The term “opioid” refers to a class of drugs that includes both prescription pain medications and illicit heroin. Highly addictive, opioids can lead to physical dependence and opioid use disorder (OUD) if they’re misused. When someone with OUD suddenly stops taking opioids, they experience withdrawal symptoms such as anxiety, muscle aches, sweating, insomnia, stomach cramps, nausea, and vomiting. Medication assisted treatment, which uses certain FDA-approved medications to help relieve withdrawal symptoms and assist with long-term abstinence, can be used to ease the recovery process. Here are four medications that can be used to treat opioid withdrawal symptoms.
“Buprenorphine is what we call a partial agonist,” Alta DeRoo, MD, Medical Director at the Hazelden Betty Ford Center in California, tells WebMD Connect to Care. “A partial agonist is only going to partially activate the opioid receptor—only about 40 percent.”
Because it doesn’t fully activate your opioid receptor, buprenorphine’s effects are not as strong as those of methadone, heroin, and other full opioid agonists. This reduces the risk of misuse.
“What happens is the patient feels relief from the withdrawal symptoms, but it doesn’t fully activate that receptor, so there’s very little risk of overdose or euphoria,” DeRoo says. “The concerns arise if somebody were to try to divert buprenorphine. It can be crushed up and injected into somebody’s blood vessels. When that happens, somebody can get euphoric, and it can be abused that way.”
Buprenorphine is sometimes combined with naloxone to prevent patients from abusing buprenorphine. Naloxone is an opioid antagonist that neutralizes the effects of opioids like fentanyl and heroin.
“If you have buprenorphine/naloxone and you put it beneath your tongue like it’s prescribed, the naloxone is not active,” DeRoo explains. “However, if you were to take buprenorphine/naloxone and somehow melt it down, dilute it, and inject it, the naloxone becomes active, and that naloxone will block the opioid receptors and cause a person to either go into withdrawal and/or make the buprenorphine not effective.
“So number one, it can make a person withdraw. And number two, they don’t get the euphoria they may have been seeking by injecting the medication,” DeRoo says.
Methadone is an opioid prescribed to manage severe chronic pain. It is also commonly used to treat withdrawal symptoms in people with OUD.
“The way that methadone works is that it goes directly to the mu-opioid receptor, and it activates that receptor as what’s called a full agonist,” DeRoo explains. “The way that it’s used in withdrawals is that methadone goes to the opioid receptor, and it satisfies it much like the drugs that somebody may be using illicitly.”
Unlike buprenorphine, which doctors can prescribe in various settings, methadone is only available in specialized clinics.
“One of the nice things about methadone is that, when you’re treating somebody with opioid use disorder, it is prescribed only in a methadone clinic,” DeRoo says. “Within that methadone clinic, you have very structured resources for the patient to engage in. The medication is given to the patient, usually in liquid form, and it’s observed. So, it’s very tightly controlled. You don’t have to worry about someone diverting it.”
Lofexidine is an alternative treatment option for opioid withdrawal. It differs from methadone, buprenorphine, and naloxone in that it’s a non-opioid.
“Lofexidine is very similar to a medication called clonidine,” DeRoo says. “They both do the same thing—they mediate and mitigate this hyper response that the body has to opioid withdrawal by taking the edge off the anxiety, the sweating, and the shaking.”
Lofexidine is far more expensive than clonidine. However, it also produces fewer side effects.
“The benefit of lofexidine is that it doesn’t cause a drop in blood pressure,” DeRoo notes. “That is one of the advantages of lofexidine. But at the high price, sometimes it’s out of reach for patients.”
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