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General Management of Opioid Withdrawal

  • Nov 26, 2020
  • 2 min read

Updated: Dec 16, 2020

Withdrawal from Interruption in Opioid Use


The excessive recommendation of opioids has resulted in a wildfire of its misuse worldwide. (Kaushal Shah, Billy Stout, n.d.)


There are more than 1.5 Million people who suffer from opioid abuse in the United States of America. For this, the psychiatrist should have a good know-how of medications and their appropriate indications.


The management of opioids needs an intensive care because the withdrawal has both physical and psychological effects on the patient. The first most management includes the opioid agonist therapy. This therapy reduces the physical dependence along with psychological dependence. (World Health Organization, 2009)


Opioid Agonist Maintenance Therapy


In most cases, methadone, in the form of oral solution and buprenorphine, in the form of sublingual tablets is used.


If we compare the treatment of methadone and buprenorphine with that of detoxification (elimination of opioid side effects) and no treatment, the use of the former said drugs have a role in decreasing the criminal activities and mortality. Both of these drugs have a role in the reduction of opioid overdose and better treatment retention. (British Psychological Society, 2008)


Comparison of Methadone with Buprenorphine in the Maintenance treatment


The clinical trials show that the cost-effectiveness of methadone is greater than that of buprenorphine. However, the efficacy of both drugs is same. The pharmacological activity of buprenorphine is a little different from the methadone.


Methadone including Maintenance Therapy


The starting dose of methadone is recommended to be less than 20mg. The methadone dose depends upon the tolerance level of opioids. The dose of methadone is adjustable. The accuracy of dosing is necessary.


In usual the range of methadone dose is about 60-120mg. The regular supervision along with testing and clinical assessment is essential for this maintenance therapy.


Buprenorphine including Maintenance Therapy


Unlike methadone, the dose of buprenorphine depends upon three factors

· The duration of action of opioid used

· The time of last dose of opioid used

· The pattern of utilization

The usual dose of this drug is about 8-24mg once a day. But the range may differ according to the requirement.

Just like methadone, the exact supervision and evaluation of the patient is necessary.


Withdrawal and Relapse Treatment


The treatment for withdrawal is mostly referred for the patients who are willing to leave the drug addiction. The will power of some of the patients makes them chose this therapy. I have heard a story of a woman in the United States; she withdraws the addiction of opioids with her self-motivation and encouragement.


The drugs, namely, methadone and buprenorphine along with alpha-2 agonists are recommended for withdrawal therapy. However, the opioid agonists are the preferred treatments.


This therapy is recommended for both ambulatory patients as well as inpatients. It is a very costly treatment and is recommended mainly for patients with “psychiatric comorbidity,” or “poly-substance dependence.”


Relapse Management


For the treatment of relapse, the use of naltrexone is mostly recommended.


Conclusion


The opioids are the drugs with a lot of side effects. But if keen observation and evaluation is done, the problems occurring due to this medicine can be reduced greatly. And if it does not go right, the management of the problem is still there for the persons who want to live. (Jason Luty, (ku.oc.rednoyeulb@7063h600ls), Colin O’Gara, Mohammed Sessay, 2005)

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About Dr. Viveck Baluja and KneeTie Vascular Neurology

Dr. Viveck Baluja, MD, is a board-certified vascular neurologist (American Board of Psychiatry and Neurology — Vascular Neurology) practicing telemedicine across California, Michigan, and Colorado, with additional consultation services available to international families, particularly in India.

KneeTie offers three focused services: emergency stroke second opinions delivered within 24 hours, traumatic brain injury (TBI) consultations for survivors and caregivers, and same-day adult ADHD evaluations for residents of CA, MI, and CO.

Stroke Second Opinion

After a stroke, families often have minutes to make decisions. Dr. Baluja provides a second set of expert eyes from a board-certified vascular neurologist — reviewing imaging, hospital records, and current treatment — typically within 24 hours of request. Common questions include: Was tPA appropriate? Should we pursue thrombectomy? What is the recovery outlook? What rehabilitation makes sense?

TBI Consultation

Traumatic brain injury recovery is rarely linear. Dr. Baluja helps patients and families understand recovery timelines, treatment options, post-concussion syndrome, and red flags that warrant emergency evaluation. Consultations typically last 50 minutes and are scheduled within the same week.

Same-Day Adult ADHD Evaluation

A real evaluation by a board-certified neurologist — not a 7-minute screening. Dr. Baluja's ADHD evaluations include comprehensive history, sleep and lifestyle assessment, and behavioral strategy alongside any medication discussion. Available same-day for residents of California, Michigan, and Colorado.

Why a Vascular Neurologist?

Vascular neurology is a subspecialty focused on stroke, cerebrovascular disease, and brain blood flow — among the rarest neurology subspecialties in the U.S. Most online telehealth services use general practitioners or nurse practitioners. KneeTie is led by a board-certified vascular neurologist with full state licensure and HIPAA-compliant telehealth infrastructure.

Schedule a consultation: Use the booking calendar above to choose a service and reserve a time. For active stroke or post-tPA emergencies, email gorungo@kneetie.com directly with "URGENT" in the subject line.

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