• 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

• 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

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

• long-term changes in opioid receptors and peptides
• adaptations in reward, learning and stress responses
• paracetamol, aspirin or ibuprofen poisoning and even death

• Tolerance occurs due to short-term and long-term receptor changes, and adaptations in intracellular signalling mechanisms.
• Withdrawal can be severe and is characterised by:
  • watering eyes
  • runny nose
  • yawning
  • sweating
  • restlessness
  • chills
  • cramps
  • muscle aches

• Activates receptors called mu and delta opioid receptors. These receptors are abundant in brain areas involved in responses to psychoactive substances, such as in the mesolimbic dopamine pathway.

• The most common are tablets, capsules and syrups/linctus taken orally.
• Solutions for injection.
• Less common forms include lozenges, nasal sprays, suppositories and skin patches.