Opiates are a class of drugs that cause physical as well as psychological dependence. This means that the user starts relying on it to get rid of the symptoms of opiate withdrawal that start appearing once you start quitting this drug.
Another common side effect of Opiates is that you start developing tolerance to it. To have the same, effects you need more and more dosage of Opiates. This is when the person becomes physically dependent on it.
The recovery of a person requires a time period after quitting Opiates. At this time the person experiences a set of responses that are termed as symptoms of opiate withdrawal. This article highlights the symptoms of Opiate withdrawal and deals with its treatment.
What is Opiate withdrawal syndrome?
Opiate Withdrawal syndrome is a condition in which a user starts relying on Opiates to an extent, that if it is withdrawn he or she will experience a set of symptoms that include the following;
Early symptoms: These symptoms start within 6-12 hours for short-acting Opiates and they start within 30 hours or more for long acting Opiates.
- Muscle aches
- Increased lacrimation
- Runny nose
Late Symptoms: The symptoms reach a peak level at 72 hours and last for up to a week.
- Abdominal cramps
- Dilated pupils
The early symptoms start appearing after 12 hours of the last usage of any Opiate. They are not life-threatening but they need prompt treatment.
The babies who are born to Opiate addicted mothers also experience withdrawal symptoms that may include;
- Poor feeding
- Gastric issues
Such babies should be immediately treated as these are the major danger signs.
What causes Opiate withdrawal?
The opiate receptors present in the body get desensitized to prolonged consumption of Opiates. The body requires a greater dosage of Opiates to achieve similar effects and this phenomenon can rightly be called tolerance.
Desensitization occurs by down-regulation of receptors. Now your body requires more Opiates and overdosing can happen accidentally which can be quite dangerous.
The body becomes accustomed to the use of Opiates and it relies on Opiates to release endorphins, dopamine and certain other neurotransmitters, that help in the sleep-wake cycle, muscle coordination and other systems of the body.
Once you leave the consumption of Opiates, you become physically sick as now there is a stop to the production and release of the necessary neurotransmitters.
If you have been using Opiates for pain, you start feeling severe pain on quitting Opiates. And they mistake the symptoms of opiate withdrawal for flu or mild infection.
Prescription Opiates include Hydrocodone, Hydromorphone, Morphine, and Oxycontin.
How to diagnose Opiate withdrawal?
Certain tests are done to diagnose if a person is suffering from the symptoms of Opiate withdrawal but prior to these tests, history is taken from patients. They are asked about the duration and frequency of Opiate consumptions. After taking history a physical examination is performed to assess the condition of the patient.
The following tests are then performed to confirm the diagnosis;
- Urine screening test
- EKG (Electrocardiogram)
- Chest X-ray
- Complete blood count
- Blood screening test
- Liver function tests such as CHEM-20
- Testing for HIV, AIDS, Hepatitis C, tuberculosis and other infections spread through the use of unsafe use of injections.
What is the treatment of Opiate withdrawal syndrome?
To get rid of the Opiate addiction, the only step is to quit the use of Opiates but as mentioned earlier sudden quitting of Opiates can lead to withdrawal syndrome which can’t be dealt with on your own as the symptoms can be quite dangerous at times.
Therefore, it is recommended to consult a doctor and take proper medications and counseling sessions to get properly cured.
To get rid of the withdrawal symptoms you can either take medications at home with a strong support system or use facilities which are specially set up to help people with the process of detoxification. If the symptoms are too severe, the patient might need to be hospitalized.
What are the medications given to rid one of the symptoms of Opiate withdrawal?
- MethadoneIt is a type of synthetic opiate that is used to help in relieving the withdrawal symptoms. It is used as a substitute to Opiate, after a certain period of maintenance it is gradually withdrawn. Some people need years to withdraw methadone.It should be used with caution in patients having a respiratory deficiency, acute alcohol dependence, head injury, treatment with monoamine oxidase inhibitors (MAOIs), ulcerating colitis and severe hepatic impairment.
- Subutex or BuprenorphineIt is also used in the treatment regimen of Opiate withdrawal. It reduces the length of the detoxification process. If it is combined with Naloxone, its misuse and dependence are prevented. Naloxone also helps in prevention of constipation.It is a partial Opiate agonist that should be used carefully in patients with respiratory deficiency, urethral obstruction, and diabetes. The dosage of Buprenorphine should be carefully regulated.
- ClonidineIt helps in reducing agitation, relaxing muscles and decreasing or removing symptoms like sweating, cramps and runny nose. It is an anxiolytic. It doesn’t reduce craving for Opiates.It reduces the intensity of withdrawal symptoms 50 to 70 percent and it is effective for cramping, muscle aches, restlessness etc. Clonidine is an alpha 2 adrenergic agonist that may cause drowsiness and low blood pressure. It should not be given in conjunction with another symptomatic treatment.
- Codeine phosphateIt alleviated the symptoms of withdrawal and also helps in reducing Opiate cravings. The dosage of Codeine phosphate should be reviewed and monitored on daily basis and it shouldn’t be given to patients with respiratory or hepatic disorders.
- StemetilStemetil can be used for treating vomiting and vertigo.
- XanaxIt is used to treat insomnia and anxiety.
- NaltrexoneIt helps in preventing relapse of Opiate withdrawal symptoms.
- Mild withdrawal symptomsMild withdrawal symptoms can be treated with acetaminophen and NSAIDs like ibuprofen.
- Loperamide or ImodiumLoperamide or Imodium can help in relieving diarrhea.
- Vistaril and AtaraxVistaril and Atarax help in easing nausea.
The patient should be closely monitored for signs and symptoms of depression and other mental disorders. Anti-depressants and anxiolytic medications should be given to the patient if he suffers from mental illnesses.
During the medical detox process, the vital signs of the patient should be monitored regularly that include pulse, respiratory rate, temperature and blood pressure.
What type of behavioral therapy can be done to reduce the withdrawal symptoms?
Along with the ongoing medical treatment and detox process, it is necessary that a behavioral therapy is also started. This could include any of the following therapies;
- Cognitive Behavioral TherapyIn this therapy, the main concept is that all thought processes, feelings, behaviors, and beliefs work in conjunction to support substance use. CBT helps in reducing craving for Opiates and also helps in modifying lifestyle of an Opiate addict.
- Motivational InterviewingThe goal of this type of therapy is to enhance the intrinsic or motivation within oneself in order to abstain from the use of Opiates and to go for recovery.
- Contingency ManagementThis type of therapy focuses on providing rewards for a drug-free oriented behavior, thus promoting the abstinence from Opiates and motivating at the same time to recover.
- Family therapyFamily therapy involves the education of family members to support the patient and encourage him to reduce the use of Opiates.
- Promoting relaxationPromoting relaxation techniques in patients with deep breathing and guided imagery can help reduce their craving for Opiates.
Complications of withdrawal symptoms
Aspiration of the vomitus is a major problem as it can cause lung infection. Diarrhea along with vomiting, if intense can cause dehydration and electrolyte disturbances. It can cause hypovolemic shock and thus lead to death if not promptly treated.
Intense muscle cramps and joint aches are another complications of withdrawal symptoms which can incline once to the use of Opiates again.
Also, some people return to the drug abuse of Opiates to get rid of the withdrawal symptoms.
Contraindications of Opiate withdrawal
Pregnant women who are dependent on Opiates should not undergo Opiate withdrawal as this can result in premature delivery or miscarriage. They should be only given methadone maintenance treatment.
Also, patients who are starting methadone maintenance treatment do not need to undergo Opiate withdrawal before the commencement of this therapy.