Quitting opioids can be twice as challenging as quitting other drugs.
When you quit a drug such as a methamphetamine, the psychological withdrawal is not at all easy to overcome. You face depression, anxiety, boredom, irritability, and, to top it all off, severe drug cravings. Yet, this is all in your mind. Physically, you feel just fine. You can go to the gym; you can go to work. Keeping busy and active will even help you to get past the feelings associated with stimulant withdrawal.
When it comes to opioids, it is a whole different story.
Not only is there a psychological withdrawal that by itself would make quitting tough, but there is also the physical withdrawal. Opioid withdrawal is terrible. While opioid withdrawal is not physically dangerous in most cases, it is so unpleasant, that few people can get through it without help. Those of us who have not gone through it have no right to judge those who have.
Opioid withdrawal is like the flu, but one hundred times worse.
There are muscle aches and cramps, chills, nausea, vomiting, diarrhea. Even the symptoms that sound mild have a quality to the person withdrawing that makes them intolerable. Feeling the cold chill to the bone that can reoccur for weeks after quitting opioids can cause the recovering drug user to believe that they will never feel normal again.
MAT has the highest chance of success.
The best chance for successfully overcoming opioid addiction is with medication-assisted treatment or MAT. These days, MAT for opioid addiction means Suboxone or ZubSolv, though there are other alternatives. However, not everyone is going to be willing to start an MAT program. And, MAT may not be the best solution for everyone.
NA vs. MAT.
For example, if you are heavily involved in Narcotics Anonymous, you may feel very strongly against MAT. NA has an official position at the highest levels against medications used to treat addiction. Long-time NA members who have a short slip and relapse on opioids are not going to take Suboxone in many cases.
We must inform our patients of evidence-based therapies.
We can give our patients all of the options and point to the data, but ultimately, it is the patient’s decision. Some members of particular religions refuse blood transfusions. When they require surgery, do their surgeons make them get transfusions against their will when blood counts go too low? No, they do not. The best that a doctor can do is educate their patients on the best and safest treatment and then let the patient make their own decision.
What options are available if you refuse Suboxone, ZubSolv, methadone, or naltrexone for MAT?
If you are a dedicated member of NA and you have a sponsor, a support network, and you work the steps of NA, you may choose to forgo MAT. The NA program and its members will provide valuable peer support to help you get through the process of getting back on track. You can also work with a psychologist who has experience in treating addiction. And, when it comes to physical sickness, your doctor can help you with that.
Comfort medications can help you to get through withdrawal.
What are comfort medications? Very simply, comfort meds are prescription drugs that help you get through opioids withdrawal. Typically, they are non-controlled drugs that have no abuse potential or addictive properties. But what about NA being against medications used to treat addiction? In this case, the meds are not treating addiction, only the physical symptoms of withdrawal. There is no conflict with the program itself, though some individual members are even more strict in their beliefs about the use of medication.
NA hardliners may have issues with even comfort medications.
Incredibly, some members of the program may even have a hardline opinion on your use of medications to ease withdrawal. I have also heard of NA members having issues with meds such as Benadryl or Advil. When it comes to opinions, everybody has one. Just because someone doesn’t agree with something does not make them right. NA has an excellent pamphlet on the subject, which is very clear on the issue. It is called “In Times Of Illness.” Your medical treatment is between you and your doctor. It is an outside issue when it comes to your recovery program and NA.
What are some of these comfort medications?
One of the most commonly used medications for opioid withdrawal symptoms is clonidine. Clonidine, or Catapres, is an old blood pressure medication that works on the central nervous system, reducing sympathetic tone. Clonidine dampens the “fight or flight response” and, as a result, diminishes the symptoms of opioid withdrawal. While it does not eliminate the symptoms, it makes them manageable and tolerable. Clonidine does have some side effects of its own. These side effects include dry mouth, fatigue, sleepiness, and low blood pressure. There is a very similar medication that has come out more recently named Lucemyra or lofexidine. The benefit of this newer alternative is that it does not lower blood pressure as much as clonidine. The downside of Lucemyra is that it is expensive and not always covered by insurance.
What are other comfort meds there for opioid withdrawal syndrome?
Another alternative medication is gabapentin or Neurontin. For many years, gabapentin was considered very safe with few side effects. More recently, some experts are concerned about some risks associated with it. Mainly, some people believe that there is abuse potential associated with gabapentin, especially when combined with other drugs. They think that it potentiates, or makes stronger, the other drug. In some states, it is even a controlled drug. Does this mean we should not use it for opioid withdrawal? We always must weight benefits and risks when considering medical treatment. If gabapentin can get someone through opioid withdrawal safely and more comfortably, then it may be worth the risks. And, risks associated with the drug are more likely due to long-term use. The comfort medications discussed here are for short term use, to get the opioid user through the worst of their withdrawal.
What is the next step to getting help?
Talk to your doctor about the best options for overcoming opioid addiction. Please be open-minded about the possibility of Suboxone or ZubSolv for medication-assisted treatment. Comfort medications can help there as well with the transitional period between quitting opioids and starting Suboxone. Typically, you must wait at least 24 hours before starting that treatment. If you choose to forgo the MAT route, you may ask your doctor about comfort medications to help with withdrawal. You may even consider a telemedicine or telehealth consultation to learn more about the best way to get through opioid withdrawal successfully.