Drug therapy for specific symptoms in planned opioid withdrawal
For treatment of anxiety and agitation in opioid withdrawal in a home setting if buprenorphine cannot be used, considerSA Health:
diazepam 5 to 10 mg orally, 6-hourly as required. Review after 2 to 3 days to assess symptom control. Maximum duration 7 days. diazepam diazepam diazepam
For treatment of anxiety and agitation in opioid withdrawal in a community residential unit or hospital setting, patients may be reviewed using the Clinical Opiate Withdrawal Scale (available from the National Centre for Education and Training on Addiction website) or other opiate withdrawal scale, provided an appropriately trained person is available before each dose. If buprenorphine cannot be used, considerSA Health:
diazepam 5 to 10 mg orally, 6-hourly as required to control anxiety and agitation. Maximum duration 10 days. diazepam diazepam diazepam
For treatment of insomnia during planned opioid withdrawal, useNSW Health, 2022:
temazepam 10 to 20 mg orally, at night as required. Maximum duration 5 days. temazepam temazepam temazepam
Benzodiazepines increase overdose risk if the person subsequently relapses; avoid prescribing more than one benzodiazepine or combinations of a benzodiazepine and other drugs with sedative effects such as opioids or gabapentinoids.
Diazepam could be collected daily by the patient or if supplying a few days’ medication at a time, administration should be supervised by a reliable person. Only prescribe 2 to 3 days of diazepam supply at a time because of risk of overdose. Avoid ongoing prescribing so the patient does not become dependent on benzodiazepines. Advise patients not to drive or drink alcohol during treatment with benzodiazepines for opioid withdrawal.
Clonidine (an alpha-2 adrenergic agonist) may be used to manage sweating, tachycardia, hypertension, agitation or restless legs in an inpatient setting if buprenorphine cannot be used. Check heart rate and blood pressure before every dose, and ensure patients are hydrated to limit risk of hypotension.
A suggested regimen for the use of clonidine to manage opioid withdrawal is:
clonidine 50 to 75 micrograms orally, 6- to 8-hourly. Increase dose as required to control withdrawal symptoms. Withhold or reduce dose if bradycardia occurs or systolic blood pressure is less than 90 mmHg. A maximum daily dose of 600 micrograms can be given in hospital. Taper dose and aim to stop in 5 to 6 days. clonidine clonidine clonidine
For more information on opioid withdrawal management, see this quick reference withdrawal guide available at the Insight website.
Sometimes inpatient admissions for planned opioid withdrawal end with the patient leaving early, before the withdrawal syndrome has ended. All patients should be offered take-home naloxone because of the risk of relapse following withdrawal.