Substance withdrawal: Difference between revisions

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'''~~Drug~~ withdrawal''' is a group of symptoms that occur upon the abrupt discontinuation or decrease in one's intake of a [[psychoactive substance|substance]]. Withdrawal develops after a physical or mental dependence, which is caused by consuming substances for an extended period of time. It is dose dependent and varies based upon the ~~drug~~ consumed, the duration of intake, as well as the [[routes of administration|route of administration]] used.

'''Substance withdrawal''' is a group of symptoms that occur upon the abrupt discontinuation or decrease in one's intake of a [[psychoactive substance|substance]]. Withdrawal develops after a physical or mental dependence, which is caused by consuming substances for an extended period of time. It is dose dependent and varies based upon the substance consumed, the duration of intake, as well as the [[routes of administration|route of administration]] used.

Each ~~drug~~ causes its own specific symptoms with opioid withdrawals causing significantly different symptoms than benzodiazepine withdrawal, for instance. The term "[[cold turkey]]" is used to describe the sudden cessation use of a substance and the ensuing physiologic manifestations. It is recommended that users [[tapering|taper their dose]] slowly over time instead of abruptly stopping, which is associated with higher rates of relapse.{{citation needed}}

Each substance causes its own specific symptoms with opioid withdrawals causing significantly different symptoms than benzodiazepine withdrawal, for instance. The term "[[cold turkey]]" is used to describe the sudden cessation use of a substance and the ensuing physiologic manifestations. It is recommended that users [[tapering|taper their dose]] slowly over time instead of abruptly stopping, which is associated with higher rates of relapse.{{opinion}}{{citation needed}}

<span style="color:red"><b>Death can occur from the withdrawal of [[GABA#GABA receptors|GABAergic substances]] such as [[benzodiazepines]], [[alcohol]], or [[barbiturates]], so [[tapering]] is especially recommended for these substances, ideally under medical supervision.</b></span><ref>A case of severe benzodiazepine withdrawal, resulting in a fatality | https://www.ncbi.nlm.nih.gov/pubmed/19465812</ref><ref>A summary of withdrawal effects from alcohol consumption, including death in severe cases. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978420/#S3title</ref><ref>A case of barbiturate misuse, death is listed as a possible outcome due to severe withdrawal. | https://www.ncbi.nlm.nih.gov/pubmed/10349206</ref>

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===Treatment===

* '''[[tapering|Gradually tapering one's intake]]''' - Withdrawal symptoms can be reduced by slowly lowering one's dosage over a period of days or weeks, which will let receptors recover somewhat before complete discontinuation. This will lessen the severity of symptoms but likely prolong their duration. It is inadvisable to self-administer a taper; the remaining substance should be given to a trusted friend or family member and distributed by only them.

* '''[[Opioid replacement therapy]]''' (ORT) - [[Methadone]] and [[buprenorphine]] (Suboxone) are longer acting but less recreational opioids that are often used to relieve opioid cravings, suppress withdrawal symptoms, and block the euphoric effects associated with opioids. However, [[methadone]] has severe withdrawal symptoms lasting multiple weeks, so this should be considered when choosing a method of treatment. When using replacement ~~drugs~~, it is highly recommended to [[tapering|gradually lower one's intake]] at the recommendation of a physician instead of abruptly stopping.

* '''[[Opioid replacement therapy]]''' (ORT) - [[Methadone]] and [[buprenorphine]] (Suboxone) are longer acting but less recreational opioids that are often used to relieve opioid cravings, suppress withdrawal symptoms, and block the euphoric effects associated with opioids. However, [[methadone]] has severe withdrawal symptoms lasting multiple weeks, so this should be considered when choosing a method of treatment. When using replacement substances, it is highly recommended to [[tapering|gradually lower one's intake]] at the recommendation of a physician instead of abruptly stopping.

* '''Over-the-counter painkillers''' - OTC painkillers such as '''naproxen''', '''aspirin''', '''acetaminophen''', or '''ibuprofen''' can reduce withdrawal symptoms and lessen pain.

* '''Weak opioids ([[kratom]],''' '''[[codeine]],''' or '''[[tianeptine]])''' - Switching to a weaker opioid can lessen the perceived symptoms, but is likely to also prolong the period of withdrawal and could potentially lead to addiction.

* '''[[Gabapentin]]''' or '''[[pregabalin]]''' - Both of these prescription ~~drugs~~ can prevent or lessen [[restless legs syndrome]].

* '''[[Gabapentin]]''' or '''[[pregabalin]]''' - Both of these prescription medicines can prevent or lessen [[restless legs syndrome]].

* '''Clonidine''' - Clonidine is a prescription alpha-2 [[epinephrine |adrenal]] [[agonist]] that is often prescribed to help alleviate some of the symptoms of opioid withdrawal.

* '''Loperamide''' - Loperamide (Immodium) is an over-the-counter ~~drug~~ used to treat diarrhea. It acts on the opioid receptors in the intestines and has no appreciable effect on the central nervous system. Therapeutic doses may help relieve some gastrointestinal issues stemming from opioid withdrawal.

* '''Loperamide''' - Loperamide (Immodium) is an over-the-counter medicine used to treat diarrhea. It acts on the opioid receptors in the intestines and has no appreciable effect on the central nervous system. Therapeutic doses may help relieve some gastrointestinal issues stemming from opioid withdrawal.

* '''[[Dextromethorphan]]''' (DXM)

* '''[[Diphenhydramine]]''' (DPH) - Some users report that DPH can mildly reduce withdrawals and assist with sleep.

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==Nicotine withdrawal==

While [[nicotine]] withdrawal may cause some withdrawal effects, it is not life-threatening. However, the mental cravings which it can induce can be as intense as other addictive ~~drugs~~ such as alcohol.

While [[nicotine]] withdrawal may cause some withdrawal effects, it is not life-threatening. However, the mental cravings which it can induce can be as intense as other addictive substances such as alcohol.

The effects generally begin 2-3 hours after cessation, peak in 2-3 days, and last 2-4 weeks.

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* '''[[Bupropion]]''' (Wellbutrin) - This is a medication primarily used as an antidepressant and smoking cessation aid, reducing the intensity of nicotine cravings and its withdrawal symptoms. It acts as an norepinephrine-dopamine reuptake inhibitor (NDRI). It doubles the chance of quitting smoking successfully, making its effectiveness comparable to nicotine replacement therapy but less effective than varenicline.<ref>Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. | https://www.ncbi.nlm.nih.gov/pubmed/17156479</ref>

* '''Varenicline''' (Chantix) - This prescription medication is a nicotinic receptor partial agonist which is similar to [[cytisine]] and works to reduce cravings by stimulating nicotine receptors more weakly than nicotine itself does. It also decreases the euphoric effects of cigarettes and other nicotine products.

* '''Cytisine''' - This ~~drug~~ is a partial agonist of nicotinic acetylcholine receptors (nAChRs), which is similar to varenicline.

* '''Cytisine''' - This substance is a partial agonist of nicotinic acetylcholine receptors (nAChRs), which is similar to varenicline.

* '''Exercise''' - Non-medications treatments such as increased exercise can also reduce nicotine withdrawal.

* '''[[NAC]]''' - In terms of reducing cravings, NAC has been shown to provide relief for those who struggle with compulsive redosing and psychological cravings.

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==Cannabis withdrawal==

Although not medically serious, cannabis withdrawal symptoms can occur in users who have been using the ~~drug~~ for an extended period of time. In comparison to most other ~~drugs~~, cannabis withdrawal is very mild. Most symptoms begin during the first week of abstinence and resolve after a few weeks. These symptoms include:

Although not medically serious, cannabis withdrawal symptoms can occur in users who have been using the substance for an extended period of time. In comparison to most other substances, cannabis withdrawal is very mild. Most symptoms begin during the first week of abstinence and resolve after a few weeks. These symptoms include:

* '''Anger'''

* '''[[Cognitive dysphoria]]'''

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* '''[[tapering|Gradually tapering one's intake]]''' - Withdrawal symptoms can be reduced by slowly lowering one's dosage over a period of days or weeks, which will let receptors recover somewhat before complete discontinuation. This will lessen the severity of symptoms but likely prolong their duration. It is inadvisable to self-administer a taper; the remaining substance should be given to a trusted friend or family member and distributed by only them.

* '''Dronabinol''' - Dronabinol is an agonist that is legally available; in some cases and trials, it reduced symptoms of withdrawal and reduced cannabis use.<ref name="two">State of the Art Treatments for Cannabis Dependence | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371269/</ref>

*'''[[Diphenhydramine]]''' (DPH) - This ~~drug~~ can assist with sleep if one has insomnia, but may also exacerbate the [[restlessness]] of withdrawal in high does.

*'''[[Diphenhydramine]]''' (DPH) - This substance can assist with sleep if one has insomnia, but may also exacerbate the [[restlessness]] of withdrawal in high does.

* '''[[Benzodiazepines]]''' - As benzodiazepines have a high risk of addiction, one should be careful not to become physically dependent on them.

* '''Exercise''' - This may reduce some symptoms and accelerates the rate that THC exits the body by releasing the THC metabolites stored in the fat tissue into the blood stream<ref> "Reintoxication: the release of fat-stored Δ9-tetrahydrocannabinol (THC) into blood is enhanced by food deprivation or ACTH exposure" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782342/</ref>.

@@ Line 1: / Line 1: @@
-'''Drug withdrawal''' is a group of symptoms that occur upon the abrupt discontinuation or decrease in one's intake of a [[psychoactive substance|substance]]. Withdrawal develops after a physical or mental dependence, which is caused by consuming substances for an extended period of time. It is dose dependent and varies based upon the drug consumed, the duration of intake, as well as the [[routes of administration|route of administration]] used.
+'''Substance withdrawal''' is a group of symptoms that occur upon the abrupt discontinuation or decrease in one's intake of a [[psychoactive substance|substance]]. Withdrawal develops after a physical or mental dependence, which is caused by consuming substances for an extended period of time. It is dose dependent and varies based upon the substance consumed, the duration of intake, as well as the [[routes of administration|route of administration]] used.
-Each drug causes its own specific symptoms with opioid withdrawals causing significantly different symptoms than benzodiazepine withdrawal, for instance. The term "[[cold turkey]]" is used to describe the sudden cessation use of a substance and the ensuing physiologic manifestations. It is recommended that users [[tapering|taper their dose]] slowly over time instead of abruptly stopping, which is associated with higher rates of relapse.{{citation needed}}
+Each substance causes its own specific symptoms with opioid withdrawals causing significantly different symptoms than benzodiazepine withdrawal, for instance. The term "[[cold turkey]]" is used to describe the sudden cessation use of a substance and the ensuing physiologic manifestations. It is recommended that users [[tapering|taper their dose]] slowly over time instead of abruptly stopping, which is associated with higher rates of relapse.{{opinion}}{{citation needed}}
 <span style="color:red"><b>Death can occur from the withdrawal of [[GABA#GABA receptors|GABAergic substances]] such as [[benzodiazepines]], [[alcohol]], or [[barbiturates]], so [[tapering]] is especially recommended for these substances, ideally under medical supervision.</b></span><ref>A case of severe benzodiazepine withdrawal, resulting in a fatality | https://www.ncbi.nlm.nih.gov/pubmed/19465812</ref><ref>A summary of withdrawal effects from alcohol consumption, including death in severe cases. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978420/#S3title</ref><ref>A case of barbiturate misuse, death is listed as a possible outcome due to severe withdrawal. | https://www.ncbi.nlm.nih.gov/pubmed/10349206</ref>
@@ Line 37: / Line 37: @@
 ===Treatment===
 * '''[[tapering|Gradually tapering one's intake]]''' - Withdrawal symptoms can be reduced by slowly lowering one's dosage over a period of days or weeks, which will let receptors recover somewhat before complete discontinuation. This will lessen the severity of symptoms but likely prolong their duration. It is inadvisable to self-administer a taper; the remaining substance should be given to a trusted friend or family member and distributed by only them.
-* '''[[Opioid replacement therapy]]''' (ORT) - [[Methadone]] and [[buprenorphine]] (Suboxone) are longer acting but less recreational opioids that are often used to relieve opioid cravings, suppress withdrawal symptoms, and block the euphoric effects associated with opioids. However, [[methadone]] has severe withdrawal symptoms lasting multiple weeks, so this should be considered when choosing a method of treatment. When using replacement drugs, it is highly recommended to [[tapering|gradually lower one's intake]] at the recommendation of a physician instead of abruptly stopping.
+* '''[[Opioid replacement therapy]]''' (ORT) - [[Methadone]] and [[buprenorphine]] (Suboxone) are longer acting but less recreational opioids that are often used to relieve opioid cravings, suppress withdrawal symptoms, and block the euphoric effects associated with opioids. However, [[methadone]] has severe withdrawal symptoms lasting multiple weeks, so this should be considered when choosing a method of treatment. When using replacement substances, it is highly recommended to [[tapering|gradually lower one's intake]] at the recommendation of a physician instead of abruptly stopping.
 * '''Over-the-counter painkillers''' - OTC painkillers such as '''naproxen''', '''aspirin''', '''acetaminophen''', or '''ibuprofen''' can reduce withdrawal symptoms and lessen pain.
 * '''Weak opioids ([[kratom]],''' '''[[codeine]],''' or '''[[tianeptine]])''' - Switching to a weaker opioid can lessen the perceived symptoms, but is likely to also prolong the period of withdrawal and could potentially lead to addiction.
-* '''[[Gabapentin]]''' or '''[[pregabalin]]'''  - Both of these prescription drugs can prevent or lessen [[restless legs syndrome]].
+* '''[[Gabapentin]]''' or '''[[pregabalin]]'''  - Both of these prescription medicines can prevent or lessen [[restless legs syndrome]].
 * '''Clonidine''' - Clonidine is a prescription alpha-2 [[epinephrine |adrenal]] [[agonist]] that is often prescribed to help alleviate some of the symptoms of opioid withdrawal.
-* '''Loperamide''' - Loperamide (Immodium) is an over-the-counter drug used to treat diarrhea. It acts on the opioid receptors in the intestines and has no appreciable effect on the central nervous system. Therapeutic doses may help relieve some gastrointestinal issues stemming from opioid withdrawal.
+* '''Loperamide''' - Loperamide (Immodium) is an over-the-counter medicine used to treat diarrhea. It acts on the opioid receptors in the intestines and has no appreciable effect on the central nervous system. Therapeutic doses may help relieve some gastrointestinal issues stemming from opioid withdrawal.
 * '''[[Dextromethorphan]]''' (DXM)
 * '''[[Diphenhydramine]]''' (DPH) - Some users report that DPH can mildly reduce withdrawals and assist with sleep.
@@ Line 85: / Line 85: @@
 ==Nicotine withdrawal==
-While [[nicotine]] withdrawal may cause some withdrawal effects, it is not life-threatening. However, the mental cravings which it can induce can be as intense as other addictive drugs such as alcohol.
+While [[nicotine]] withdrawal may cause some withdrawal effects, it is not life-threatening. However, the mental cravings which it can induce can be as intense as other addictive substances such as alcohol.
 The effects generally begin 2-3 hours after cessation, peak in 2-3 days, and last 2-4 weeks.
@@ Line 104: / Line 104: @@
 * '''[[Bupropion]]''' (Wellbutrin) - This is a medication primarily used as an antidepressant and smoking cessation aid, reducing the intensity of nicotine cravings and its withdrawal symptoms. It acts as an norepinephrine-dopamine reuptake inhibitor (NDRI). It doubles the chance of quitting smoking successfully, making its effectiveness comparable to nicotine replacement therapy but less effective than varenicline.<ref>Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. | https://www.ncbi.nlm.nih.gov/pubmed/17156479</ref>
 * '''Varenicline''' (Chantix) - This prescription medication is a nicotinic receptor partial agonist which is similar to [[cytisine]] and works to reduce cravings by stimulating nicotine receptors more weakly than nicotine itself does. It also decreases the euphoric effects of cigarettes and other nicotine products.
-* '''Cytisine''' -  This drug is a partial agonist of nicotinic acetylcholine receptors (nAChRs), which is similar to varenicline.
+* '''Cytisine''' -  This substance is a partial agonist of nicotinic acetylcholine receptors (nAChRs), which is similar to varenicline.
 * '''Exercise''' - Non-medications treatments such as increased exercise can also reduce nicotine withdrawal.
 * '''[[NAC]]''' - In terms of reducing cravings, NAC has been shown to provide relief for those who struggle with compulsive redosing and psychological cravings.
@@ Line 216: / Line 216: @@
 ==Cannabis withdrawal==
-Although not medically serious, cannabis withdrawal symptoms can occur in users who have been using the drug for an extended period of time. In comparison to most other drugs, cannabis withdrawal is very mild. Most symptoms begin during the first week of abstinence and resolve after a few weeks. These symptoms include:
+Although not medically serious, cannabis withdrawal symptoms can occur in users who have been using the substance for an extended period of time. In comparison to most other substances, cannabis withdrawal is very mild. Most symptoms begin during the first week of abstinence and resolve after a few weeks. These symptoms include:
 * '''Anger'''
 * '''[[Cognitive dysphoria]]'''
@@ Line 233: / Line 233: @@
 * '''[[tapering|Gradually tapering one's intake]]''' - Withdrawal symptoms can be reduced by slowly lowering one's dosage over a period of days or weeks, which will let receptors recover somewhat before complete discontinuation. This will lessen the severity of symptoms but likely prolong their duration. It is inadvisable to self-administer a taper; the remaining substance should be given to a trusted friend or family member and distributed by only them.
 * '''Dronabinol''' - Dronabinol is an agonist that is legally available; in some cases and trials, it reduced symptoms of withdrawal and reduced cannabis use.<ref name="two">State of the Art Treatments for Cannabis Dependence | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3371269/</ref>
-*'''[[Diphenhydramine]]''' (DPH) - This drug can assist with sleep if one has insomnia, but may also exacerbate the [[restlessness]] of withdrawal in high does.
+*'''[[Diphenhydramine]]''' (DPH) - This substance can assist with sleep if one has insomnia, but may also exacerbate the [[restlessness]] of withdrawal in high does.
 * '''[[Benzodiazepines]]''' - As benzodiazepines have a high risk of addiction, one should be careful not to become physically dependent on them.
 * '''Exercise''' - This may reduce some symptoms and accelerates the rate that THC exits the body by releasing the THC metabolites stored in the fat tissue into the blood stream<ref> "Reintoxication: the release of fat-stored Δ9-tetrahydrocannabinol (THC) into blood is enhanced by food deprivation or ACTH exposure" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782342/</ref>.