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    What is Clonidine, and Can It Be Used for Opiate Withdrawal?

    What Is Clonidine?

    Clonidine is a centrally acting antihypertensive and has been broadly prescribed for over 20 years. That means that clonidine is frequently used to treat high blood pressure by slowing your heart rate so that blood can flow more easily through the body. Because it decreases norepinephrine activity, it has been looked at as an antipsychotic. (Norepinephrine is a chemical in your body that acts as an excitatory neurotransmitter in your nervous system. It stimulates activity in the brain.)

    Is Clonidine Addictive?

    It’s not a controlled substance, so it doesn’t have much value on the streets. Due to this, doctors are often more willing to prescribe clonidine due to the low potential for abuse. Don’t confuse clonidine with Klonopin which is used to prevent and control seizures. Klonopin is a controlled substance with a high risk of addiction.

    Other Uses

    Clonidine extended-release tablets can be used to treat ADHD (attention-deficit hyperactivity disorder) in children by affecting the part of the brain that controls impulsivity and attention. 

    It is also used to treat dysmenorrhea (severely painful cramps during the menstrual period), menopausal hot flashes, alcohol and opiate withdrawal, and Tourette’s syndrome.

    What Are Side Effects of Clonidine?clonidine for opiate withdrawal

    Although it’s not addictive, clonidine may cause side effects. Notify your doctor if any of these symptoms are severe or do not go away:

    • Dry mouth
    • Tiredness
    • Weakness
    • Headache
    • Nervousness
    • Decreased sexual ability
    • Nausea
    • Vomiting
    • Constipation

    Clonidine for Opiate Withdrawal

    Medical professionals commonly prescribe clonidine for opiate withdrawal. Research has shown that clonidine hydrochloride can significantly weaken opiate withdrawal syndrome. Inpatient and outpatient clinical studies indicate that clonidine is a reasonably safe, specific, and effective treatment for detoxifying opiate addicts.

    It appears that it’s best adapted for use as a transitional treatment between dependence on opiates and introduction of  the opiate antagonist naltrexone. (Opioid antagonists block the effects of opioids.)

    Recent studies also indicate that clonidine is also useful for withdrawal from methadone maintenance. Methadone is a synthetic drug that is used in medication-assisted treatment (MAT) to help people stop using heroin and other opiates. It can help detoxify the patient in less than 14 days, instead of the usual three to six months. 

    What’s the Difference Between Opiates and Opioids?

    Although these terms are frequently used interchangeably, they are different. 

    Opiates

    Opiates refer to chemical compounds that are refined from opium.  Opium comes from the opium poppy. (Poppy sap and fibers). Some examples are:

    • Opium
    • Morphine
    • Codeine

    Opioids

    Opioids refer to any drug, natural, synthetic, or semisynthetic that produces opiate-like effects. However, most opioids are made in the lab or “synthesized.” Therefore, while all opiates are opioids, not all opioids are opiates.  Some examples of opioids are:

    • Heroin
    • Hydrocodone
    • Oxycodone
    • Fentanyl
    • Methadone

    Both groups of drugs are considered “narcotics.” (The word narcotic means sleep- or numbness-inducing.) And even though it is more accurate to refer to the groups as separate “opiates and opioids,” most people refer to all of these drugs as opioids.

    Here’s Why

    If a person is dependent on one of the opiate or opioid drugs, whether prescribed or acquired illegally, they can switch to a different opiate or opioid drug to maintain their addiction. This means that substituting an opiate for an opioid, and vice versa, can prevent withdrawal.

    Sadly, many people with actual pain issues become addicted to their prescription pain medications. They may then switch to illicit opioids, specifically heroin, when the medically supplied narcotics run out. According to the American Medical Association (AMA), about 3% to 19% of people who take prescription pain medications develop an addiction to them. Plus, about 45% of people who use heroin started with an addiction to prescription opioids.

    Opioid Use Disorder (OUD)

    OUD is a pattern of opioid use that causes notable impairment or distress. Diagnosing OUD is based on specific examples such as:

    • Taking larger amounts or taking drugs over an extended period,
    • spending a lot of time obtaining or using the drug,
    • craving or a strong urge to use,
    • tolerance,
    • unsuccessful efforts to control use or cut down,
    • continued use despite social problems resulting from opioid use, or
    • failure to fulfill obligations at work, school, or home due to opioid use,
    • experiencing withdrawal or using a different opioid (or opiate) to prevent withdrawal symptoms. 

    Opioid addiction isn’t about weakness or personal failure. It is a disease that takes over the brain and physically changes it and drives people to put opioids before anything else. Even when the addiction is destroying their lives. 

    Clonidine for Opiate WithdrawalThe Takeover

    Like many other substance use disorders (SUDs), opioid addiction happens when a biological system in the brain (the Reward System) is hijacked by opioids. Basically, the reward system causes us to repeat natural things that we enjoy or need to do to survive. Like sex or eating when we’re hungry. These activities trigger the release of a chemical messenger in the brain called dopamine.

    In turn, dopamine rewards us with a feeling or calm or pleasure. But the natural levels of dopamine and the effects can’t compare to the flood of dopamine that is released when opioids are used. In time, the brain may be rewired, needing higher levels of dopamine just to feel “normal.” After this rewiring occurs, the individual is trapped in a continuous cycle.

    OUD vs. SUDs

    OUD is similar to other substance use disorders in many ways. Nevertheless, it is different in a couple ways:

    • Opioids can lead to physical dependence in a relatively short time, as little as 4 to 8 weeks.
    • For chronic users, stopping the use leads to severe withdrawal symptoms

    Symptoms of Opiate or Opioid Withdrawal

    When a person stops taking these drugs, the body needs time to recover. This causes symptoms of withdrawal that include:

    Early Symptoms

    • Agitation
    • Anxiety
    • Muscle aches
    • Teary eyes
    • Insomnia
    • Runny nose
    • Sweating
    • Yawning

    Late Symptoms

    • Abdominal cramping
    • Diarrhea
    • Dilated pupils
    • Goosebumps
    • Nausea
    • Vomiting

    Although these symptoms are extremely uncomfortable, they are not generally life-threatening. They can, however, cause a person to relapse and begin using again just to end the symptoms. That’s why it’s helpful to go through detoxification with medical supervision. Many symptoms can be managed with medications.

    Treatment for Opiate Withdrawal

    There are effective treatments available. Still, only about 1 in 4 individuals with OUD receive specialty treatment. Withdrawal from opiates can be very difficult and may be dangerous. For example, vomiting may cause asphyxiation and diarrhea and vomiting can cause severe dehydration.

    Medication-Assisted Treatment (MAT) 

    MAT has proved to be an effective treatment for individuals with an opioid use disorder. MAT involves the use of medication along with counseling and behavioral therapies. Medications are also used to relieve cravings, relieve withdrawal symptoms and block the euphoric effects of opioids. Clonidine for opiate withdrawal is an excellent example of medication-assisted treatment.

    In the long-term, MAT has been shown to help people:

    • stay in treatment longer, 
    • reduce opioid use, and
    • reduce opioid overdoses and risks associated with opioid use disorder.

    Dual Diagnosis

    Brain chemistry may contribute to an individual’s mental illness as well as to their addiction treatment. When a person has a co-occurring mental health disorder and a substance use disorder, it is considered a dual diagnosis. For this reason, medications might be prescribed to help modify one’s brain chemistry as related to the mental disorder.

    The Behavioral Approachclonidine for opiate withdrawal

    Treatment for OUD also usually includes cognitive-behavioral approaches. These include:

    • encouraging motivation to change 
    • behavior modification techniques 
    • education about treatment
    • education about preventing relapse

    Self-Help Programs and Peer Groups

    Another important tool in overcoming addiction includes participation in self-help programs, such as Narcotics Anonymous. Taking part in these peer groups can help an individual in recovery stay honest with themselves by being held accountable by the group. Hearing from other people in the same situation can provide understanding and perspective. In addition, peers can share tips for relapse prevention.

    Medications Commonly Used to Treat Opioid Addiction

    • Clonidine: Clonidine is now being used to ease and shorten detox. It acts as a bridge to maintenance medications so the individual can get on with their treatment in a more timely manner.
    • Methadone: Prevents withdrawal symptoms and reduces cravings in people addicted to opioids. Individuals can become tolerant and it will not cause a euphoric feeling. It is available only in specially regulated clinics and dispensed daily. Clonidine for opiate withdrawal is also effective for stopping the use of methadone.
    • Buprenorphine: Blocks the effects of other opioids, reduces or eliminates withdrawal symptoms, and reduces cravings. Treatment with buprenorphine (during detox or maintenance) is provided by specially trained and qualified physicians, nurse practitioners, and physician assistants.
    • Naltrexone: Blocks the effects of other opioids which prevents the feeling of euphoria. It is available from office-based providers in pill form or a monthly injection.

    Isn’t That Just Substituting One Drug for Another?

    The National Institute on Drug Abuse (NIDA) makes it clear these medications do not substitute one addiction for another. Dosages used in treatment don’t get a person high. They are used to reduce opioid cravings and withdrawal. The goal is to restore balance to brain circuits affected by the addiction.

    Levels of Treatment

    Different individuals may need different levels of treatment and at different times. Levels of care include:

    Inpatient Treatment

    Inpatient programs provide a safe, structured environment where the individual is free from coping with the distractions and triggers to use. The patient lives at the treatment facility and has access to round-the-clock medical supervision. These programs are best for people with a long-term addiction or co-existing mental disorder.

    Outpatient Treatment

    An outpatient program can be used as a step-down from an inpatient program. The same types of therapies are provided in outpatient programs but the individual does not live at the facility. This program is for very motivated patients who have a strong support system at home or have already completed an inpatient program.

    Sober Living

    A sober living program is not actually a treatment program but it can be considered a step-down from outpatient care. It is a transitional living program where individuals can live outside the facility and get back to a less regimented life. Sober living provides a substance-free residence with other people who are likewise re-entering normal daily life.

    Continuing Care

    Opioid use disorder typically requires continuing care. Relapse is often just a stop along the road to recovery. Maintaining some type of counseling or self-help participation is important for long-term recovery.

    Elements of Care for OUD

    Evidence-based care for opioid use disorder includes several components:

    • Personalized diagnosis and treatment planning tailored to the individual and family
    • Long-term management. Addiction is a chronic condition with the potential for both recovery and relapse. Ongoing outpatient care can greatly improve outcomes.
    • Access to FDA-approved medications
    • Effective behavioral interventions delivered by trained professionals
    • Coordinated care for addiction and other co-occurring conditions
    • Recovery support services, such as mutual aid groups, peer support specialists, and community services

    Let Addiction Intervention Help You Find Treatment

    You can find this type of comprehensive treatment at Addiction Intervention. We understand what it takes to help an individual regain their life. If you or someone you know and care for has an opiate/opioid addiction, we realize that it is an all-consuming problem and that it affects more than just the addict themself. 

    Let us help you get back on track through tried and true treatment methods and programs that can be shaped to fit your personal needs. If your loved one has not honestly faced their addiction, we have intervention specialists who can help you stage an intervention. There is no time to wait; no doubt you have already waited long enough. Contact us at Addiction Intervention for support and to have your questions answered. We are available 24/7.

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