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Review
. 2020 Oct;45(5):892-903.
doi: 10.1111/jcpt.13114. Epub 2020 Jan 27.

Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: Current understanding and approaches to management

Joseph V Pergolizzi Jr  1   2 , Robert B Raffa  2   3   4 , Melanie H Rosenblatt  5
Affiliations
Review

Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: Current understanding and approaches to management

Joseph V Pergolizzi Jr et al. J Clin Pharm Ther. 2020 Oct.

Abstract

What is known and objective: Opioid use in the United States has reached unprecedented-some would even say crisis-levels. Although many individuals use opioid drugs as part of legitimate pain management plans, a significant number misuse prescription or illicit opioids. With regular opioid use, individuals develop tolerance and physical dependence; both are predictable, physiologic responses to repeated opioid exposure. However, a substantial number of individuals who misuse opioids will develop opioid use disorder (OUD), a complex, primary, chronic, neurobiological disease rooted in genetic, environmental and psychosocial factors. This article discusses OUD, opioid receptor physiology, and opioid withdrawal symptomatology and pathophysiology, as well as current treatment options available to reduce opioid withdrawal symptoms in individuals with physical dependence and/or OUD.

Methods: The research articles regarding OUD and its management have been reviewed thoroughly based on a PubMed literature search using keywords related to opioid dependence, its pathophysiology and current treatment strategies.

Results and discussion: Tolerance/physical dependence and the behavioural characteristics associated with OUD reflect complex neurobiologic adaptations in several major systems of the brain, including the locus ceruleus and mesolimbic systems. Physical dependence is responsible for the distressing withdrawal symptoms individuals experience upon abrupt cessation or rapid dose reduction of exogenous opioids. Opioid withdrawal symptoms are a key driver behind continued opioid use, and a barrier to opioid discontinuation. Several opioid-based medications are available to treat patients with OUD; these treatments can diminish opioid withdrawal symptoms and cravings as well as block opioid effects in the event of relapse. Additionally, non-opioid drugs may be used during acute detoxification to help alleviate opioid withdrawal symptoms.

What is new and conclusion: The opioid crisis has produced many challenges for physicians, one being the need to determine which patients would benefit most from maintenance therapy and which may be candidates for opioid discontinuation. In addition to summarizing current understanding of OUD, we provide a new algorithm for determining the need for continued opioid use as well as examples of situations where management of opioid withdrawal symptoms is indicated.

Keywords: dependence; detoxification; opioid use disorder; opioid withdrawal symptoms; pain management.

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References

REFERENCES

    1. What is the U.S. opioid epidemic? U.S. Department of Health and Human Services. https://www.hhs.gov/opioids/about-the-epidemic/index.html. Accessed July 15, 2019.
    1. Stumbo SP, Yarborough BJ, McCarty D, et al. Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement. J Subst Abuse Treat. 2017;73:47-54.
    1. Cicero TJ, Ellis MS. Understanding the demand side of the prescription opioid epidemic: does the initial source of opioids matter? Drug Alcohol Depend. 2017;173(Suppl 1):S4-S10.
    1. Christie MJ. Cellular neuroadaptations to chronic opioids: tolerance, withdrawal and addiction. Br J Pharmacol. 2008;154(2):384-396.
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MeSH terms

Substances