Identifying Opiate Withdrawal Symptoms

Identifying Opiate Withdrawal Symptoms

Opiates are often called the lion of drugs. This is not only because of their potency, but also because they cause the most severe withdrawal symptoms when their use is stopped. Severe opiate withdrawal symptoms, although not dangerous by themselves, can cause the individual suffering from it to go back to the drug in order to obtain immediate relief from the opiate withdrawal symptoms. Oftentimes this leads to overdose as abstinence for a certain period of time lowers tolerance. Management of opiate withdrawal in New Jersey is available at several locations: Salem county, Ocean county, Essex county, Atlantic county, Middlesex county, Bergen county, Monmouth county, Somerset county, Hunterdon county, Hudson county, Union county, Morris county, Passaic county, Sussex county, Warren county, Mercer county, Burlington county, etc.

Individuals addicted to opioids find it extremely difficult to stop use because of the severe opiate withdrawal symptoms. While not life threatening, it can cause acute physical distress. Hence, stopping opiate use must be coupled with medical detoxification so that the physical symptoms can be alleviated or eliminated. Opioids such as oxycontin, morphine, heroin, methadone etc. are used widely due to the euphoria and relaxation it provides. It can be dangerous to stop opiate use abruptly as the severe withdrawal symptoms could cause the individual suffering from opiate dependence to go back to opiate use after their physical tolerance level has fallen and consumption of the same dosage of opiate as before could now lead to overdose. Some studies on the etiology of opiate withdrawal suggest that they are related to adenylyl cyclase super activation based central excitation, caused due to three types of opioid receptors namely, mu, delta, and kappa, out of which, the mu receptor heightens actions of opioids. The locus coeruleus of the brain is the site that triggers the opioid withdrawal symptoms. With optimal, medicated assisted treatment, MAT, withdrawal symptoms can be fully addressed.

Opiate Withdrawal Could Cause Psychological Issues

Opioid drug users could experience psychological issues during the withdrawal phase. These include dysthymia, depressed mood and opioid-induced depressive disorder. However, diagnostic investigation is required to identify opioid withdrawal symptoms which are different from general opioid-induced disorders.

Primary Signs of Opiate Withdrawal

Some of the commonly found signs and symptoms of opioid withdrawal include the following:

  1. Lacrimation or rhinorrhea
  2. Piloerection or Goose Flesh,
  3. Myalgia
  4. Diarrhea
  5. Nausea/vomiting
  6. Pupillary dilation and photophobia
  7. Insomnia
  8. Autonomic hyperactivity like tachypnea, hyperreflexia, tachycardia, sweating, hypertension, hyperthermia
  9. Chills
  10. Tremors
  11. Upset stomach

There are certain sedative-hypnotic withdrawal symptoms that are quite similar to opioid withdrawal symptoms, but the latter is defined by lacrimation, rhinorrhea, and pupillary dilation. Similarly, pupillary dilation can be caused due to Hallucinogen and stimulant intoxication, but when it comes to opioid withdrawal symptoms, the person may also experience nausea, diarrhea, vomiting, lacrimation, and rhinorrhea. During diagnosis, symptoms of alcohol intoxication, hypnotic, or anxiolytic intoxication, should be carefully studied and ruled out.

In most cases, urine toxicology can determine which kind of drugs the person has consumed as it turns positive for most opioids like morphine, heroin, codeine, oxycodone, propoxyphene for 12 to 36 hours after use. One must note that most urine opiate tests do not detect the use of Methadone, buprenorphine, and LAAM and hence a special test needs to be conducted for this. Electrolyte abnormalities can be checked through ECG, complete blood count (CBC), and basic metabolic panel (BMP).

The severity of opioid withdrawal is identified generally by the Clinical Opioid Withdrawal Scale assessment, or COWS, which ranges from 0 to 47. It has 11 items of common symptoms of opiate withdrawal. When the reading is between 5 to 12, it’s considered to be mild, 13 to 24 is moderate, 25 to 36 is moderately severe, and greater than 37 is considered to be severe.

Detox treatments to recover from withdrawal symptoms vary depending on the type and severity of these symptoms.

Opiate detox treatment in New Jersey, to recover from opiate withdrawal symptoms vary depending on the type and severity of these symptoms. The Center for Network Therapy has three locations in New Jersey to treat opiate withdrawal and perform Opiate detoxification. CNT has locations in Freehold in Monmouth County, West Orange in Essex county and Middlesex in Middlesex county. CNT is an expert at addressing Suboxone withdrawal in New Jersey.

Opiate Detox program

Opiate Detox program

Detox

SAMHSA Responds to Opiate Detoxification Need

SAMHSA, the Substance Abuse and Mental Health Services Administration, is a federal agency that sits at the apex of alcohol and drug treatment, research, referral and other services. SAMHSA has the best response to opiate detox program and opioid treatment needs through a free national helpline that provides treatment referral and information.

The telephone number for the helpline is 1-800-662-4357 (HELP). The Center for Network Therapy is the nation’s leading addiction treatment provider – opiate detoxification, benzo detoxification, and alcohol detoxification – and is licensed by SAMHSA to provide addiction treatment.

SAMHSA’s national helpline operates 24/7, 365 days a year. The service is free of charge and can be accessed in English or Spanish. All information provided is kept confidential.

SAMHSA’s website also has a treatment locator provision to find facilities that provide opiate detoxification and the Center for Network Therapy can be located using SAMHSA’s treatment locator.

Opioid and Heroin Facts – Highlights Need for Opiate Detox:

    • About 808,000 people had used heroin in the past year.
    • 10.3 million people over the age of 12 misused opioids in the past year – most misused prescription pain relievers.
    • Roughly 2 million people over the age of 12 suffered from an opioid use disorder – all these people will need opiate detoxification.
    • Injection opioid use raises risk of contracting HIV, Hepatitis B, and Hepatitis C. People who injected drugs accounted for 9 percent of HIV infections in America.
    • About 130 people die from opioid overdose every day – access to opiate detoxification could save thousands of lives. Opiate detoxification utilizes methadone, buprenorphine, suboxone or Subutex.

 

Opiate program and Opiate Detoxification Guidelines

1. Addiction to opiates is a chronic, but treatable illness – opiate dependence often requires continuing care for effective treatment rather than episodic, acute-care treatment approach.

2. Treatment providers should approach Opiate Use Disorder as a chronic illness, so that they deliver care that will help patients stabilize, achieve remission of symptoms and establish and maintain recovery.

3. Medication alone is not enough – patients should be able to access mental health services, addiction counseling and recovery support services.

4. Patient treatment time with medication will vary depending on the individual – one size does not fit all.

5. Treatment with medication saved lives – methadone, extended release injectable naltrexone (XR-NTX) and buprenorphine were found more effective in reducing opiate use than no medication at all. Buprenorphine and methadone were associated with reduced risk of overdose.

Emerging Trends in Substance Abuse:

Methamphetamine—Use is rising in America with 1.9 million using methamphetamine in the past year. Roughly 1.1 million people had a methamphetamine use disorder, much higher than in 2016. Overdose death rates involving methamphetamine quadrupled between 2011 and 2017. Frequent meth use leads to mood disturbances, hallucinations, and paranoia.

Cocaine—About 5.5 million people over the age of 12 or were past users of cocaine, including about 775,000 users of crack. Overdose deaths involving cocaine increased by one-third from 2016 to 2017. Short-term effects of cocaine include increased blood pressure, restlessness, and irritability. Over the longer term, cocaine can cause heart attacks, seizures, and abdominal pain.

Kratom—Kratom is a tea leaf like substance that comes from a tropical plant from Southeast Asia. The leaves, when brewed, provide psychotropic effects by affecting opioid brain receptors. This product is not regulated despite a high risk of abuse and dependence. Kratom can cause nausea, itching, seizures, and hallucinations. Kratom acts like an opiate, and same protocols as that for opiate detoxification – i.e. methadone, buprenorphine, Suboxone or Subutex.

Recovery @ CNT: Brian’s Story of Addiction Treatment

Brian’s childhood was no different from a million other kids – he grew up in a quiet suburban town; he played soccer in the fall, basketball in the winter and baseball in the spring. In his teenage years, he found he had a talent for music and became adept at the guitar, the bass and the piano.

He first tried alcohol at 13 from a friend’s parent’s minibar. After avoiding pot for a while, he did try it finally, at a party and started drinking to the point of blacking out. Brian kept his grades up and he was smart, smart enough to get a full college scholarship.

He got his first pain pills as tips after he delivered pizza delivery job and he fell in love with the high it gave him- it made him feel more confident, and more creative, even though he would forget half of the songs he wrote when he was high. His frequency of use increased to the point where he was snorting pills before class in school bathrooms.

But soon he found out that it cost a lot of money to get high and someone told him there was a cheaper alternative, heroin. At first he started borrowing money, then started to steal. His parents kicked him out the house and he slept in motels and on strangers’ sofas. He was shooting 20-30 bags of heroin a day, smoking crack and snorting cocaine.

That’s when his mother and girlfriend at the time suggested the Center for Network Therapy, an addiction treatment center on Cedar Avenue in Middlesex, NJ to get a grip on his opiate addiction and get over his fear of withdrawal from opiates. He told them he would give it a shot, but he had no faith it was going to work. Brian was stoned for his first therapy session with Dr. Indra Cidambi and several other individuals with substance use disorder. And then Dr. Cidambi said goodnight, and everyone left. What was going on? No other treatment program let participants leave in the evening. Brian was terrified; he didn’t trust himself. Would he use the minute he walked out the door?

“That night I went to the movies with my girlfriend. I went to the bathroom and shot up. And I remember thinking, ‘Why am I doing this? This s–t is getting so old. I walked in the next day and announced to everyone, ‘I used last night. I’m ready to get clean.'”

A different kind of addiction therapy

“The thing is, we don’t view relapses as setbacks here,” said Dr. Cidambi, MD, who is board-certified in psychiatry and addiction medicine. “I try to make every relapse a learning experience: How did you relapse? What made you do this? We talk about it, and the patient often says, ‘I see how I could have stopped myself, I see that this was the trigger.’ If they learn from a relapse, they’ve achieved a step forward.” The Center, or CNT as its called, is also unique because it is not an overnight in-patient facility. At the end of each day, patients leave and are expected to return in the morning for more talk therapy. “You go back and sleep in your own bed. It gives you autonomy. That way, you make the decision every single day whether you want to come back again, whether you want to continue treatment or not,” Dr. Cidambi said. Brian called it “the ultimate test.”

“It made me realize if you’re serious about getting clean, you can go home and stay away from temptation. That’s when I finally realized I was really ready to get sober this time,” he said.

“These people really do not know how to be sober. Nobody recognizes this. I tell them they learned how to shoot drugs and they are smart enough to unlearn that behavior. They recognize, ‘I am not a bad person. I am just an addict. I can overcome this,” says Dr. Cidambi.

It worked for Brian. He’s been clean more than a year. You can hear the pride in his voice when he says the date he became sober. “CNT taught me you can’t get clean for your kids, your parents or your wife,” he said. “You have to do it for you. You have to get clean for yourself.”

Now 28, he works as a cable technician. He still takes 1 milligram of Suboxone a day, a drug that is supposed to control cravings and block opiate receptors in his brain. But he is trying to get off it completely. He attends twelve-step meetings several times a week, which he said really helps.

“I’ve built up a network of people who are staying clean,” he said. “I got back into writing music. I’m rebuilding relationships with people I hurt. I’m going on hikes. Little by little, I’m learning how to enjoy things in life that used to make me happy, and still make me happy.”

But the specter of heroin is never far away. Often, it’s right down the block.

“I would guess there are 5-6 heroin dealers in Middlesex right now. You don’t have to go to Newark or Bloomfield to get it anymore, because there are people who have it five minutes away. It’s getting more accessible and the kids are getting younger who try it,” he said. “It’s a virus.” Ambulatory Detox gives an individual an opportunity to learn to remain sober in their home environment rather than being isolated from it.

About CNT: The Center for Network Therapy (CNT), a seven-year-old substance abuse treatment program and ambulatory (outpatient) detox facility in Middlesex, NJ and it employs unique approaches to treat addiction and offers drug and alcohol detoxification – CNT offers alcohol detoxification, benzodiazepines (“benzos”) detoxification, opiate (pain pills, heroin, methadone) detoxification, as well as detoxification from buprenorphine. CNT offers a safe environment to deal with opiate withdrawal, alcohol withdrawal and benzo withdrawal. The program utilizes medication-assisted treatment, such as suboxone (buprenorphine), to help ease withdrawal symptoms.

Insurance

In-network with:

Aetna
AmeriHealth
Anthem BCBS
Beacon Health Options
Emblem BCBS
GHI
Empire BCBS
Horizon BCBS (EPO, HMO, PPO)
Oscar
QualCare
United Health/Optum/Oxford
Emblem GHI*
Humana*

 

* If the QualCare logo is on the
insurance card