From the Guidelines
Non-Opioid Options for Opioid Withdrawal Management
Non-opioid treatment is a viable option for managing opioid withdrawal symptoms. According to 1, non-opioid treatment for opioid withdrawal may include the administration of α2-adrenergic agonists, such as clonidine and lofexidine, which can help alleviate symptoms in nonhypotensive patients.
- Antiemetics, like promethazine, can be used to treat nausea and vomiting.
- Benzodiazepines may help reduce catecholamine release during withdrawal, alleviating muscle cramps and anxiety.
- Antidiarrheals, such as loperamide, can be used to treat diarrhea. These medications can be used to manage specific symptoms of opioid withdrawal, as outlined in 1, which includes cravings, abdominal cramping, nausea, vomiting, diarrhea, agitation, anxiety, and myalgias. By using these non-opioid options, healthcare providers can help patients manage their withdrawal symptoms and reduce the risk of continued hazardous opioid use, as noted in 1.
From the Research
Non-Opioid Options for Opioid Withdrawal Management
- Non-opioid drugs have been studied for their potential to alleviate opioid withdrawal symptoms, with varying degrees of efficacy 2
- A scoping review identified non-opioid agents that can be used to manage acute opioid withdrawal, including α-adrenergic receptor agonists, N-methyl-d-aspartate (NMDA) antagonists, gamma-aminobutyric acid (GABA) modulators, and serotonergic agents 3
- α-adrenergic receptor agonists, such as clonidine and lofexidine, have been shown to have the best evidence of efficacy as alternative agents for acute opioid withdrawal 3
Specific Non-Opioid Medications
- Benzodiazepines and tricyclic antidepressants have been reported to have a moderate positive effect on opioid withdrawal symptoms 2
- Non-opioid medications like α-2 adrenergic agonists can facilitate opioid tapering for opioid-dependent patients without opioid use disorder (OUD) 4
- A novel non-opioid protocol using tizanidine, hydroxyzine, and gabapentin has been shown to be effective for medically supervised opioid withdrawal and transition to antagonist treatment 5
Mechanisms and Pathophysiology
- Opioid withdrawal symptoms are a key driver behind continued opioid use and a barrier to opioid discontinuation, and are caused by noradrenergic hyperactivity 6, 4
- Non-opioid medications can help alleviate opioid withdrawal symptoms by targeting different mechanisms, such as α-adrenergic receptor agonism or GABA modulation 3, 5