Treating Opioid Withdrawal: What Are My Options?

If you’re using opioids, your body might grow accustomed to their presence and effects. When you’re frequently using, the body develops a physical dependence. Then, if you cut back on using opioids, you may experience opioid withdrawal syndrome.

Opioid withdrawal syndrome is a condition in which your body needs time to recover and readjust to the loss of opioids that it got used to. In severe cases, opioid withdrawal syndrome can be life threatening.

During opioid withdrawal syndrome, your body experiences uncomfortable symptoms of withdrawal, such as:

• watery eyes
• goosebumps
• muscle pain
• diarrhea
• nausea, vomiting, or both
• extreme sensitivity to brightness
• insomnia
• excessive sweating and chills

Overcoming withdrawal requires mental and physical effort. Having the right team of people supporting you can help make the recovery process easier.

Doctors can prescribe medication to manage opioid withdrawal. Many opioid withdrawal medications work to stimulate opioid receptors in the brain while minimizing the euphoria, or “high,” and respiratory depression.

Over time, your doctor may lessen the amount of withdrawal medication you take. The purpose of this is to get your body accustomed to not having opioids present.

Some people may remain on these medications for a longer time, or indefinitely. Experts say that the longer someone is on medications for opioid use disorder, the more successful they are in recovery.

Psychiatrists and therapists can help with any emotional side effects or psychological cravings.

Your opioid withdrawal treatment may vary depending on the type of opioid you’ve been using. Consider talking with your healthcare team to find which treatment regimen is right for you.

Methadone

Methadone is an opioid, but it’s also a medication for opioid use disorder. It helps with suppressing withdrawal symptoms of other opioids.

Methadone works by blocking opioid receptors in the brain, which helps reduce cravings. The medication treats withdrawal symptoms for several types of opioids, including heroin.

You take it daily for at least 1 year. It can always be prescribed for longer if you need it. The higher the dose of opioid you’re used to taking, the higher the dose of methadone you may need to manage withdrawal symptoms.

Methadone is available in liquid, powder, or tablet form.

Though methadone can help reduce the withdrawal symptoms for other opioids, it’s important to note that you may experience methadone withdrawal if you stop using methadone after using it regularly for some time.

Buprenorphine

This medication can help with opioid cravings. It reduces your body’s physical dependence on opioids.

It can give you feelings of euphoria at low doses, but not as much as methadone or heroin. Research suggests that buprenorphine may help manage withdrawal symptoms better than clonidine, another medication people use for treating opioid withdrawal.

Your doctor might prescribe buprenorphine when you start showing early withdrawal symptoms. They may recommend you keep taking it long term, or they’ll help you stop using it after a period of treatment by gradually reducing your dosage.

Clonidine

Clonidine is a medication used to treat ADHD and high blood pressure. It’s also been prescribed off-label for managing opioid withdrawal.

In the absence of opioid-assisted detoxification, a 2014 study found that clonidine can help with acute withdrawal symptoms and help with completing withdrawal treatment.

Your doctor may prescribe a 0.1- to 0.3 -milligram oral dose of clonidine to be taken every 6 to 8 hours. They may also decide to pair clonidine with other medications to alleviate specific opioid withdrawal symptoms. Examples include:

• benzodiazepines for anxiety
• loperamide for diarrhea
• NSAIDs for pain
• ondansetron for nausea

Diphenhydramine

Diphenhydramine — the generic name for the cold medicine Benadryl — is an antihistamine used to treat allergies. A 2019 research review suggests diphenhydramine is also helpful for alleviating anxiety symptoms that opioid withdrawal may cause.

It may also help with insomnia and relief from the “wet” effects of opioids (like runny nose, tearing, or sweating) since antihistamines are drying.

Antidepressants

Trazodone is a Food and Drug Administration (FDA) approved antidepressant. It has off-label uses for anxiety and insomnia, which are other complications from opioid withdrawal.

Doxepin is another antidepressant that healthcare professionals may recommend to help treat withdrawal-induced anxiety and insomnia.

Z-hypnotics

If you’re undergoing opioid withdrawal, you might find it harder to fall asleep.

Insomnia is a common symptom of opioid withdrawal. If fast-acting medications are to be considered, experts recommend the three Z’s to help you fall asleep faster: zolpidem, zopiclone, and zaleplon.

These medications are known as Z-hypnotics. Hypnotics help reduce the time it takes to fall asleep and help you get a better night’s sleep.

Antipsychotics

For opioid withdrawal, antipsychotics are typically used to treat insomnia and the “wet” effects of opioids, rather than managing psychosis.

NSAIDs

Opioid withdrawal can feel like a severe fever. You might feel chills, general pain, a high body temperature, and sweating. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve) can mitigate these symptoms by reducing inflammation in the body.

Tylenol

Like NSAIDs, acetaminophen (Tylenol) also reduces pain in the body. It works by blocking pain receptors on nerves that send pain signals to the brain and spinal cord. It could help you if you’re experiencing withdrawal induced-muscle pain, headaches, and fever.

Muscle relaxants

If you’re having stomach cramps, your doctor may prescribe muscle relaxants that relax the smooth muscle in your gut and bladder.

Dicyclomine is a potential candidate because it helps prevent muscle spasms in the gastrointestinal tract. You can take it orally or through an injection.

Anti-nausea medications

As you go through withdrawal, you might find it hard to eat. Treating symptoms of nausea and vomiting with anti-nausea medication can help keep food down and make it easier to take oral medications.

You can find over-the-counter anti-nausea medication, such as dimenhydrinate (Dramamine), at your local pharmacy. Ondansetron (Zofran) is a potent anti-nausea medication available through a prescription.

Antidiarrheal medications

Frequent diarrhea is a common but concerning symptom of opioid withdrawal. It’s important to treat withdrawal-induced diarrhea because it increases the risk of severe dehydration.

Consider using antidiarrheal medication, such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol).

Before you begin taking loperamide, talk with your doctor about the amount of loperamide you should use during withdrawal. Very high doses have been associated with heart problems and an increased risk of dying.

Want to learn more? You can read about treatments for substance use disorder here.

As soon as you take an opioid, your body starts breaking it down. Withdrawal symptoms start happening as levels of the opioid in your blood go down over time. Opioids can stay in your body for several hours or days after you take them, depending on the particular opioid.

Scientists use the half-life of a substance to measure how long it stays in your system. The half-life is the time it takes for your body to get rid of half the substance. Substances with shorter half-lives tend to have shorter withdrawal periods.

Withdrawal from the opioid fentanyl can start happening in less than a day after your last use, according to the FDA.

With heroin, you might experience withdrawal symptoms starting 8 to 24 hours after your last use. This can last from 4 to 10 days, according to the World Health Organization (WHO).

With methadone, unlike with fentanyl and heroin, you might feel a delay in withdrawal symptoms. According to the WHO, symptoms happen 1 to 3 days after the last dose, with the most severe symptoms occurring in 7 to 10 days. You may expect to have withdrawal for up to 3 weeks.

Other factors also influence how long withdrawal lasts. If you’ve been taking opioids at high doses for a long time, this may increase the duration and intensity of your withdrawal symptoms.

You can make it through withdrawal, no matter how unbearable it may feel right now. Here are some tips to help you get over the hurdle.

Find a support system

Withdrawal side effects can be severe, but you don’t have to go through the experience alone. Having a strong support system will help you make it through.

Find someone who will check in on you and your progress through the withdrawal period. This can make a world of difference when times get tough.

Your support system can be more than your family. Narcotics Anonymous is a peer support network that can help you in your journey to recovery. The organization’s inpatient or outpatient substance use treatment centers provide group, family, and individual therapies that you may find very helpful.

Stock up on these supplies

To prepare for stopping opioid use, consider gathering a few essential supplies at home to help support your comfort through the withdrawal period, such as:

• 2 to 3 liters of water to drink every day
• antidiarrheal medication
• sleep supplements (ask a healthcare professional to recommend what type would work best for you)
• NSAIDs like aspirin
• vitamin B and vitamin C supplements

It can be uncomfortable to stop using opioids, but it is very possible. Don’t give up. Remember that opioid withdrawal is temporary. It will go away as long you continue to stick to your treatment and surround yourself with the supports you need.

Everyone’s journey is different. If you experience relapse, remember that this is a normal step in the recovery process.

These resources can also support you with opioid withdrawal:

• American Society of Addiction Medicine
• The Recovery Village
• SAMHSA