Opioid withdrawal can be an uncomfortable experience, and it is one of the first major obstacles in many people’s recovery journey. The importance of medications in managing withdrawal symptoms needs to be emphasized. Medication for Addiction Treatment (MAT) can make withdrawal easier or even totally avoidable with few downsides.[1]
If you want to quit opioids, talk to a professional about the best way to do so. With telehealth options available, MAT is more accessible than ever before.
Medication is an important part of managing opioid withdrawal symptoms. Using MAT to combat opioid use disorder (OUD) is strongly supported by the available evidence. Use of medications produces better results in the majority of cases over forms of addiction treatment that don’t utilize it.[1]
While you should talk to an addiction treatment expert about your particular needs and the exact medications that might benefit you most, any attempt to address OUD should usually involve medication.
The following chart outlines medications that are commonly used to treat opioid withdrawal:[1-7]
MedicationMain Use in Opioid TreatmentBuprenorphineCan suppress opioid cravings and reduce or eliminate opioid withdrawal with low misuse riskMethadoneCan suppress opioid cravings and reduce or eliminate opioid withdrawal with low misuse riskNaltrexoneBinds to opioid receptors and blocks them, preventing a person from experiencing an opioid high and reducing their risk of opioid misuseLoperamideHelps treat diarrhea, a relatively common symptom of opioid withdrawalClonidineAn antihypertensive medication is viewed as generally helpful in the short-term treatment of opioid withdrawal symptomsHydroxyzineAn antihistamine that can help reduce anxiety and tension—common symptoms people experience when going through opioid withdrawalTizanidineAn FDA-approved drug for managing spasticity but often used off-label for migraine headaches, insomnia and as an anticonvulsant; can help people detox from opioids who are experiencing rebound headachesOndansetronCan reduce feelings of nausea and risk of vomiting, a very common symptom of opioid withdrawalDicyclomineAn anticholinergic that can help regulate the bowels if they’ve been disrupted due to symptoms of opioid withdrawal
Of the medications listed, most are primarily used to directly treat symptoms one might experience during opioid withdrawal. However, the first three medications are different and have been directly approved for use in the long-term treatment of OUD.
Buprenorphine is a partial agonist opioid, which binds to opioid receptors in the brain but with a much weaker effect than full agonist opioids (which is the class of opioids we typically associate with addiction). Because of its weak effects, it has a low risk of misuse.[8] However, its effects on opioid receptors means it still reduces cravings for opioids, and it can eliminate opioid withdrawal symptoms.
It may seem paradoxical to use a drug that is technically an opioid to treat OUD, but this treatment works and is very different from misusing illicit opioids like fentanyl. A person is much more likely to successfully maintain long-term abstinence from uncontrolled opioid misuse when taking buprenorphine or Suboxone as prescribed. It also has a ceiling effect where, even if one attempts to misuse it, it is unlikely to cause much of a sense of euphoria before the effects plateau.[9]
In many ways, methadone is similar to buprenorphine. However, methadone is a long-acting full agonist opioid. This can make its use for OUD treatment seem even more odd, since highly destructive opioids are also full agonist opioids.
However, methadone is administered in a very tightly controlled setting, and it acts very differently because it gets into the brain slowly and is chemically different from other opioids like fentanyl, which means that it should not cause people to feel a ‘high’ when used as prescribed. Its long-acting nature is very helpful in suppressing cravings to misuse opioids and reducing withdrawal symptoms. It can be equally effective to buprenorphine in managing OUD. However, restrictions around the medication mean many patients have to go to a special type of treatment center every day to receive their dose from a healthcare professional, which can make it a much less convenient form of treatment.[10]
Naltrexone significantly differs from these other two drugs. It is essentially an opioid use deterrent.[11] If a person takes this drug, it prevents them from getting high on opioids while under its effects. This can be useful for people who genuinely want to stay opioid abstinent but who struggle when they experience cravings or encounter one of their triggers.
While a person’s addiction treatment should obviously involve their own input, you shouldn’t be the one who decides which medications to use when trying to quit opioids (at least not on your own). The medications discussed are prescription drugs, and you will need to talk to a healthcare professional to assess your needs and determine the most suitable medication and dosage to help you stop misusing opioids.
Medication can be a crucial portion of a treatment plan, but therapy also helps. A comprehensive addiction treatment plan that maximizes a person’s chances of a successful recovery generally involves ongoing support and counseling.
Addiction treatment generally should involve some level of counseling, where a person works with a treatment professional to identify some of their short-term needs and set achievable goals that help them progress in recovery.
Cognitive behavioral therapy (CBT) is one of the most commonly recommended treatments for OUD and addiction in general. CBT is about learning to understand your own thought processes and better control those processes. In therapy sessions, you’ll develop strategies to alter how you think about drugs and change destructive thought patterns before they lead to drug misuse.
Many people also benefit from support meetings, where individuals in recovery can meet and discuss different aspects of recovery. Many people find this helps them access a support network of people with similar issues who all work to help each other recover. In meetings, participants find actionable advice based on personal experiences.
There are many medications that can help treat the symptoms of opioid withdrawal. Some can even allow a person to bypass the need to go through withdrawal entirely.
If you intend to quit using opioids, speak with a treatment professional. They can help you plan so that stopping opioid misuse is a safer and more comfortable process. If you attempt to simply stop on your own, you are likely to be met with severely uncomfortable withdrawal symptoms, and this greatly increases your risk of relapse.
Through the use of MAT, you can successfully navigate the early phases of recovery. You may also opt to remain on Suboxone or another form of MAT indefinitely. As long as it continues to support your recovery, there’s no reason to stop taking it.
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role of the brain dopamine system in substance use disorders and in aging. He also studies brain function in obesity and eating disorders.
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