From the Guidelines
Opioid withdrawal symptoms include cravings, abdominal cramping, nausea, vomiting, diarrhea, agitation, anxiety, feelings of hopelessness, dysphoria, piloerection, and myalgias, and treatment typically involves medication-assisted therapy with buprenorphine or methadone to alleviate withdrawal symptoms. The symptoms of opioid withdrawal can vary in onset, depending on the half-life of the opioid and the amount consumed, nominally 12 hours for heroin and up to 30 hours for methadone 1. Treatment of opioid withdrawal may be symptomatic, often involving the use of α2-adrenergic agonists such as clonidine or lofexidine, as well as antiemetics, atypical antipsychotics, and other medications targeting the withdrawal symptoms 1.
Treatment Options
- Medication-assisted therapy with buprenorphine or methadone is effective in alleviating withdrawal symptoms, with buprenorphine potentially being superior to other modalities of opioid withdrawal treatment 2.
- Buprenorphine and methadone are the most effective methods of opioid detoxification, with buprenorphine potentially being the most effective 3.
- Clonidine can help manage autonomic symptoms like high blood pressure and sweating, and supportive medications include loperamide for diarrhea, ondansetron for nausea, NSAIDs for pain, and trazodone for insomnia.
- Treatment should include behavioral therapy and counseling alongside medications, and proper hydration, nutrition, and rest are also essential during withdrawal.
Clinical Policy
The use of buprenorphine for the treatment of opioid withdrawal in the emergency department is supported by clinical policy, with the medication being approved by the Food and Drug Administration for the treatment of OUD/opioid dependence in 2002 4. However, there is no nationwide standard protocol for treating opioid withdrawal in the ED with buprenorphine, and individual institutions have developed internal treatment plans. The most effective treatment approach is to use buprenorphine or methadone to alleviate withdrawal symptoms, and to provide supportive care and behavioral therapy to address the underlying addiction.
From the FDA Drug Label
Opioid withdrawal. This can include: shaking, sweating more than normal, feeling hot or cold more than normal, runny nose, watery eyes, goose bumps, diarrhea, vomiting and muscle aches. Physical dependence is manifested by withdrawal symptoms after abrupt discontinuation of a drug or upon administration of an antagonist The opioid abstinence or withdrawal syndrome is characterized by some or all of the following: restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis Other symptoms also may develop, including: irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate.
Symptoms of Opioid Withdrawal:
- Shaking
- Sweating
- Feeling hot or cold
- Runny nose
- Watery eyes
- Goose bumps
- Diarrhea
- Vomiting
- Muscle aches
- Restlessness
- Lacrimation
- Rhinorrhea
- Yawning
- Perspiration
- Chills
- Myalgia
- Mydriasis
- Irritability
- Anxiety
- Backache
- Joint pain
- Weakness
- Abdominal cramps
- Insomnia
- Nausea
- Anorexia
Treatment of Opioid Withdrawal: To have fewer withdrawal symptoms, ask your doctor how to stop using Buprenorphine Sublingual Tablets the right way 5. In general, opioids should not be abruptly discontinued (see DOSAGE AND ADMINISTRATION: For Medically Supervised Withdrawal After a Period of Maintenance Treatment ) 6.
From the Research
Symptoms of Opioid Withdrawal
- The symptoms of opioid withdrawal can be severe and include anxiety, insomnia, and restlessness 7, 8, 9, 10, 11
- The intensity of withdrawal symptoms can vary depending on the individual and the type of opioid used 7, 8
- Withdrawal symptoms can be managed with medications such as buprenorphine, methadone, and alpha2-adrenergic agonists 7, 8, 9, 10, 11
Treatment of Opioid Withdrawal
- Buprenorphine is more effective than clonidine or lofexidine for managing opioid withdrawal in terms of severity of withdrawal, duration of withdrawal treatment, and the likelihood of treatment completion 7, 8
- Buprenorphine and methadone appear to be equally effective, but data are limited 7, 8
- Alpha2-adrenergic agonists, such as clonidine and lofexidine, are more effective than placebo for the management of withdrawal from heroin or methadone 9, 10, 11
- The choice of treatment should be based on individual patient needs and medical history 7, 8, 9, 10, 11
Comparison of Treatments
- Buprenorphine is associated with a lower average withdrawal score and longer treatment duration compared to clonidine or lofexidine 7, 8
- Methadone is associated with fewer adverse effects than clonidine, and lofexidine has a better safety profile than clonidine 9, 10, 11
- The duration of treatment is significantly longer with reducing doses of methadone compared to alpha2-adrenergic agonists 9, 10, 11