Opioid abuse kills 115 people every day in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). This deadly epidemic of substance abuse began around 1999, and it has worsened every year since then.
Now that illicitly produced fentanyl has entered the supply of opioids in this country, the rate of overdose deaths has skyrocketed. This drug is often sold as mixed into heroin or in place of heroin or other narcotics. It is between 50 to 100 times more potent than morphine and roughly 80 times more potent than heroin. If you do not know that fentanyl is in a drug you take, you are very likely to overdose on it and die.
Abusing opioids is still very dangerous, even if you do not accidentally consume fentanyl. Many people who struggle with opioid addiction want to quit and try to stop taking the drugs without help. Cold-turkey quitting is risky – not because opioid withdrawal symptoms are dangerous, but cravings for the substance and the discomfort of the symptoms are likely to lead to relapse. A relapse increases the risk of overdose.
Getting help to overcome opioid addiction through evidence-based treatment is the best way to end an addiction to opioids. There are several approaches to medically supervised detox for opioid addiction, most of which involve receiving a prescription for a medication like buprenorphine or methadone and then slowly tapering off that drug until the body no longer needs opioids to feel normal.
Tapering opioid consumption with a doctor’s supervision is the safest method to quit using them. This is true even if you take an opioid painkiller as prescribed. You may develop a physical dependence on these drugs even if you are not addicted to them. When you’re ready to quit taking an opioid painkiller, your doctor will work with you to taper the use of the medication.
The tapering process is very individual. It can depend on age, gender, body weight, how much of the opioid has been consumed, how long the drug has been consumed, and what type of opioid was consumed. The CDC recommends four basic steps to clinicians to help them understand the tapering process.
Encourage the patient. Most people who take opioid painkillers as prescribed do not experience increased pain after they are done with the drug. They also have better functioning in their daily lives because they suffer fewer side effects.
The CDC guidelines hint at what the medication-assisted treatment (MAT) process looks like. However, instead of working with the original opioid medication, an addiction specialist at a detox program may prescribe a long-lasting medication that manages withdrawal symptoms, which can be tapered slowly over time.
If your doctor determines that you need a medication to ease withdrawal symptoms, you may receive either buprenorphine or methadone. These medications both bind to the opioid receptors in the brain, although buprenorphine is a partial opioid agonist, meaning it does not elicit the same level of intoxication as methadone or opioid drugs. Methadone is a long-lasting full opioid agonist, but for people who have abused large doses of narcotics for a long time, it is a great approach to treating addiction to other substances.
Some people struggle with opioid abuse for so long that they require a longer taper – sometimes this can last for a year. It is important to note that methadone tapering is no longer the preferred method of opioid detox, so it is not appropriate for most patients.
The process of tapering off buprenorphine medications like Suboxone can take several weeks, but it involves less time than methadone tapering. If the individual does not respond well to buprenorphine and continues to experience withdrawal symptoms, they may benefit more from longer-lasting methadone treatment; however, this is rare.
A doctor can determine if you need medications like buprenorphine or methadone and how rapidly these can be tapered. Often, mild withdrawal symptoms are managed with over-the-counter drugs or symptom-specific drugs, and many people who have moderate withdrawal symptoms can go without replacement medications. Severe withdrawal symptoms should be managed in a clinical setting, usually a form of inpatient detox, so the person can be monitored three or four times a day for symptom severity.
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There is no safe way to detox at home. The risk of relapse is too high, and it will likely lead to an overdose. Get medical help to overcome physical dependence on opioids and then follow the other recommended steps to overcome addiction. Enter a rehabilitation program for behavioral treatment and create an aftercare plan to stay sober.
(August 30, 2017). Opioid Overdose: Understanding the Epidemic. Centers for Disease Control and Prevention (CDC). Retrieved October 2018 from https://www.cdc.gov/drugoverdose/epidemic/index.html
(June 2016). What is fentanyl? National Institute on Drug Abuse (NIDA). Retrieved October 2018 from https://www.drugabuse.gov/publications/drugfacts/fentanyl
(April 20, 2016). Opiate and opioid withdrawal. Medline Plus. Retrieved October 2018 from https://medlineplus.gov/ency/article/000949.htm
(August 19, 2018). Treating Opioid Use Disorder With Medications. WedMD. Retrieved October 2018 from https://www.webmd.com/mental-health/addiction/breaking-an-addiction-to-painkillers-treatment-overvew#1
Pocket Guide: Tapering Opioids for Chronic Pain. Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention (CDC). Retrieved October 2018 from https://www.cdc.gov/drugoverdose/pdf/clinical_pocket_guide_tapering-a.pdf
(September 28, 2015). Medication and Counseling Treatment. Substance Abuse and Mental Health Services Administration (SAMHSA). Retrieved October 2018 from https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in-mat
(May 2015). A practical guide to tapering opioids. The Mental Health Clinician (MHC). Retrieved October 2018 from http://mhc.cpnp.org/doi/full/10.9740/mhc.2015.05.102?code=cpnp-site
Dosing Guide: For Optimal Management of Opioid Dependence. The National Alliance of Advocates for Buprenorphine Treatment (NAABT). Retrieved October 2018 from http://www.naabt.org/documents/Suboxone_Dosing_guide.pdf