Opioids are a group of drugs that act on the opioid receptors within the brain. Withdrawal occurs when someone suffering from opioid addiction stops using. A medical detox in a hospital is recommended for safe withdrawal from opioids.
What are Opioids?
Derived from the opium poppy, these drugs occur in both natural and synthetic forms and can be short or long acting. There are various forms of administration including intravenous forms, tablets, liquids, and patches.
In medicine, opioids have long been prescribed to manage pain. Their mechanism of action is to bind to opioid receptors in the brain which depresses the central nervous system and slows messages between body and brain, which have a “blunting” effect on pain. Additionally, opioids can stimulate the release of dopamine, resulting in the effect of pleasure as well as pain reduction.
Opioids reduce respiration (breathing) and heart rate. If these rates fall low enough, a user can fall into unconsciousness because of overdose. This constitutes a medical emergency and is usually treated by the administration of naloxone, a drug which also binds to opioid receptors, but prevents further binding to receptors by opioid drugs.
People can become dependent upon opioids as a means of managing chronic pain, and the nature of the drug promotes tolerance – that is, larger doses become required to manage the same levels of pain.
Generally, opioid users who present with dependence issues fall into two separate groups – those that have become dependent through use of prescription medication prescribed for pain management, or those users who seek out opioids illicitly and often mix and match various drugs to achieve varying effects.
Therefore, there are several factors to be considered when initiating a detox from opioids. For example, patients that are managing complex pain still need to have their pain addressed whilst withdrawing from opioids.
Users of illicit opioids can present with a spectrum of symptoms, which needs to be assessed prior to withdrawal, especially if they are being used with other illicit drugs.
Effects of opioids include:
- relaxation and drowsiness
- slow breathing and heartbeat
- cold clammy skin
- blue extremities (large doses)
- falling asleep (‘going on the nod’)
- respiratory depression/death
When combined with other CNS depressants – e.g. benzodiazepine, codeine containing pain killers, alcohol and cannabis, opioids:
- slow down breathing
- slow down brain activity
- increase the chances of overdose
When combined with methamphetamines (ice, speed, meth), opioids:
- place enormous strain on the heart and kidneys
- increase probability of overdose
The exact protocol for opioid detox will depend upon the type and number of opioids used as well as whether other drug use (polyuse) is involved.
Opioid Withdrawal Symptoms
Symptoms of opioid withdrawal include:
- increased pulse rate
- dilated pupils
- bone and joint aches
- gastrointestinal upsets
- piloerection (‘gooseflesh’)
- anxiety and irritability
- tremor of outstretched hands
- sweating and perspiration
- runny nose
How to Safely Treat Opioid Withdrawal Symptoms
Opiate substitution treatments such as buprenorphine/naloxone combinations (brand name – Suboxone or Subutex) are often initiated depending on the severity of addiction. These drugs assist in titrating users off opioids.
Additionally, detox and withdrawal are monitored using a COWS scale – that is, a “clinical opiate withdrawal scale”.
In addition to medical detox, a psychosocial program that addresses pain management (if required by pain specialists and psychologists) or management of long term addictive behaviours should be engaged.
How Long Does Opioid Detox Take?
Usually, a withdrawal protocol is initiated by an addiction specialist after assessment and the length of detox is largely patient dependent.
Hader Clinic Queensland Private hospital offers medical detox and psychosocial management of detox in tandem. Additionally, the clinic offers users the option to continue their longer-term treatment in residential rehab which improves long term abstinence from addictive substances.