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Opioid Withdrawal Treatment Medications

opioid pills and different opioid prescription bottles

Opioid withdrawal can be extremely uncomfortable and hard to overcome, but there are many treatment medicines that can make the withdrawal process easier. This article will help you understand the medications used to treat opioid addiction, including those that relieve withdrawal symptoms and those that can be used for maintenance to help in long-term recovery.

Medicines Used During Opioid Withdrawal

Opioid treatment medicines can be used for different purposes. Some ease distressing withdrawal symptoms, so you feel more comfortable during the detox process.1–3 Others, such as methadone and buprenorphine, can be started during detox but are also geared for long-term treatment beyond the detox phase in hopes to reduce relapse risk (return to drug use after a period of not using) and overdose.1–3 This long-term treatment approach is often called “maintenance treatment.”3

According to the National Institute on Drug Abuse (NIDA), people with opioid use disorder (OUD) have a higher risk of relapse after detox if they stop using treatment medicines.1 When you relapse after going through detox, you are at a higher risk of a fatal opioid overdose because your body is no longer used to (tolerant) opioids.1 This lower tolerance means that you can easily overdose on even smaller opioid doses than you took before.1 Maintenance medicines help reduce cravings, which can give you the time you need to address your triggers (the people, places, and things that make you want to use) and manage your life while in treatment.3,4

Methadone

Methadone is the longest-used and most-studied opioid treatment medicine.1,3 It is an opioid agonist, meaning that it attaches (binds) to and activates the same nerve cells in the brain as other opioids do.1,5 These nerve cells are called opioid receptors, and when opioids bind to and activate them, they send signals to the body that cause feelings of pleasure, or a “high.” When methadone binds to and activates opioid receptors in the brain of an opioid-dependent person, it does so more slowly than other opioids, such as heroin and fentanyl. As a result, treatment doses of methadone ease withdrawal symptoms and reduce cravings without the high.1,5

Methadone also blocks the effects of any other opioids and is safe to use for extended periods, making it one of the most common maintenance medicines for opioid addiction.4,6 It helps people stay in treatment, reduces the risk of relapse and overdose, and improves treatment results.1,3

Buprenorphine

Buprenorphine is another common opioid treatment drug. It is a partial opioid agonist, meaning it binds to opioid receptors the same way methadone does, but activates them more slowly.1,7 Like methadone, buprenorphine also reduces withdrawal symptoms and cravings, making it easier to detox from opioids without causing a high.1,3 It also blocks the rewarding effects of any other opioids used, making it a safe and effective maintenance medicine that can help support long-term recovery.8

Buprenorphine can also be combined with naloxone (Suboxone) to prevent opioid misuse.1,8 If Suboxone is crushed and snorted or injected, the naloxone blocks the effects of the buprenorphine, causing withdrawal symptoms in people who are physically dependent on opioids.3,4

Clonidine

Though clonidine isn’t specifically an opioid addiction treatment medication, it has been used off-label (in other words, a different way than intended) during opioid detox since 1978.2,9 It is a blood pressure medicine that relieves many of the more troublesome withdrawal symptoms, such as sweating, anxiety, and irritability.2,9 Opioid withdrawal causes overactivity in certain parts of the brain, and clonidine reduces this activity.2

Since clonidine is not an opioid, it is easier to get by prescription, more affordable, and is less likely to be misused.9 Clonidine doesn’t work well for insomnia, opioid cravings, or muscle pain, so your care team may give you other medicines to treat those symptoms.2,9

Lofexidine

In 2018, the Federal Drug Administration (FDA) approved a new opioid treatment drug called lofexidine (Lucemyra).11 Lofexidine is a non-opioid medicine that helps ease withdrawal symptoms such as racing heart, muscle twitching, and stomach pain.1,10 It helps blood move more freely through your body by relaxing your blood vessels.10 Lofexidine doesn’t address any mental health symptoms that often go along with opioid withdrawal, such as anxiety, so it may be combined with other medicines.11

Supporting Medicines

Some opioid treatment medicines do not fully manage all symptoms. So your care team may also use some supporting medicines to treat specific lingering symptoms.2,9 The most common supporting medicines include:3,9

Nurse assisting patient in medically supervised opioid detox

  • Over-the-counter pain medicines, such as acetaminophen (Tylenol), aspirin, and ibuprofen (Advil, Motrin) to help treat aches and pains.
  • Hydroxyzine (Vistaril) to help treat anxiety.
  • Milk of magnesia to help with constipation (a side effect of taking methadone).
  • Loperamide (Imodium) or bismuth subsalicylate (Pepto-Bismol) can treat diarrhea.
  • Diphenhydramine (Benadryl), hydroxyzine (Vistaril), or trazodone (Desyrel) to treat insomnia.
  • Ondansetron (Zofran) or metoclopramide (Reglan) to help treat nausea.
  • Dicyclomine (Bentyl, Maalox, or Mylanta) can help with other stomach issues.

Finding Opioid Withdrawal Treatment

Supervised medical detox is a highly effective way to manage opioid withdrawal.4 It helps you stay as safe and comfortable as possible during the earliest stages of recovery.9 Detox can also help ease your transition into further treatment where you’ll learn how to address the underlying causes of your addiction.9 In addition, some opioid addiction treatment medications started during detox (buprenorphine and methadone) can be continued throughout treatment and during ongoing recovery.1 Your care team can work with you to choose the right medicine to meet your needs.

American Addiction Centers is one of the country’s leading providers of detox and addiction treatment. With treatment centers located across the country, we make it easier to find treatment no matter where you are. Contact us any time at . Our caring and knowledgeable staff can answer any questions you have about detox and addiction treatment. Recovery from addiction is possible, and we can help.

Sources

  1. National Institute on Drug Abuse. (2018, June). Medications to treat opioid use disorder research report.
  2. American Society of Addiction Medicine. (2015). The ASAM national practice guideline for the use of medications in the treatment of addiction involving opioid use.
  3. Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63 Publication No. PEP21-02-01-002. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2021.
  4. National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research-based guide (Third edition).
  5. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 6, Methadone maintenance treatment.
  6. Substance Abuse and Mental Health Services Administration. (2021, June 8). Methadone.
  7. Substance Abuse and Mental Health Services. (2021, May 14). Buprenorphine.
  8. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Medication-Assisted Treatment for Opioid Use Disorder; Mancher M, Leshner AI, editors. Medications for Opioid Use Disorder Save Lives. Washington (DC): National Academies Press (US); 2019 Mar 30. 2, The Effectiveness of Medication-Based Treatment for Opioid Use Disorder.
  9. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006.
  10. U.S. National Library of Medicine. (2021, August 23). Lofexidine.
  11. Volkow, N. (2018, May 16). NIDA-supported science leads to first FDA-approved medication for opioid withdrawal.
  12. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.