Opioids are a class of highly addictive drugs that include both prescription painkillers and street drugs like heroin and illicit fentanyl. The National Survey on Drug Use and Health (NSDUH) reports that more than 2 million Americans, age 12 and older, battled opioid addiction in 2016.
Opiates can be extremely habit-forming in a very short period. They interact with the brain’s chemistry to create a physical and psychological dependence that includes difficult withdrawal symptoms when they process out of the body. Withdrawal symptoms are often similar to a really bad case of the flu physically, and they also include emotional distress, such as anxiety, irritability, depression, trouble thinking clearly, sleep disturbances, and restlessness. Drug cravings can be intense when stopping an opiate drug after regular use as well.
Discontinuing an opiate drug suddenly, or cold turkey, is physically and emotionally difficult, and it can even be dangerous as the withdrawal symptoms can be particularly intense in the case of significant dependence. Medical detox that uses substitution and prescription medications help to alleviate withdrawal symptoms and minimize discomfort while managing cravings. Hence, it is the safest method to help a person stabilize during opiate withdrawal.
There are several over-the-counter (OTC) medications and remedies that can help with opiate withdrawal. These methods are best used in conjunction with a specialized detox and opioid addiction treatment program.
Opiate drugs interact with brain chemistry by binding to opioid receptors in the brain and creating a flood of dopamine. This is very pleasurable and a desirable experience to recreate, which is what makes opioids so addictive. Dopamine is one of the brain’s chemical messengers that serves to increase happiness and promote relaxation.
Opiates are central nervous system depressants, so they slow down some of the body’s autonomic functions like breathing, blood pressure, and heart rate. The brain and body can quickly get used to opiate drugs interacting with its chemical system and start to rely on them to remain balanced. When the opioids process out of the body, the brain can struggle to keep up, and this is when withdrawal symptoms kick in. Many of the functions that had been suppressed by the opioid drug spike. For example, heart rate, body temperature, blood pressure, and respiration rates can go up quickly.
The relaxation induced by the opiate is reversed. During opiate withdrawal, insomnia, anxiety, restlessness, muscle tension, chills, agitation, and tremors are common. Flu-like symptoms, such as a runny nose, tearing, goosebumps, sweating, diarrhea, nausea, stomach upset, muscle aches, and yawning, are typical side effects of opiate withdrawal as well.
The U.S. National Library of Medicine (NLM) reports that opioid withdrawal symptoms can start as soon as 12 hours after stopping the use of an opioid drug. The withdrawal process can be significant and both emotionally and physically uncomfortable.
Medical detox, which provides around-the-clock care and supervision, is the ideal environment to allow opiates to process out of the body safely. Medical professionals can attend to the drug cravings and withdrawal symptoms with the aid of medications and medical interventions when needed.
OTC medications and herbal remedies are often heralded as helpful during opioid withdrawal, typically as adjunctive treatments. They can be bought without a prescription and picked up at a local drugstore, health food, or supplement store. Several OTC meds may be beneficial in managing specific symptoms of opiate withdrawal. Some are listed below.
St. John’s wort (Hypericum perforatum): St. John’s wort is an herbal remedy that comes from a flowering shrub. While its exact mechanism isn’t fully understood, the active ingredient hypericin is thought to act similarly to selective serotonin reuptake inhibitor (SSRI) medications which makes it an appealing option as an antidepressant.
However, St. John’s wort is not approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression, as it has not been clinically proven to be effective. It is also known to interact with other important drugs when taken simultaneously, like Indinavir and Warfarin, and could lead to serious consequences. Studies have shown that it may have some use in managing abdominal cramping and some of the physical side effects of opiate withdrawal, as reported by the journal Phytotherapy Research. Patients should always consult with their provider about taking supplemental OTC medications, like St. John’s wort, and should not use it as a means of replacing conventional care for depression.
Imodium (loperamide): Imodium is an antidiarrheal medication that has opioid-like properties. Off-label use of Imodium has skyrocketed in recent years as a potential OTC remedy to manage opiate withdrawal. It serves as an alternative to prescription medications, per the Journal of the American Board of Family Medicine (JABFM).
To minimize opioid withdrawal symptoms, however, Imodium needs to be taken in doses significantly higher than recommended dosages, and this can lead to bigger problems. The FDA has issued a warning regarding the use of Imodium in this way, stating that doing so can lead to serious heart problems, including abnormal heart rhythms that can even be fatal.
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin) and acetaminophen (Tylenol): Muscle, bone, and joint pain are common symptoms of opiate withdrawal, as opioid drugs block pain receptors. When they are no longer doing so, pain can come back and even potentially be magnified during detox. Alternatives to prescription pain medications are OTC analgesics, and medications such as Tylenol and Motrin are commonly used to minimize pain sensations. These NSAID meds can be helpful during opiate withdrawal.
The Iranian Journal of Psychiatry reports that while ibuprofen can help to reduce pain related to opioid withdrawal, it is not as effective as other prescription medications, such as Celebrex (celecoxib), in reducing cravings. Doctors regularly recommend and use NSAID medications as part of a complete opiate detox program that will include other methods and medications as well.
Gastrointestinal and anti-nausea agents like Pepto-Bismol, Kaopectate (bismuth subsalicylate) and Dramamine (dimenhydrinate): Stomach upset, diarrhea, nausea, and vomiting are difficult side effects of opiate withdrawal that can be helped with OTC gastrointestinal agents. Medications like Pepto-Bismol or Kaopectate may help to reduce vomiting and diarrhea, and Dramamine can minimize nausea.
The journal Dialogues in Clinical Neurosciences reports that gastrointestinal agents can be useful during opiate withdrawal as ancillary methods. It is also important to hydrate to replace electrolytes that can be lost through vomiting and diarrhea during opiate withdrawal.
Natural sleep aids like melatonin and valerian root: Another difficult side effect of opiate withdrawal is insomnia. Sleep is one of the most important aspects of healing and helping the brain and body to function to their fullest capacity. Getting enough sleep is vital for being able to think clearly and manage cravings during opiate withdrawal.
Prescription sleep aids may be used during opioid withdrawal, but they often have a tendency to be misused and can also be habit-forming, so OTC and natural remedies may be preferable. Melatonin is a hormone produced by the body that helps a person to fall and stay asleep. Johns Hopkins Medicine reports that melatonin supplements can be a healthy and natural sleep aid.
Valerian and valerian root is another natural, herbal remedy for insomnia that may be helpful during opiate withdrawal. Mayo Clinic warns that it can also interact with other medications and remedies, such as St. John’s Wort, so it is important to check with a doctor before using this supplement.
Before taking any OTC medications, supplements, or herbal remedies, it is important to discuss them with a medical professional. These products can interact with each other and may have unintended and unpredictable side effects.
Generally speaking, opiate withdrawal is optimally managed through a specialized program that can attend to all aspects of the process. This is usually accomplished through a medical detox program that will use substitution medications, such as methadone or buprenorphine, to wean the body and brain off opioids instead of going cold turkey. A slow and safe taper can be used to minimize withdrawal symptoms.
Prescription and OTC medications are often helpful, both during detox and beyond, to alleviate the discomfort of withdrawal. Medications are only part of the equation, however. They should be included as part of a comprehensive addiction treatment program that can also teach coping skills and other methods to reduce episodes of relapse.
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(June 2016). FDA Drug Safety Communication: FDA Warns About Serious Heart Problems With High Doses of the Antidiarrheal Medicine Loperamide (Imodium), Including from Abuse and Misuse. U.S. Food and Drug Administration. Retrieved November 2018 from https://www.fda.gov/Drugs/DrugSafety/ucm504617.htm
(October 2017). Craving and Drug Reward: A Comparison of Celecoxib and Ibuprofen in Detoxifying Opiate Addicts. Iranian Journal of Psychiatry. Retrieved November 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816911/
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(February 2018). Valerian: A Safe and Effective Herbal Sleep Aid? Mayo Clinic. Retrieved November 2018 from https://www.mayoclinic.org/diseases-conditions/insomnia/expert-answers/valerian/faq-20057875