dopesickness

Causes, incidence, and risk factors

About 9% of the population is believed to misuse opiates over the course of their lifetime, including illegal drugs like heroin and prescribed pain medications such as Oxycontin.

These drugs can cause physical dependence. This means that a person relies on the drug to prevent symptoms of withdrawal. 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

Symptoms of withdrawal include:

• Abdominal pain
• Agitation
• Diarrhea
• Dilated pupils
• Goose bumps
• Nausea
• Runny nose
• Sweating
• Vomiting

Signs and tests

Your doctor can often diagnose opiate withdrawal after performing a physical exam and asking questions about your medical history and drug use.

Urine or blood tests to screen for drugs can confirm opiate use.

Treatment

Treatment involves supportive care and medications. The most commonly used medication, clonidine, primarily reduces physical symptoms.

Buprenorphine (Suptex) has been shown to work better than other medications for treating withdrawal from opiates, and can shorten the length of detox. It may also be used for long-term maintenance like methadone.

Persons withdrawing from methadone may be placed on long-term maintanence. This involves slowly reducing the dosage of methadone over time. This helps reduce the intensity of withdrawal symptoms.

Some drug treatment programs have widely advertised treatments for opiate withdrawal called detox under anesthesia or rapid opiate detox. Such programs involve placing you under anesthesia and injecting large doses of opiate-blocking drugs, with hopes that this will speed up the return to normal opioid system function.

There is no evidence that these programs actually reduce the time spent in withdrawal. In some cases, they may reduce the intensity of symptoms. However, there have been several deaths associated with the procedures, particularly when it is done outside a hospital.

Because opiate withdrawal produces vomiting, and vomiting during anesthesia significantly increases death risk, many specialists think the risks of this procedure significantly outweigh the potential (and unproven) benefits.

Support Groups

Support groups, such as Narcotics Anonymous and SMART Recovery can be enormously helpful to persons addicted to opiates.

Expectations (prognosis)

Withdrawal from opiates is painful, but not life threatening.

Complications

The biggest complication is return to drug use. Most opiate overdose deaths occur in persons who have just withdrawn or detoxed. Because withdrawal reduces your tolerance to the drug, those who have just gone through withdrawal can overdose on a much smaller dose than they used to take.

Longer-term treatment is recommended for most persons following withdrawal. This can include self-help groups, like Narcotics Anonymous or SMART Recovery, outpatient counseling, intensive outpatient treatment (day hospitalization), or in-patient treatment.

Those withdrawing from opiates should be checked for depression and other mental illnesses. Appropriate treatment of such disorders can reduce the risk of relapse. Antidepressant medications should NOT be withheld under the assumption that the depression is only related to withdrawal, and not a pre-existing condition.

Treatment goals should be discussed with the patient and recommendations for care made accordingly. If a person continues to withdrawn repeatedly, methadone maintenance is strongly recommended.

Calling your health care provider

Call your doctor if you are using or withdrawing from opiates.

Review Date:1/22/2008
Reviewed By:Eric Perez, MD, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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