Opioid Withdrawal Over-The-Counter Treatment

Opioid withdrawal is a condition characterized by unpleasant physiological and psychological symptoms that occur when a person abruptly stops using opioid drugs or reduces the amount of opioid used. If a person experiences withdrawal symptoms when not taking opioid drugs, that is a sign that a person has developed physical dependence on opioids.¹

Opiates, in comparison to opioids, are a category of addictive substances extracted from the poppy plant, such as heroin, morphine, and codeine. Using these drugs can lead to physical dependence quite fast, even in 4 to 8 weeks.²

When the body gets used to the presence of an opioid and this substance is suddenly removed from the body, in many cases, a user may experience withdrawal. The symptoms of withdrawal can be so distressing that the person cannot withstand abstinence and goes back to using opioid drugs.³

In such cases, opioid withdrawal treatment medications are used to alleviate withdrawal symptoms, help the person detox without serious consequences to their health, and prevent relapse.⁴

Opiate & Opioid Withdrawal

Withdrawal symptoms are experienced by opioid drug users in the following two situations:

• When they abruptly stop using opioid drugs. This is referred to as spontaneous withdrawal.⁵
• Before opioid detoxification is completed, when a person is treated with antagonist or partial agonist treatment drugs which bind to opioid receptors and prevent the person from feeling the effect of opioids. This is referred to as precipitated withdrawal.⁶

For short-acting opioids such as heroin, withdrawal symptoms appear between 8 and 24 hours following the last use. They peak between 36 and 72 hours and usually last for 4 to 10 days.³

What Are Withdrawal Symptoms?

The common symptoms of opioid withdrawal are:⁷

• Nausea, vomiting, and diarrhea.
• Anxiety and insomnia.
• Hot and cold flushes and perspiration.
• Muscle cramps.
• Watery eyes and rhinorrhea.

In addition to physical symptoms, drug-seeking behavior is also typical for withdrawal and continues after the physical symptoms have disappeared.¹

How long and how intensive these symptoms will be depends on the type of opioid, duration of drug use, and the patient’s individual characteristics.³ The tool used for assessing withdrawal severity and the patient’s response to treatment is the 11-item list of symptoms called Clinical Opiate Withdrawal Scale (COWS).⁸ In cases where there is a risk of severe withdrawal symptoms or the patient suffers from some co-occurring disorders, it is recommended that medically managed withdrawal takes place in inpatient settings.⁴

Although these symptoms would eventually disappear, they can be so unpleasant that without the help of opiate withdrawal treatment medications many patients are not able to endure and they resume using drugs.3

 

Opioid & Opiate Withdrawal Treatment Medications

There are several categories of medications used in opioid withdrawal treatment that have been approved by the US Food and Drug Administration (FDA):

• Drugs for opioid addiction treatment: methadone, buprenorphine, naltrexone. These drugs deal with opioid receptors of the nervous system by fully or partially activating or blocking them. These medications are used for managing withdrawal, gradual reduction of use of another opioid medicine, and maintenance therapy which may last as long as medically necessary. They are all prescription medications and some of them are available only within specialized addiction treatment programs.¹⁰
• Opioid treatment medicines that are not used for treating opioid addiction but opioid withdrawal symptoms such as high blood pressure: clonidine, guanfacine, and lofexidine.³
• Prescription medications that can help with anxiety, nausea, or insomnia, such as metoclopramide, hydroxyzine, ondansetron, eszopiclone, or benzodiazepines.³
• Ancillary over-the-counter (OTC) medications that are used for other conditions but in this case are used for treating withdrawal symptoms such as pain, nausea, or diarrhea. These are sometimes referred to as opioid withdrawal over-the-counter treatment or OTC. However, it is important to note that these medications are not a treatment for addiction but are used only to ease withdrawal.³

OTC Opioid Withdrawal Treatment

The medicines commonly used by patients experiencing withdrawal symptoms and can be obtained over the counter are the following:¹¹

• Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, ketorolac, and acetaminophen, which are used for treating chills or fever, as well as muscle and bone pain.
• Dimenhydrinate (Dramamine), prochlorperazine (Compazine, Compro, Compazine Spansule, Procot), or meclizine (Bonine), which are used for nausea.
• Loperamide (Imodium) and bismuth subsalicylate (Bismusal, Kaopectate, Peptic Relief, Pepto-Bismol, Pink Bismuth, Stomach Relief), which are used for diarrhea.
• Diphenhydramine, which is used for anxiety and insomnia.

Risks of Misusing Opioid Withdrawal OTC Medications

Some OTC medicines for treating withdrawal symptoms have the potential to be misused or abused. This means taking medicine in a larger dose, not using it according to the instructions on the package, taking medicine to get high, or mixing medicines.¹²

For example, loperamide misuse can cause stomach pain or constipation, fainting, eye changes, kidney problems, and increased heart rate. Moreover, it can cause euphoria similar to opioids. Finally, there is a risk of overdose with some OTC medications, so it is crucial that the patient uses them responsibly.¹²