Opioid withdrawal
[1][2] Signs and symptoms of withdrawal can include drug craving, anxiety, restless legs syndrome, nausea, vomiting, diarrhea, sweating, and an elevated heart rate.
Opioid use triggers a rapid adaptation in cellular signaling pathways that, when reduced or stopped, can cause adverse physiological effects.
[5] The symptoms of opioid withdrawal may develop within minutes or up to several days following reduction or stopping.
[1] Symptoms can include: extreme anxiety, nausea or vomiting, muscle aches, runny nose, sneezing, diarrhea, sweating, and fever.
[9][7] The effects of morphine withdrawal can range from gastrointestinal disturbances to symptoms like tremors (involuntary shaking, most commonly in hands), opioid cravings, anxiety and insomnia.
For instant-release morphine (shorter duration of action), withdrawal symptoms begin 8 to 24 hours after the last dose and persist for 4 to 10 days.
For extended-release morphine (longer duration of action), withdrawal symptoms begin 12 to 48 hours after the last dose and persist for 10 to 20 days.
[7] However, a toxicology test using urine is conducted to determine if withdrawal symptoms are caused by other non-opioid drugs or a combination of both.
[17] Additionally, it has several off-label uses (use of a drug for purpose different than what it is approved for), one being the management of symptoms due to opioid withdrawal.
A review of UK hospital policies found that local guidelines delayed access to substitute opioids.
For instance, requiring lab tests to demonstrate recent use or input from specialist drug teams before prescribing.
[20][21]Buprenorphine is an FDA approved medication that can be prescribed in clinics to treat opioid dependence.
[23][22] Naloxone, a drug that blocks the opioid receptors, may be added to the medication regimen to avoid misuse of Buprenorphine.
[22] Under the Mainstreaming Addiction Treatment (MAT) Act, Buprenorphine is prescribed in events of Opioid misuse.
[25][22] Furthermore, the dose and frequency of dosage of both buprenorphine and methadone should be altered based on symptomatic control and degree of morphine use.
At high doses, loperamide has been reported by some drug users to alleviate opioid withdrawal syndrome.
Common signs associated with the CNS are high-pitched crying, reduced sleep, tremors, seizures, gastrointestinal dysfunction, and vomiting.
Common ANS-associated signs include sweating, hyperthermia, yawning, sneezing, faster breathing rate, and nasal congestion.
[33] The dopaminergic pathway and neuron adaptations are two possible mechanisms that lead to the development of morphine dependence and withdrawal symptoms.
