Clonidine Treatment for Opioid Withdrawal
Clonidine is a medication originally developed in the 1950s to treat the effects of high blood pressure (hypertension). Over time, doctors have adapted the medication for use in a number of different medical contexts. Among these contexts is treatment of the symptoms that commonly appear during the process of withdrawal from opioid drugs. Clonidine produces benefits during the opioid withdrawal process by easing the severity of withdrawal-related changes in a part of the human nervous system called the sympathetic nervous system. Generally speaking, people who receive clonidine have improved chances of breaking their active addictions to opioid drugs.
Opioid Withdrawal Basics
Opioids create their addicting effects inside the brain and body by making long-term changes in the production of two chemicals, called dopamine and gamma-aminobutyric acid (GABA), which help control nerve cell communication and coordinate brain activity. Among its many jobs, dopamine helps produce feelings of euphoria by promoting activity in the brain’s reward/pleasure control centers. Among its many jobs, GABA helps limit the amount of dopamine released at any given time by dopamine-producing nerve cells. Opioids effectively suppress the amount of GABA produced inside the brain; in turn, underproduction of GABA frees dopamine-producing nerve cells from their normal restraints and leads to an abnormal boost in the brain’s dopamine supply.
Over time, an opioid addict’s brain gets used to its altered levels of dopamine and GABA, and starts to treat this new chemical environment as a normal situation. When an addict’s level of opioid intake drops significantly or ceases altogether, GABA production starts to return to normal and dopamine levels fall off. The brain reacts badly to this changing circumstance and triggers the onset of withdrawal symptoms, which can be viewed as an unconscious urge for the addict to return to his or her now-accustomed level of opioid use.
Common initial symptoms of opioid withdrawal include drug cravings, irritability, headaches, a general feeling of emotional unease, restlessness, increased sweat production, unusually rapid breathing, appetite loss, fatigue, anxiety, pupil dilation, involuntary tear secretion and a runny nose. Symptoms that typically appear in later stages of withdrawal include nausea, vomiting, fever, hypertension, an accelerated heart rate, sleep disturbances, cold flashes, hot flashes, abdominal cramping, increased pupil dilation, muscle spasms, and pain in the muscles and bones. The length of withdrawal can vary considerably, although the withdrawal period for most opioids lasts roughly a week to 10 days, with peak intensity of symptoms occurring within 36 hours to three days after opioid intake drops sharply or stops entirely.
Many of opioid withdrawal’s worst effects come from alteration of normal function in a nerve network called the sympathetic nervous system, which branches into the central nervous system on one end and extends out into the rest of the body. Normally, this system is responsible for activating the stress and danger reactions that appear when the body’s inborn “fight-or-flight” response kicks in.
Clonidine belongs to a group of medications called sympatholytics; these medications block the actions of epinephrine and norepinephrine, the two naturally occurring chemicals that trigger sympathetic nervous system activity and the onset of fight-or-flight. In a person dealing with opioid withdrawal, blocking of these chemicals leads to a reduced intensity in a range of common symptoms. While the full force of opioid withdrawal can overwhelm an addict and encourage a rapid return to active drug use, people with clonidine in their systems commonly find the withdrawal process more tolerable, and therefore have improved chances of making it through withdrawal and advancing down the road to long-term recovery.
Clonidine is available as a tablet and a patch that’s applied to the skin. During the first day of opioid withdrawal, doctors commonly prescribe an oral dose of the medication that ranges from roughly 0.1 mg to 1 mg every four hours. During the next three days of treatment, oral doses may increase to a maximum of 1.2 mg per four hours. Throughout the remainder of withdrawal, oral doses of the medication usually taper off substantially. Clonidine patches come in varying strengths meant to accommodate varying body sizes. Typically, any given patch strength supplies enough of the medication within one week to equal a single day’s worth of oral doses.
Potential side effects of clonidine use include dizziness during changes in posture, sleepiness, constipation, loss of physical energy, dry mouth, and nausea. Other potential side effects specifically associated with a clonidine patch include burning or other forms of skin irritation, rash, and localized hair loss. In addition, rapid cessation of clonidine use can cause unwanted spikes in blood pressure.