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Post-acute withdrawal syndrome is the part of the timeline for quitting opiates where the physical symptoms tend to all be gone, but psychological symptoms remain or come and gone. Because these symptoms may last weeks or even months, additional opioid addiction treatment is often needed after detox to help the person maintain their abstinence from opiate use.
The exact opiate withdrawal timeline can vary widely because its length as well as the symptoms depend on several variables. Even in more mild cases, the opiate withdrawal timeline can be an incredibly uncomfortable and trying time for someone. While many people tend to be wary of the idea of using other drugs during the detox process, doctors may prescribe or recommend medications as needed to provide a safer and more beneficial experience for the patient.
In particular, medication-assisted therapy MAT uses certain FDA-approved medications like buprenorphine, methadone, and naltrexone to help ease psychological cravings, reduce withdrawal symptoms, and block the euphoric effects of opioid use. While these medications can make opiate withdrawal more manageable, detox is only the first step.
Additional treatment is often necessary to address the emotional and psychological aspects of addiction. Our residential addiction treatment in Texas provides a safe and comfortable environment for patients to overcome these lingering symptoms and build a foundation for lasting recovery.
The four men who had received placebos in the first experiment received both ondansetron and morphine while the remaining four received the placebo and the morphine.
Both objective and subjective signs of withdrawal were assessed and compared to the baseline survey [ 7 ]. Evaluation of the effects on all of the human subjects showed that seven of the eight volunteers developed 12 of 13 objective signs of withdrawal.
The 16 subjective symptoms, however, were not shown to be significantly lower with the use of ondansetron [ 7 ]. The principle central nervous system effects of opioids are analgesia, euphoria, sedation, respiratory depression, cough suppression, pupil constriction, and temperature changes.
Peripheral effects are sometimes seen on the cardiovascular system in patients with hypotension, in the gastrointestinal tract causing constipation , on the biliary tract, on the functioning of the renal system, on the neuroendocrine system, and in the skin causing pruritus and sweating.
Effects are also seen in the immune system. People show physical dependence on opioids when they are abruptly stopped.
The number and intensity of the signs and symptoms of withdrawal are dependent upon the degree of physical dependence that has developed.
Withdrawal signs usually start within 6—10 h after the last dose [ 9 ]. Physical dependence should not be confused with tolerance or addiction. Tolerance, a gradual loss of effectiveness, occurs during treatment when large doses of opioid are given close together [ 10 ].
Addiction is a relapsing compulsion to obtain and use the drug even after successful withdrawal and in spite of negative effects [ 9 ]. Ondansetron is a 5-HT 3 antagonist that blocks the action of serotonin.
Serotonin is both a powerful stimulant of pain and a strong activator of chemosensitive endings [ 11 ]. Serotonin is accepted by 5-HT 3 receptors located in the chemoreceptor trigger zone of the brain area postrema , the vomiting center in the medulla, and in the gastrointestinal tract.
It participates in the vomiting reflex, especially in vomiting caused by chemical triggers [ 11 ]. Ondansetron is tolerated well and has an excellent safety record. It has proved to be therapeutic in preventing nausea and vomiting related to surgery, chemotherapy, and whole body or abdominal radiation therapy [ 12 ].
Ondansetron has been used in the treatment of irritable bowel syndrome, and a Cochrane Collaboration review described its use in relieving acute gastroenteritis in children and adolescents [ 13 ]. As for a safe dose in adults and children over 12 years of age, oral ondansetron is given as an 8 mg tablet, 30 min before and again 8 h after an initial dose of chemotherapy or radiation therapy.
Then, 8 mg is given every 8—12 h for 1—2 days [ 14 ]. The patient was assisted in becoming oxycodone free, by tapering the doses of oxycodone and by using ondansetron to make the process more tolerable. Ondansetron had reduced artificially induced withdrawal symptoms for eight male volunteers [ 7 ], but the question remained as to whether ondansetron could help alleviate withdrawal in a year-old premenopausal woman who had been on oxycodone for 5 weeks.
The patient obtained prescriptions for oxycodone 10 mg and for oral ondansetron 8 mg. Ondansetron 8 mg was given at 8 a. It began 48 h before the first dose reduction in oxycodone and continued until 48 h after the last dose of oxycodone. The evening dose of oxycodone was the first to be reduced to 10 mg.
The planned protocol can be seen in Table 1. A day protocol for administering ondansetron and tapering oxycodone to alleviate opioid withdrawal symptoms. Institutional Review Board approval from the University of Tennessee at Chattanooga and written permission from the subject were obtained.
During the 10 days of the weaning process, the patient neither exhibited nor voiced any symptoms of withdrawal from the opioid. In fact, she expressed fear of becoming dependent on the ondansetron because of the feeling of well-being it gave her. She was reassured that the ondansetron acted on different receptors in the body than did the opioids, and that her prior withdrawal symptoms had been normal for what she had been through, and not symptoms of addiction.
This reassurance stemmed from knowing that antidepressants, which like ondansetron block serotonin uptake, have not been shown to cause addiction even after prolonged use [ 9 ]. At the conclusion of the protocol, the patient disposed of the remaining oxycodone according to the Food and Drug Administration FDA guidelines.
She was featured as a model patient after a month of visits to a physical therapy group. Some may argue that the same effect could have been achieved by simply tapering the dose of opioids at a slower rate and over a longer period of time.
For instance, the patient could have been advised to remove only 10 mg of the middle dose of oxycodone, wait 4 days and remove 10 mg of the evening dose, then wait the same number of days and remove 10 mg of the morning dose.
Since oxycodone does not come in smaller doses than 10 mg, and since controlled release could not be effectively achieved by cutting the tablet in half 5 mg , the patient may have had to endure some withdrawal symptoms as the remaining doses were discontinued over a day period. Reducing dependence on oxycodone is a big hurdle for many people who have had orthopedic or other major surgery. Looking for guidance or assistance? See our Directory Of Rehabilitation Services.
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