- Causes, Signs and Symptoms of Oxycodone Withdrawal
- Severity of Withdrawal Symptoms
- Treatment for Withdrawal from Oxycodone
- Help Someone Through Withdrawal
What is Oxycodone? Are There Withdrawals from Oxycodone Use?Oxycodone (Percodan®, Oxycontin®) is an opiate drug, mainly used for the relief of pain.
Repeated use of Oxycodone, like the other opiates, leads to long-lasting changes in the brain (neuroadaptation) which alter voluntary control over the use of the drug (Volkow and Li, 2009).
Changes in brain pathways caused by Oxycodone use endure long after an individual stops taking it, causing negative physical and psychological/emotional effects once the drug use is reduced or abruptly suspended (Koob and LeMoal, 2006).
When this occurs, the negative effects may range from mild discomfort to extreme distress, depending on how much was used and how long the individual was using (Russell, 1976). This is withdrawal.
The intensity of withdrawal from Oxycodone will depend on the:
- Duration of use.
- Amount of use.
- Degree of neuroadaptation (Wright et al., 2009).
Route of administration appears to be important as well, with significantly higher withdrawal symptoms for injection drug users (Tetrault and O’Connor, 2009).
Taking Oxycodone intravenously may result in more severe withdrawal symptoms.For example, if you have been using Oxycodone intravenously, and have been ‘shooting up’ for some time, you will more likely experience withdrawal symptoms with greater intensity and for longer duration than someone who takes Oxycodone for pain as prescribed, but who suspends use of the medication or reduces their use of it.
Other psychological factors can contribute significantly to the distressing experience of withdrawal, such as:
- Poor self-esteem.
- Poor coping mechanisms.
- Environmental stressors, such as low socioeconomic status.
These factors often lead the individual to relapse to remit the withdrawal symptoms (Volkow and Li).
Causes, Signs and Symptoms of Oxycodone Withdrawal
There are 2 phases of the withdrawal process in individuals who have become dependent on the use of Oxycodone:
- Acute withdrawal.
- Protracted Abstinence/Post-Acute Withdrawal Syndrome (Sometimes known as PAWS).
Acute withdrawal is the initial phase of withdrawal in which an individual typically experiences symptoms such as:
- Gastrointestinal distress (diarrhea and vomiting).
- Muscle and joint pain.
- Marked anxiety.
- Irritability (dysphoria).
This can be very uncomfortable, but is not dangerous or life-threatening. Without treatment, this phase of withdrawal runs its course in 7-10 days with symptoms peaking after 72 hours (Koob and LeMoal).
Protracted Abstinence Withdrawal Syndrome (PAWS)
PAWS in individuals with a chronic history of dependence on opiates such as Oxycodone can last up to 6 months or longer. This is the phase of withdrawal in which an individual is most prone to relapse.
While there can be continued physical symptoms such as those listed above, there is also a very strong motivational component to PAWS, in which a person may experience ‘gray like’ moods, where little or nothing gives them pleasure.
One individual expressed it as follows: ‘When I stop [drug use] I just feel vacant, with no direction or energy and that lasts for months’ (Stewart, 1987, in Koob and LeMoal). With time and treatment, this too, will pass.
Severity of Withdrawal Symptoms
For those individuals unfortunate to go through it, withdrawal from Oxycodone and other opiates is unpleasant, uncomfortable, painful, and depressing, but rarely dangerous or life threatening.
Who is Prone to Severe Withdrawal from Oxycodone?
Both pregnant women who are opioid-dependent and their fetus have an increased risk of severe withdrawal, which can contribute to:
- Spontaneous abortion.
- Disrupted placenta.
The neonate (newborn) in withdrawal from the drug is at increased risk due to dehydration, which, in this case, requires immediate medical attention, as it can be fatal.
Individuals in Palliative Care
If a patient is switched from Oxycodone to a rapid-onset/short-acting opioid such as Alfentanil, their quality of life can be adversely affected (Carmichael and Lee, 2010).
Dehydration is a common symptom of acute withdrawal. The elderly need plenty of hydration if experiencing withdrawal, especially if they take diuretic medications.
Individuals with High Blood Pressure
In withdrawal, there is an increase in blood pressure that should not be ignored in patients with a previous diagnosis of hypertension.
Treatment for Withdrawal from Oxycodone
Opioid/opiate medications that treat the acute phase of withdrawal include methadone or buprenorphine (Suboxone ® or Subutex ®) which are slowly tapered or ‘dosed down’ under medical supervision.
Non-opioid medications used to treat the acute phase of withdrawal include Clonidine, a blood pressure medication, which can control increases in blood pressure and other autonomic nervous system functions.
For the PAWS syndrome, Naltrexone (Vivitrol®) is an option. It is not an opiate/opioid and blocks the effects of opiate/opioid drugs such as Oxycodone in the Central Nervous System (CNS). Methadone can add to symptom relief. Buprenorphine, also reduces craving and does not produce the euphoric ‘high’ of other opiates/opioids.
Psychosocial Treatments (Counseling, Therapy, Support)
Non-drug treatments for opiate/opioid withdrawal include individual counseling and therapy, such as cognitive-behavioral therapy (CBT), which emphasizes teaching the client how to take charge of their thinking and behavior. Individual Psychology therapy emphasizes personal insight and awareness of current life circumstances, leading to a healthy lifestyle (Howatt, 2005).
Support groups such as Alcoholics Anonymous and Narcotics Anonymous provide a spiritual path of recovery after withdrawal for drug-dependent persons who are also addicts.
Spirituality—and not institutional religion—is becoming a core theme in psychosocial treatment of opiate/opioid addiction. Formerly the proverbial elephant in the therapeutic setting, spirituality emphasizes the importance of relationship to self, others, and a transcendent order in which questions of meaning and purpose, belonging and trusting, and values and actions consistent with important ideals are integral to recovery and relapse prevention (Cook, 2004; Masuda, 2014).
Inpatient vs. Outpatient Treatment
However, withdrawal treatment complications require residential/hospital care and must be provided regardless of the cost.
Oxycodone is one of many opioids and, like others in this class of drugs, acute and protracted withdrawal can complicate co-occurring illnesses.
Help Someone Through Withdrawal
People in withdrawal also need to feel that they are in a safe place.
The degree of discomfort experienced in withdrawal can be significantly reduced by the:
- Simple reassurance of the course of withdrawal by a friend or family member.
- Provision of accurate information about what will happen.
- Offer of continued support (Gossop, 2007).
People in withdrawal also need to feel that they are in a safe place and need continued hydration (water). Orange juice and honey are believed by some to be well tolerated, replenishing vital minerals lost to dehydration.
Anecdotally, long hot showers are suggested to remit the severe muscle or joint pain and rest is important.
Our trained treatment support staff are available 24 hours a day. For you, or for someone you love, this is the first day of the rest of your life.
- Barthwell, A.G., and Brown, L.S., (2009) The Treatment of Drug Addiction: An Overview. In Ries, R.K., Fiellin, D.A., et al., eds. Principles of Addiction Medicine. 349-359. Philadelphia, PA: Lippincott, Williams, & Wilkins.
- Carmichael, J.P., and Lee, M.A., (2010). Symptoms of Opioid Withdrawal Syndrome after Switch from Oxycodone to Alfentanil. J Pain Symptom Manage, 40(6), e4-6.
- Cook, C.C. (2004). Addiction and Spirituality. Addiction, 99:539-51.
- Gossop, M., (2007). Living with Drugs. Sixth Edition. Burlington, VT: Ashgate Publishing Company.
- Howatt, W.A., (2005). Cognitive Behavioral Models. In Coombs, R.H., ed., Addiction Counseling Review. 337-355. Mahwah, NJ: Lawrence Erlbaum Associates.
Koob, G.F., and LeMoal, M., (2006). Neurobiology of Addiction. Boston, MA: Academic Press/Elsevier Inc.
- Masuda, A., ed., (2014). Mindfulness & Acceptance in Multicultural Competency: A Contextual Approach to Sociocultural Diversity in Theory & Practice. Oakland, CA: Context Press/New Harbinger Publications, Inc.
- Tetrault, J.M., O’Connor, P.G., 2009. Management of Opioid Intoxication and Withdrawal. In Ries, R.K., Fiellin, D.A., et al., eds. (op.cit.).
- Volkow, N.D., and Li, T-K., (2009). Drug Addiction: The Neurobiology of Behavior Gone Awry. In Ries, R.K., Fiellin, D.A. et al., eds. (op. cit).
- Wright, T.M., Cluver, J.S., and Myrick, H., (2009). Management of Intoxication and Withdrawal: General Principles. In Ries, R.K., Fiellin, D.A., et al., eds. (op.cit.).