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Medically supervised opioid withdrawal during treatment for addiction

Author
Kevin Sevarino, MD
Section Editor
Andrew J Saxon, MD
Deputy Editor
Richard Hermann, MD

INTRODUCTION

Medically supervised opioid withdrawal, also known as detoxification, involves the administration of medication to reduce the severity of withdrawal symptoms that occur when an opioid-dependent patient stops using opioids [1]. Symptoms of opioid withdrawal include drug craving, anxiety, restlessness, gastrointestinal distress, diaphoresis, and tachycardia. Medications used in the treatment of withdrawal symptoms include opioid agonists such as methadone and buprenorphine (a partial agonist), as well as alpha-2 adrenergic agonists such as clonidine.

The principal purpose of supervised withdrawal is to safely and successfully transition the patient to medication-assisted treatment for opioid use disorder. Supervised withdrawal alone does not generally result in sustained abstinence from opioids [2], nor does it address reasons the patient became dependent on opioids or the damage that the addiction has done to relationships, employment, finances, and the mental, physical, and spiritual health of the patient.

This topic describes indications and contraindications, monitoring, treatment options, and selection among them in medically supervised opioid withdrawal. Clinical manifestations, course, assessment, and diagnosis of opioid withdrawal are described separately. The management of unplanned withdrawal in the emergency department is also described separately, as is opioid withdrawal in adolescents. Pharmacotherapy and psychosocial interventions for opioid use disorder are also discussed separately. (See "Opioid withdrawal: Clinical manifestations, course, assessment, and diagnosis" and "Opioid withdrawal in the emergency setting" and "Opioid withdrawal in adolescents" and "Pharmacotherapy for opioid use disorder".)

INDICATIONS AND CONTRAINDICATIONS

Using medications to lessen the severity of withdrawal symptoms is indicated when opioid dependent patients abruptly stop taking the opioid. Patients may do so for a number of reasons, such as:

As the first step in treatment for opioid use disorder, involving transition to an opioid or nonopioid medication-assisted treatment. (See "Pharmacotherapy for opioid use disorder".)

                         

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Literature review current through: Nov 2016. | This topic last updated: Mon Aug 29 00:00:00 GMT+00:00 2016.
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