From the Guidelines
Non-Opioid Options for Opioid Withdrawal Management
Non-opioid treatment is a viable option for managing opioid withdrawal symptoms. According to recent clinical guidelines 1, non-opioid treatment for opioid withdrawal may include the administration of:
- α2-adrenergic agonists, such as clonidine and lofexidine, for symptomatic patients with nonhypotensive opioid withdrawal
- Antiemetics, like promethazine, to treat nausea and vomiting
- Benzodiazepines, which can help reduce catecholamine release during withdrawal, alleviate muscle cramps, and anxiety
- Antidiarrheals, such as loperamide, to treat diarrhea These medications can be used to manage specific symptoms of opioid withdrawal, providing an alternative to opioid-based treatments 1.
From the Research
Non-Opioid Options for Opioid Withdrawal Management
- Non-opioid medications can be used to manage opioid withdrawal symptoms, including α-adrenergic receptor agonists, N-methyl-d-aspartate (NMDA) antagonists, gamma-aminobutyric acid (GABA) modulators, and serotonergic agents 2
- α-adrenergic receptor agonists, such as clonidine and lofexidine, have the best evidence of efficacy as alternative agents for acute opioid withdrawal 2
- Other non-opioid options that may be effective in managing opioid withdrawal symptoms include:
- Benzodiazepines, which were reported to have a moderate positive effect on opioid withdrawal 3
- Tricyclic antidepressants, which were also reported to have a moderate positive effect on opioid withdrawal 3
- Tizanidine, hydroxyzine, and gabapentin, which were used in a novel non-opioid protocol for medically supervised opioid withdrawal and transition to antagonist treatment 4
- Non-opioid treatments can facilitate opioid tapering and provide a gateway into long-term treatment with naltrexone or psychosocial therapies 5
Mechanisms of Non-Opioid Options
- α-adrenergic receptor agonists work by reducing noradrenergic hyperactivity, which generates many opioid withdrawal symptoms 5
- NMDA antagonists, GABA modulators, and serotonergic agents may also be effective in managing opioid withdrawal symptoms, although more research is needed to fully understand their mechanisms and efficacy 2
Efficacy and Safety of Non-Opioid Options
- The available literature suggests that α-adrenergic receptor agonists have the best evidence of efficacy as alternative agents for acute opioid withdrawal, although more research is needed to fully understand their safety and efficacy 2
- Other non-opioid options may have varying degrees of efficacy and safety, and more research is needed to fully understand their potential as treatments for opioid withdrawal 3, 2, 5, 6, 4