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
Frequently Asked Questions
The purpose of medication-assisted treatment is to stabilize the patient both physiologically and psychologically by combining medicines with behavioral therapy. The medication helps the patient safely detox, overcome withdrawal, and prevent relapse. This makes it possible for the patient to focus on changing the patterns of thinking and behavior that have led to drug abuse. This is done through various forms of counseling, individual psychotherapy, support groups, or family therapy.13
Yes. Medications approved for addiction treatment have undergone clinical trials that tested their effectiveness. For example, there are studies that compare the effectiveness of certain medications compared to placebo or the percentage of people who stay in treatment when medications are used in comparison to situations when no medications are used and when patients are more likely to quit their treatment.14, 11
Moreover, there is research evidence that treatment that may include opioid withdrawal over-the-counter medication and other drugs has the following positive effects:15
- Reduced opiate use
- Prevention of overdose deaths
- Lower risk of catching infections such as HIV or hepatitis C
- Reduced criminal activities
- Improved social functioning of patients
- Better birth outcomes in pregnant patients who abused opiates
It is a misconception that substance abuse treatment medications are used merely to replace the harmful drugs with less harmful ones. Although some medications may be used infinitely in order to maintain the patient’s stability, the purpose of medications is to restore the disturbed biochemical balance in the body and enable the patient to function normally.16
In addition, not all medications work with opioid receptors such as methadone. For example, there are opiate withdrawal over-the-counter treatment medications used only for easing withdrawal symptoms such as nausea or muscle pain.Another misconception is that medications provide a cure for a substance abuse disorder. This is surely not the case. Addiction is a much more complex condition than the presence of addictive substances in the body. Unless the person works on the causes of addiction and makes the necessary changes in their lifestyle, they will not be able to recover from addiction. Medically-assisted detoxification that may include OTC medication for opioid withdrawal is only the first step in treatment.13
1. World Health Organization. Withdrawal state.
2. American Psychiatric Association. Opioid Use Disorder.
3. Kosten, T. R., & Baxter, L. E. (2019). Review article: Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment. The American journal on addictions, 28(2), 55–62.
4. Lee, J., Kresina, T. F., Campopiano, M., Lubran, R., & Clark, H. W. (2015). Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care. BioMed research international, 2015.
5. Tompkins, D. A., Smith, M. T., Mintzer, M. Z., Campbell, C. M., & Strain, E. C. (2014). A double blind, within subject comparison of spontaneous opioid withdrawal from buprenorphine versus morphine. The Journal of pharmacology and experimental therapeutics, 348(2), 217–226.
6. The National Alliance of Advocates of Buprenorphine Treatment. Avoiding Precipitated Withdrawal with buprenorphine induction.
7. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.
8. American Psychiatric Association. Clinical Opiate Withdrawal Scale.
9. Food and Drug Administration (2009). FDA approves the first non-opioid treatment for management of opioid withdrawal symptoms in adults.
10. Substance Abuse and Mental Health Service Administration. (2020). MAT Medications, Counseling, and Related Conditions.
11. Providers’ Clinical Support System. Module 4: Special Aspects of the Treatment of Substance Use Disorders.
12. National Institute on Drug Abuse. (2018). Over-the-Counter Medicines DrugFacts.
13. Substance Abuse and Mental Health Service Administration. (2021). Medication-Assisted Treatment (MAT).
14. Food and Drug Administration (2018). FDA approves the first non-opioid treatment for management of opioid withdrawal symptoms in adults.
15. National Institute on Drug Abuse. (2018). Effective Treatments for Opioid Addiction.
16. Substance Abuse and Mental Health Service Administration. (2009). Know Your Rights: Rights for Individuals on Medication-Assisted Treatment.