Treating ‘Skin Crawling’ (Formication) During Opioid Withdrawal

Skin crawling (often referred to casually as itchiness) is a common symptom of opioid withdrawal. The medical term for this is formication. People who experience formication often feel the false sensation of insects crawling on or under the skin. Formication can be a very unsettling experience for people who are going through opioid withdrawal. 

Formication is very uncomfortable, but it can be prevented or minimized by taking buprenorphine/naloxone (Suboxone).

Other opioid withdrawal side effects, including severe dehydration, can be much more serious. Experts consider withdrawal a life-threatening consequence of opioid dependence. If you’re thinking of quitting, consider using medications like Suboxone to ease your transition to sobriety.

What is ‘Skin Crawling’ (Formication)?

Skin crawling (formication) results from central nervous system hyperactivity that occurs during opioid withdrawal. It can also occur as a result of stimulant drug use. The name formication comes from the term for a type of ant, called Formica ants. It is different from a general sensation of itchiness, which is a common side effect of opioids themselves. 

With formication, the individual has the delusion or sensation of something actually crawling under the skin. It can be a very uncomfortable and unnerving sensory experience, and it’s often part of the other symptoms experienced during opioid withdrawal.

Symptoms of Formication 

Formication is just one of the withdrawal symptoms associated with OUD. Other withdrawal symptoms, like insomnia, irritability, cramps, and sweating (to name just a few), often occur at the same time. 

‍‍The intensity and duration of formication (and other withdrawal symptoms) depends on several factors, including whether the individual has started Medication for Addiction Treatment (MAT) or not. The factors include the following: 

• How long the person struggled with opioids
• What type of opioid they take
• What other health conditions they might have 

Formication is more likely to occur during early, acute stages of opioid withdrawal. It may persist anywhere from hours to days or even weeks.

What Percentage of People Experience Formication During Suboxone Treatment?

This symptom is very rare in people treated with suboxone. Formication is more common in people who are withdrawing from opioids rather than those who take Suboxone or another maintenance medication. Because Suboxone is a lot less potent than full opioids, formication as a symptom is also very rare after discontinuing Suboxone.

Is Itching the Same as Formication?

No – Itching is different from formication. Opioids and opioid medications, including Suboxone (although to a lesser extent than full opioids like heroin or oxycodone) cause itching. In fact, itching is a relatively common side effect of opioid use. 

If you experience itching while taking opioids or Suboxone, an antihistamine may help. Less than 2% of the general population is allergic to opioids. 

If you know that you have a sensitivity or allergy to either chemical in Suboxone, talk to your doctor before beginning Suboxone treatment. As long as you have not experienced anaphylaxis or another life-threatening allergic reaction to the medications, your symptoms may abate with time, or they can even be treated with a prescribed antihistamine.

Detox Itching vs. Other Itches

Is the itch you feel caused by detox or something else? Understanding the clinical signs associated with opioid allergies, adverse effects and pseudo allergies may help. This table explains their differences:

Immediate Relief for Detox Itching

Research conducted on mice suggests that opioid withdrawal can cause itching. Moving through withdrawal repeatedly seems to make itching more likely. Higher levels of histamine are to blame, and they can be effectively treated with over-the-counter antihistamine medications.

Histamine-based itches stem from blood moving from capillaries into surrounding areas. Swelling begins, and itching intensifies. Antihistamines work by slowing down histamine receptors and easing the resulting symptoms.

Other therapies your team might try include the following:

·   Applying ice packs to itchy skin

·   Providing plenty of moisturizer

·   Encouraging you to take an oatmeal bath

In a detox program, your doctor can provide therapy to ease your itching. Be open and honest about how you’re feeling and the symptoms you’re experiencing, so your team can adjust your treatment program accordingly and provide you with the help you need.

How Can Formication Be Treated/Alleviated?

Formication is fundamentally caused by hyperactivity in the central nervous system. Therefore, medications that decrease central nervous system activity can help reduce these symptoms.  

If a patient does not want to be on Suboxone or methadone, certain adjunctive medications like Clonidine can be used to decrease CNS activity and decrease formication symptoms. However, MAT like methadone and Suboxone are by far the most effective medications for formication and other withdrawal symptoms.

At Bicycle Health, our health care providers have specialized training on how to treat opioid use. This includes training on how to treat formication and other withdrawal symptoms.

The team at Bicycle Health is committed to fast response times. Telehealth appointments with our healthcare providers are usually available in under 24 hours. If you are currently experiencing withdrawal symptoms (including formication), or if you would like to talk with a health care provider about your options for stopping opioid use, please get in touch with us. To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment, call us at (844) 943-2514 or schedule an appointment here. 

Photo by Ximena Mora from Pexels.