Come Off of Opiates

Whether you were prescribed opiates for a medical issue or began taking opiates recreationally, dependence or addiction can develop very quickly. Dependence is usually characterized by withdrawal symptoms and tolerance (resulting in the need for higher doses), while addiction is characterized by compulsive abuse coupled with physical and mental dependence beyond medical pain relief.[1] If you believe you may be dependent on or addicted to opiates, it's best to seek medical care to ensure that you taper off your drug use safely and effectively, although it is possible to gradually wean yourself off of opiates at home as well. Learning how to come off of opiates can help you return to optimum health, eliminate the unpleasant side effects of opiate use, and return to a normal, functional lifestyle.

Steps

Tapering Off Opiates at Home

  1. Resolve to quit. Addiction is a complex physical and/or mental dependence on a chemical (in this case opiates), and becoming addicted is not caused by any lack of willpower; however, willpower does play a role in overcoming addiction. Having strong willpower and a commitment to quitting are key components of modern addiction recovery.[2]
    • The first step to recovery is to admit that you have a problem and make the choice to seek recovery.[2]
    • Consider joining a support group. Even if you have supportive friends and family members in your life, it may be helpful to surround yourself with other individuals who have gone through addiction or dependence and understand first-hand what you're going through.[3]
    • Narcotics Anonymous (NA) and SMART Recovery are popular support groups that can help you if you're struggling with opiate use.[3]
    • Sometimes, if people don't like NA, they join Alcoholics Anonymous groups if they agree to completely clean living. Some people find a more stable brotherhood in AA over NA.
  2. Anticipate withdrawal symptoms. People who have become dependent or addicted to opiates will most likely experience mild, moderate, or severe withdrawal symptoms.[4] Symptoms may vary from one person to the next, but typically include:[5][6][4]
    • Depression
    • Anxiety
    • Irritability
    • Pain
    • Nausea/vomiting
    • Diarrhea
    • Hypertension
    • Tachycardia (abnormally rapid heart beat)
    • Seizures
  3. Assess your level of use. If you have been using opiates on an as-needed basis and have not been using opiates daily, you should be able to stop using opiates without having to taper down your usage.[7] You may experience increased pain after discontinuing opiate use, but should not experience significant withdrawal symptoms; however, if you've been using opiates on a daily basis and have developed moderate to severe dependence or addiction, you may need to taper off your use.[7]
    • Dependence is marked by the continued use of a drug in order to avoid withdrawal symptoms. Even though dependent users may still experience some degree of euphoria from opiate use, the primary purpose of the dependent user's drug consumption is to alleviate pain, rather than explicitly trying to get high.[8]
    • Addiction operates within the reward pathway of the brain, leading to compulsive behavior in order to acquire and use the drug. Addiction is usually marked by drug use with the intent of getting high, rather than for pain relief.[8]
    • It is possible to be dependent on opiates without being addicted; however, most addicts are also physically and mentally dependent.[8]
  4. Begin tapering your use. The safest way to discontinue opiate use, especially at home without medical supervision, is to gradually decrease your usage on a daily or weekly scale. This will help minimize the withdrawal symptoms experienced after discontinuing use of the drug.[5]
    • There is some disagreement on how to scale back opiate use. Some medical experts recommend tapering down opiate use by 10 percent every one to two weeks.[5] Others recommend tapering down opiate use by 20 to 50 percent every week.[7]
    • The percentage of tapering down drug use will vary, depending on the severity of addiction.[7]
    • The faster you cut down on drug use, the more likely you are to experience withdrawal symptoms. The overall duration of drug use is also a factor: the longer you've been using opiates, the slower your tapering off should be.[7]
  5. Stop and avoid opiate use. Once you've tapered down to the minimum possible dose, you should be able to safely discontinue opiate use. Once you've stopped, it's important that you avoid future opiate use, unless recommended by your doctor.[7]
    • The duration of taper will vary, depending on your needs and the severity of your opiate use. Unfortunately, there is no cut-and-dry duration of taper. Consult your doctor about how long to continue tapering before you discontinue use completely.[9]
    • Switch to non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and acetaminophen.[10]
    • If you've been acquiring opiates illegally, cut off all ties with dealers and other addicts you used to know. Removing the temptation to try opiates again will improve your chances of success.

Developing a Plan With Your Doctor

  1. Trust your doctor's decision. If you've talked to your doctor about your opiate use, there may be a number of reasons why your doctor may have recommended that you come off of opiates. Common medical reasons for tapering off of opiates include:
    • Inadequate pain relief— Many people who experience chronic pain and take a high dose of opiates experience improved pain management, as well as greater functioning skills and overall mood, after tapering down or discontinuing opiate use.[5]
    • Decreased levels of pain — Once the pain has become more manageable or disappeared entirely, your doctor will recommend discontinuing the use of opiates.[7]
    • Adverse side effects — Some people experience unpleasant or dangerous side effects related to opiate use, including (but not limited to) constipation, sedation, sleep apnea, injuries (sustained as a result of opiate intoxication or sedation), and overdose[5]
    • Opiate abuse/addiction — Most doctors will recommend tapering or completely discontinuing opiate use if abuse occurs or addiction develops[5]
  2. Consider Check Into Rehab. Although some individuals are able to successfully come off of opiates at home without medical assistance, some medical professionals will recommend inpatient detoxification for people with long-lasting or severe addiction. The advantage of an inpatient setting is that medical professionals can be on hand around the clock to help treat the symptoms of withdrawal.
    • Inpatient detoxification is usually recommended for people who are medically unstable (typically those whose pain is so intense that withdrawal could increase the pain they feel), have not succeeded in outpatient programs, are not compliant with outpatient medical advice, or require detoxification from multiple substances.[9]
    • Inpatient services are offered at hospitals and at residential treatment centers.[11] You can find an inpatient facility by searching online, or by asking your primary care physician for a recommendation.
    • Inpatient detoxification typically lasts three to four days, though it may take longer, depending on the severity of symptoms.[12] Most inpatient detoxifications are then co-administered with a 28 day rehabilitation program for complete care.
  3. Choose a detoxification plan. There are numerous detox plans available for inpatients at a medical facility. Each plan has its advantages and disadvantages, and it's important to talk to your doctor and/or an addiction specialist to determine the plan that's right for you.
    • Medical Detoxification — This detox plan involves tapering down the dosage of opiates. Tapering is done in a controlled medical setting that allows nurses to administer any medication necessary to help counteract the effects of withdrawal, if those effects arise.[11]
    • Rapid Detoxification — This plan involves stopping all use of the opiate immediately. You will be anesthetized and given intravenous opiate blockers (such as naltrexone, naloxone, and nalmefene) to ensure that you do not get high on any opiates you subsequently take. After approximately four to eight hours under general anesthesia, your body goes through sudden and rapid withdrawal, but you will not experience the unpleasant physical effects of withdrawal. You will then typically be discharged within 48 hours after an assessment and medical evaluation. There are risks of complications from the use of anesthesia, however, including the risk of death.[11]
    • Stepped Rapid Detoxification — In this alternative plan, opiate blockers like naloxone are administered intravenously and withdrawal-management medications are administered orally, reaching the same ultimate effects of rapid detox but over a more gradual period of time. Stepped rapid detox may be less taxing on the body than regular rapid detoxification. In stepped rapid detox, you are alert and awake the whole time, but your symptoms of withdrawal are closely monitored and quickly addressed with medication.[11]
    • Buprenorphine — This is an opioid medication used to help ease withdrawal symptoms and help ease you off opiates. It is a partial opioid agonist, meaning you will experience less euphoria, less dependence, and the withdrawal is more mild than with other opiates. It can reduce cravings, suppress withdrawal symptoms, and block the effects of other opioids.[13] Not all doctors can prescribe buprenorphine so you will need to find an addiction specialist who is able to do so. It comes three administration forms including by mouth, through a patch, or via injection.
    • Methadone — Some doctors recommend methadone treatments to help addicts come off of opiates. Methadone is the most commonly used method of opiate detoxification. In methadone treatment, you will receive daily doses of the synthetic narcotic medication methadone from an approved clinic over a period lasting around 21 days, after which you should be able to discontinue all opiate use. Methadone detox still subjects you to a painful period of withdrawal and may not adequately prevent you from using other opiates.[11]

Managing the Symptoms of Withdrawal

  1. Treat mood problems. Many people experience mood swings, depression, and anxiety as they go through withdrawal. That is because opiates can affect a person's mood, and also act as a numbing agent. As a result, many people going through withdrawal begin to feel painful emotions over events that happened before or during their addiction.[10] The treatment for this will vary, depending on your doctor's recommended course of action.
    • Some doctors prescribe antidepressants or mood stabilizers to help manage the symptoms of depression and mood swings.[10]
    • Your doctor may administer either clonidine (0.1 mg three times daily) or hydroxyzine (25 to 50 mg every four to six hours) to manage the anxiety and anxiety-related symptoms of withdrawal.[14]
  2. Take medicine for stomach issues. Many people going through opiate withdrawal experience moderate to severe gastrointestinal problems. The most common include abdominal cramping, diarrhea, nausea, and vomiting.[14]
    • For abdominal cramping and/or diarrhea, take a 0.125 mg dose of hyoscyamine every four to six hours.[14] This medication may not be recommended for people age 65 and older, as it may induce dementia-like symptoms in some patients.[15]
    • To treat nausea and/or vomiting, take either Phenergan (12.5 to 25 mg every four to six hours) or Zofran (four mg every 12 hours).[14]
  3. Manage pain associated with tapering/withdrawal. If you became dependent on or addicted to opiates while treating severe or chronic pain, you may experience increased pain during the tapering/withdrawal period. To manage this pain, try taking over-the-counter NSAIDs, which do not have any risk of dependence or impairment.[14]
    • Ibuprofen may be administered in 400 to 600 mg doses up to three times each day (usually taken with food); however, elderly individuals or people with chronic kidney disease, history of GI bleeding, or chronic warfarin use should not be given ibuprofen.[14]
    • Take 500 mg doses of acetaminophen every four to six hours, not to exceed 3,250 mg in a 24 hour period. This may be the preferred course of action for patients who are unable to take ibuprofen.[14]
  4. Try to rest and sleep. Some people going through opiate withdrawal experience night sweats and insomnia, which may make it difficult to feel rested. This is caused in part by having become reliant on the opiate's sedative effects to induce sleepiness. To manage night sweats and promote a more restful bedtime routine, try keeping the room temperature slightly cooler than usual, and keep extra pillowcases and pajamas on hand. If insomnia continues to be a problem, talk to your doctor about prescribing a non-narcotic sleep aid.[10]

Tips

  • Drink water throughout the day. Water flushes out the toxins in your system and helps your kidneys to remove everything from your body.
  • Do not have caffeine, as it may worsen the symptoms of anxiety, agitation, and diarrhea.

Warnings

  • Detoxification from opiates is a painful and unpleasant experience. If you are worried about being able to manage the symptoms on your own, you may find it helpful to enlist the help of friends or family members. Alternately, you may want to consider checking into an inpatient rehabilitation program. Talk to your doctor about your level of opiate dependence/addiction, and work out a recovery plan that will work best for you.

Sources and Citations

  1. ↑ http://www.webmd.com/mental-health/addiction/painkillers-and-addiction-narcotic-abuse?page=2#2
  2. ↑ 2.0 2.1 https://www.psychologytoday.com/blog/where-science-meets-the-steps/201211/does-willpower-play-role-in-addiction-recovery
  3. ↑ 3.0 3.1 https://www.nlm.nih.gov/medlineplus/ency/article/000949.htm
  4. ↑ 4.0 4.1 http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/americas-addiction-to-opioids-heroin-prescription-drug-abuse
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 https://www.cpso.on.ca/uploadedFiles/members/resources/Opioid-Tapering-Protocols_Dial-I_2012.pdf
  6. ↑ http://www.webmd.com/pain-management/guide/narcotic-pain-medications?page=2
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 http://www.healthquality.va.gov/guidelines/Pain/cot/OpioidTaperingFactSheet23May2013v1.pdf
  8. ↑ 8.0 8.1 8.2 http://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/10-addiction-vs-dependence
  9. ↑ 9.0 9.1 https://www.nhms.org/sites/default/files/Pdfs/Safely_Tapering_Opioids.pdf
  10. ↑ 10.0 10.1 10.2 10.3 http://blogs.psychcentral.com/chronic-pain/2013/12/opiate-withdrawal-outpatient-slow-and-steady-wins-the-race/
  11. ↑ 11.0 11.1 11.2 11.3 11.4 http://www.addictionrecoveryguide.org/treatment/detoxification/opiates
  12. ↑ http://www.mchonline.org/hospital-services/inpatient-medical-detoxification-therapy
  13. ↑ https://www.naabt.org/faq_answers.cfm?ID=2
  14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 14.6 http://www.ohsu.edu/gim/epiclinks/opioidresources/OHSU_Opioid%20Guideline_1%2014.pdf
  15. ↑ http://www.medicinenet.com/script/main/art.asp?articlekey=2281
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