Many patients with withdrawal symptoms have other medical problems that must be diagnosed and treated. Opioid users may have mixed addictions, and although providing appropriate withdrawal measures for each drug is theoretically feasible, it is not required. Methadone substitution is the preferred method of opioid withdrawal because of its long half-life and less profound sedation. Higher doses should be given when physical signs of withdrawal are observed. Doses of 25 to 45 mg can produce unconsciousness if the person has not developed tolerance.
Patients commonly become angry and frequently request additional medication.
Acute manifestations of withdrawal usually subside within 7 to 10 days, but patients often complain of weakness, insomnia, and severe pervasive anxiety for several months. 500 to 1000 mg po can improve sleep. Minor metabolic and physiologic withdrawal effects may persist for up to 6 mo. Whether this protracted withdrawal syndrome contributes to relapse is unclear. The central adrenergic drug clonidine can halt almost all signs of opioid withdrawal.