Opioid Withdrawal

When you cease the use of opioid drugs that your body has become dependent on for well-being, you may experience symptoms of opioid withdrawal.

This can manifest in various ways as opioids bind to receptors on nerve cells in the brain, spinal cord, and other areas to inhibit pain signals and stimulate the release of dopamine, a neurotransmitter associated with feelings of pleasure.

Opioid medications such as oxycodone or morphine are commonly used to manage pain following surgery or injuries. Unfortunately, some individuals resort to using illicit opioids, such as heroin.

Opioids include:

• Codeine
• Fentanyl
• Heroin
• Hydrocodone (alone or with acetaminophen)
• Morphine
• Oxycodone (alone or with acetaminophen)
• Oxymorphone

Short-acting opioids such as heroin have an onset of opioid withdrawal symptoms at 8-24 hours after last use for a duration of 4-10 days.

Long-acting opioids such as Methadone have an onset of opioid withdrawal symptoms 12-48 hours after last use for a duration 10-20 days.

Symptoms include:

• Nausea and vomitingAnxiety
• Insomnia
• Hot and cold flushes
  Sweating
• Hypertension
• Tachycardia
• Hyperreflexia
• Tachypnea
• PerspirationMyalgia (muscle aches, pains and cramps)Watery discharge from eyes and nose
• Diarrhoea
  Piloerection (goosebumps)
• Lacrimation (tearing from the eyes)
• Rhinorrhea (runny nose)
• Dilated pupils
• Light sensitivity

Management

Getting help

Those addicted to opioids can get help by contacting their GP, local drug service or needle exchange clinic.

When opioid withdrawal signs are present, pharmacological management of opioid withdrawal is needed. Long-term opioid replacement is accomplished using methadone or buprenorphine. 

Methadone

Methadone is administered in both inpatient and outpatient treatment facilities. Initially, patients are given a dose of 10 mg of methadone orally or intravenously every 4 to 6 hours if withdrawal symptoms continue. The total daily dose is divided equally for the following day. It is uncommon for a patient to require more than 40 mg in a 24-hour period. The prescribed dose can be administered once or twice daily by the second day. The process of adjusting the dosage, known as titration, begins on the third day to establish a maintenance dose.

Buprenorphine

Instead of methadone, an initial dose of 4 to 12 mg of sublingual buprenorphine can be prescribed. Buprenorphine may cause withdrawal symptoms in opiate-dependent individuals without signs of withdrawal. Therefore, it should be administered 12 to 18 hours after the last dose of short-acting agonists like heroin or oxycodone and 24 to 48 hours after the last dose of long-acting agonists such as methadone.

Outcomes

The symptoms of opioid withdrawal can last a few days to more than two weeks. For most people, the worst symptoms get better after a few days.

Prognosis

Opioid users who have a strong support system and good impulse control are more likely to have a better prognosis. Furthermore, patients likely to follow up with their outpatient care with a psychiatrist and/or detoxification program are also likely to have a favourable prognosis.