Other Opioids

  • Opiate/opioid painkillers are medicines with effects similar to opium. They act by stimulating opioid receptors in the brain and nervous system.
  • There are a large number of opiate/opioid medicines including codeine, morphine, dihydrocodeine, methadone, buprenorphine and diamorphine (also known as heroin).  
  • Opium comes from the flower of the opium poppy and has been used for many hundreds of years to treat pain, sleeplessness and diarrhoea. Increasingly the terms opiate and opioid are used interchangeably when referring to these drugs.
  • Opiate is sometimes used to refer only to those drugs derived directly or indirectly from natural opium. However, they all act on the opioid receptor in the body.
Onset & Duration

Onset

  • Opiate withdrawal can start within 12 hours of last using and symptoms kick in properly after 24 hours. Withdrawal is worst on day 3 to 4.
  • Methadone symptoms emerge 36-48 hours after last dose

Duration

  • The worst of the ‘detox’ is over in 4 - 5 days although people will not begin to feel back to normal for a couple of weeks. 
  •  For methadone withdrawal, low grade symptoms can remain for 3-6 weeks
Clinical Features
  • Flu-like illness: people present pale and restless with dilated pupils, hot and cold sweats, body aches, sweating and goosebumps (cold turkey).
  • Watering eyes and nose
  • Diarrhoea 
  • Severe cravings
  • Fatigue
  • Abdominal cramps
  • Anxiety, irritability and dysphoria
  • Back aches, cramps and joint pain
  • Disturbed sleep
  • Elevated blood pressure
  • Increased sweating
  • Lacrimation
  • Muscle spasm leading to headaches
  • Nausea and vomiting
  • Rhinorrhoea
  • Twitching
  • Urinary frequency 
Care & Treatment
  • Pharmacotherapy-based withdrawal regime

Diarrhoea

  • Atropine Sulphate/Diphenoxylate Hydrochloride (Lomotil)
  • Loperamide Hydrochloride (Imodium)
  • Drink plenty of fluids - 6 - 8 glasses of water a day
  • Eat regular meals

Headaches

  • Paracetamol (Panadol)
  • Massage

Nausea and Vomiting

 

  • Metoclopramide (Maxolon)
  • Prochlorperazine (Stemetil)
  • Eat small meals and snacks often
  • Drink plenty of water
  • If vomiting, stop eating solid food and try small sips of liquid, or sucking an ice cube. Try a small amount of food once you have kept fluids down for a few hours
  • Rehydration/sports/isotonic drinks such as ‘Powerade'
  • Avoid citrus and caffeine on an empty stomach

Anxiety and insomnia

  • Clonidine (do not use is patient is hypotensive)
  • Benzodiazepines: Diazepam, Temazepam tablets* (*Risk/benefit analysis required due to propensity for misuse and exacerbation of depressive symptoms)
  • Reduce coffee, tea, cola and energy drinks during the day and have none after 2 pm
  • Eat 3 meals a day and avoid heavy, spicy meals late at night
  • Avoid napping during the day and keep to regular bed and wake times
  • Exercise regularly (in the day, not after 6 pm)
  • Use relaxation techniques
  • Avoid doing things (i.e. tough phone calls) that might upset you before going to sleep
  • Have a bath in the evening

Stomach cramps

  • HyoscineButylbromide (Buscopan)
  • Have a bath
  • Use a heat rub/ wheat bag
  • Massage

Aches and pains

  • Quinine 300–600 mg at night as required for skeletal muscle cramps (Quinine is potential toxic in overdose (causing blindness or severe liver disease) therefore supply may need to be monitored.
  • Ibuprofen
  • Paracetamol
  • Have a bath
  • Use a heat rub/ wheat bag
  • Do gentle exercise e.g. walking
  • Massage

Cravings

  • Remove ‘cues’ or reminders of use as these intensify craving.
  • Keep busy, use distractions
  • Focus on what is happening at the moment and take each hour and day as it comes. Thinking too far ahead can often be overwhelming and counterproductive.

Sweating & hot and cold flushes

  • Have regular showers or baths
  • Paracetamol