Taking Care Of Opioid Withdrawal
The withdrawal period is the initial step in ending an opioid use disorder (OUD).
The withdrawal period is the initial step in ending an opioid use disorder (OUD). Withdrawing from opioids can be exceedingly painful. Treatment of withdrawal effectively is critical to long-term abstinence success. Opioid drugs, non-opioid supplementary medications, and a variety of non-pharmacologic therapy such as nutrition, exercise, and alternative modalities are all available.
Recognizing the Signs of it Withdrawal
When someone stops using opioids (such as heroin), withdrawal symptoms usually start 8-24 hours after the last use and last 4-10 days. Withdrawal symptoms begin 12-48 hours after the last use of a long-acting opioid (e.g., methadone) and can linger for 10-20 days.
Nausea and vomiting, anxiety, insomnia, hot and cold flashes, perspiration, muscle cramps, watery eyes and nose discharge, and diarrhea are some of the symptoms. Opioid withdrawal symptoms vary widely in severity and length from person to person, and are influenced by a variety of factors that are difficult to anticipate.
Withdrawal Treatment
Medication That is Based on Opioids
Regardless of the eventual therapeutic aim, the first step in opioid discontinuation or dose decrease is to manage acute opioid withdrawal symptoms. Suboxone is often preferred over methadone, buprenorphine/naloxone (Suboxone), and naltrexone as opioid-based medication assisted treatment (MAT) for opioid use disorder.
Suboxone can be prescribed by a licensed medical provider in any treatment setting, whereas methadone is strictly regulated in the United States and can only be provided through federally licensed treatment centers. To avoid triggered withdrawal, the user should be experiencing mild-to-moderate withdrawal symptoms from the opioid (e.g., heroin) they were taking before to commencing Suboxone.
The starting phase of Suboxone treatment is the initial stage. Because the distress in the first few days after quitting can be severe, efficient treatment of withdrawal symptoms is a key first step on the route to successful OUD treatment during this time. Many people are unable to maintain opiate cessation without effective care (2019 clinical review).
Non-Opioid/Adjunctive Drugs
The evidence regarding the effectiveness of opioid medicines (MAT) in treating withdrawal symptoms is far and away the finest. Non-opioid medicines have less evidence of effectiveness in treating withdrawal. These drugs, on the other hand, can be useful as adjuvant or extra treatments, or as substitutes for MAT if it is not available or tolerated. Non-opioid adjunctive medicines include:
Anxiety, tremors, and restlessness can all be alleviated with a-2 adrenergic agonists. Clonidine is the most widely recommended drug for this reason. There are, however, a few more: In May 2018, the FDA authorized lofexidine, making it the first non-opioid medicine to be approved for the treatment of opioid withdrawal symptoms in the United States. "Clonidine and lofexidine are more effective than placebo for the management of withdrawal from heroin or methadone," according to one clinical review paper, "as no significant difference in efficacy between treatment regimens based on Clonidine or lofexidine and those based on reducing doses of methadone [were detected] over a period of around 10 days; however, methadone was associated with fewer adverse effects than Clonidine, and lofexidine has
Anti-diarrheal loperamide can be used to treat GI distress and diarrhea symptoms.
Bentyl is an antispasmodic that can help with stomach cramps.
Many of the most prevalent opioid withdrawal symptoms are included below, along with non-opioid drugs that can be used in conjunction with to give assistance. If you have any questions about whether or not any of these medications are right for you, talk to your doctor.
Exercise, Hydration, and Nutrition
Patients with OUD often go extended periods of time without appropriate meals and are malnourished, depending on the intensity of their addiction. Opioids have a variety of effects on the gastrointestinal system. Opioid use is associated with constipation, while withdrawal is associated with diarrhea, nausea, and vomiting.
This can result in nutrient losses, electrolyte imbalances, and dehydration, which can deplete a person even more while their body goes through withdrawal. When a result, appropriate water and nutrition are critical as the body goes through withdrawal. Eating well-balanced meals, following a high-fiber diet rich in complex carbohydrates (such as whole grains, vegetables, peas, and beans), staying hydrated, and increasing protein intake can all aid to strengthen the body during the withdrawal process.
Calcium and magnesium shortages are key causes in pain and nervous/muscular disorders in addicts, and zinc can aid to strengthen immune system and appropriate brain function. Supplements of vitamin B and vitamin C are frequently prescribed as well. Endorphins released by physical activity can improve mood and pain tolerance, thus little exercise is recommended. Endorphins are naturally occurring opioids.
Psychosocial Assistance
During withdrawal, psychosocial assistance from both experts and loved ones is critical. Families are urged to cultivate a caring, judgment-free environment. Speak up if you have concerns about a loved one's rehabilitation. Here are some useful websites/resources for more information on how to have this conversation
https://www.samhsa.gov/sites/default/files/samhsa families conversation guide final508.pdf
further recommendations for family support and direction