Opioid withdrawal can be physically uncomfortable and emotionally stressful. Medications can reduce symptoms, lower the risk of relapse and help people engage with ongoing treatment. This article summarizes commonly used medications, how clinicians choose among them, safety considerations, and where to look for care in New Jersey. This content is general education only and not individualized medical advice. Placement and medication decisions require evaluation by a qualified clinician.

How clinicians approach opioid withdrawal

Treatment teams use two overlapping approaches: medications to treat opioid use disorder, often called MOUD or medication for opioid use disorder, and medications that reduce withdrawal symptoms while a patient stabilizes or transitions care. The three FDA approved medications for opioid use disorder most commonly used are methadone, buprenorphine, and naltrexone; each has a different role and setting of use. National guidance emphasizes combining medications with counseling and supportive services rather than relying on medication alone. SAMHSA TIP 63 and the National Institute on Drug Abuse describe these approaches in detail.

Common goals when treating withdrawal

• Reduce acute physical symptoms such as nausea, muscle aches, diarrhea, tremor, and anxiety.
• Prevent dangerous complications including severe dehydration, seizures, or uncontrolled psychiatric symptoms.
• Create a safe path to evidence based ongoing treatment, including MOUD when appropriate.

Medications you may hear about

Below are commonly used medications, with short descriptions of their role.

Methadone

Methadone is a full opioid agonist used for withdrawal management and long term maintenance. In the United States it is dispensed for opioid use disorder only through licensed opioid treatment programs, sometimes called methadone clinics. Methadone helps prevent withdrawal and reduces opioid craving, but its use requires daily dosing routines and program monitoring. SAMHSA TIP 63 explains methadone program requirements.

Buprenorphine

Buprenorphine is a partial opioid agonist that relieves withdrawal and reduces craving while producing a lower risk of respiratory depression than full agonists. It can usually be prescribed in office based settings by clinicians who follow federal and state rules. Starting buprenorphine in low barrier settings including emergency departments improves linkage to follow up care and reduces risk of overdose. For clinical details see the NIDA summary on ED initiation and national guidance.

Naltrexone

Naltrexone is an opioid antagonist that blocks opioid effects. Because it precipitates withdrawal if opioids remain in the system, patients must be fully withdrawn before starting naltrexone. It is sometimes used for people who prefer a non-opioid maintenance option and for patients who complete detoxification, but it is not appropriate for acute relief of withdrawal symptoms.

Lofexidine and clonidine: symptom-directed medicines

Alpha-2 agonists such as lofexidine and clonidine reduce many autonomic symptoms of withdrawal, such as sweating, tremor, and diarrhea. Lofexidine is FDA indicated to mitigate opioid withdrawal symptoms during abrupt discontinuation in adults and has specific dosing guidance in its prescribing information. Clonidine is commonly used off label for the same purpose. These medicines reduce symptom severity but do not block opioid effects or prevent opioid overdose. See the FDA prescribing information for lofexidine for dosing and warnings. Lofexidine prescribing information and the CDC clinical guideline on alpha-2 agonists for details.

How clinicians choose a medication

Choice depends on the persons history, current medical and psychiatric conditions, pregnancy status, treatment goals, local availability, and patient preference. National treatment guidance notes that methadone, buprenorphine, and naltrexone are each effective components of care and that medications should be paired with counseling and supports. SAMHSA TIP 63 provides details on selection and supervision.

For people who are pregnant, national guidance recommends medications for opioid use disorder rather than planned withdrawal because maintenance strongly reduces risks to the mother and fetus. See the CDC clinical guideline for maternal considerations.

Safety and high risk situations

Finding care in New Jersey

New Jersey supports expanded access to opioid treatment services. In 2025 the New Jersey Department of Health issued a waiver to align state treatment program rules with federal best practices and increase flexibility of opioid treatment programs. Contact local treatment programs, your primary care clinician, or the SAMHSA national helpline to locate services. The NJ Department of Health summary of the waiver explains state changes and access goals. NJDOH waiver announcement.

Low barrier and same day starts

Many programs and emergency departments now support same day buprenorphine starts and low barrier models that reduce delays. These programs aim to help patients begin medication and schedule follow up quickly. For research and program descriptions see NIDA and SAMHSA materials on buprenorphine initiation and low barrier care. NIDA ED buprenorphine summary.

Frequently asked questions

Can I get buprenorphine the same day I ask for help?

Possibly. Many clinics and emergency departments offer rapid assessment and same day buprenorphine starts when clinically appropriate. Availability depends on local providers and program capacity. NIDA summarizes evidence for ED initiation and linkage to follow up care.

Is withdrawal dangerous?

Most opioid withdrawal is uncomfortable but not life threatening. However, some complications such as severe dehydration, seizure, or psychosis may be dangerous and require urgent medical care. People with complex medical problems or poly-substance exposure may be at higher risk and should be assessed by a clinician.

Which medication is best for pregnancy?

For people who are pregnant, medications for opioid use disorder are preferred over planned withdrawal. Treatment with methadone or buprenorphine during pregnancy is associated with better maternal and fetal outcomes than stopping opioids. Discuss options with an obstetric clinician and addiction specialist. See the CDC guidance for details.

Can I stop opioids on my own without medication?

Some people attempt to taper or stop without medication, but evidence indicates that using medications for opioid use disorder increases retention in treatment and reduces overdose risk compared with no medication. Decisions about tapering or withdrawal should be made with medical oversight. SAMHSA and NIDA provide evidence summaries.

Next steps and resources

If you or a loved one is considering treatment, a clinical assessment is the first step. Ask whether the program offers medication options, same day starts, telehealth follow up, and family supports. To learn about programs and treatments offered by this provider, see our treatment options at Treatments, locations at Locations, or request an appointment through Contact Us. Placement and medication decisions require an individualized evaluation by a qualified clinician, and availability varies by program and insurance.

Sources

• SAMHSA TIP 63: Medications for Opioid Use Disorder
• SAMHSA: What is Buprenorphine?
• NIDA: Initiating Buprenorphine Treatment in the Emergency Department
• FDA DailyMed: Lofexidine prescribing information
• CDC Clinical Practice Guideline for Prescribing Opioids for Pain, 2022
• New Jersey Department of Health: Waiver to Improve Access to Opioid Treatment Services
• About 988, the Suicide and Crisis Lifeline

For emergencies call 911. For a mental health or suicide crisis, call or text 988. To request a confidential assessment or speak with our admissions team about options and next steps, please contact us. We can help you explore appropriate medication options and care settings without pressure.