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Using Xanax for Opiate Withdrawal: Is It a Legitimate Solution?

The symptoms of opiate withdrawal are very distressing and can often lead to relapse. The first line of approach in the treatment of opiate withdrawal is the use of opiate replacement medications.

Xanax is not a primary treatment for opiate withdrawal, but it may be useful as a supplementary medication.

Opiate Withdrawal

Those who have developed a physical dependence on opiates will often begin to experience withdrawal symptoms within 12 hours of their last use of the drug. Opiate withdrawal symptoms, such as anxiety, nausea, vomiting, insomnia, and confusion, can be very distressing, but they usually are not considered to be potentially fatal.

One of the greatest dangers of opiate withdrawal is an individual will relapse due to the discomfort and overdose.

Different medications, including Xanax, may be used during withdrawal to smooth the process.

Treatment of Withdrawal

Opiate abusers often find that they need to take more and more of their drug of choice to avoid the withdrawal symptoms that will inevitably occur when they stop using.

The primary treatment for opiate withdrawal is the use of medication-assisted treatment (MAT). The  U.S. Food and Drug Administration (FDA) has approved four medications for the treatment of opiate use disorders.

  • Buprenorphine, a partial opiate agonist that addresses withdrawal systems and is the active ingredient in Suboxone
  • Methadone, a full opiate agonist, used to control withdrawal symptoms
  • Naltrexone (ReVia), an opiate antagonist used to reduce cravings for opiates
  • Lucemyra (lofexidine hydrochloride), a non-opioid drug that can be used for up to 14 days to treat withdrawal symptoms

The drug naloxone (Narcan) is used to reverse an opiate overdose. It is not used to address opiate withdrawal. In fact, it often induces opiate withdrawal when administered.

What Replacement Medications Do

Methadone and buprenorphine are opioid replacement medications that can be used in place of powerful drugs like heroin, morphine, and others. They occupy the receptors in the brain that these drugs hold, but they do not produce the full effects of these drugs. This process results in a person not experiencing withdrawal symptoms.

If you are in a medical detox program for an opioid use disorder and the replacement medication is abruptly stopped, you will experience an opioid withdrawal syndrome. Instead, you will receive increasingly smaller doses of the drug over time to wean you off of it. This allows your system to slowly adjust to decreasing amounts of the drug as you gain a strong foothold in recovery.

Opiate Withdrawal and the Locus Coeruleus

Earlier research with rodents attempted to investigate why those who abuse opioids often also abuse benzodiazepines. Researchers found that Xanax use led to decreased neural activity in the area of the brain known as the locus coeruleus (LC).  They hypothesized that benzodiazepines decreased issues with anxiety related to opioid withdrawal.

The LC is a part of the brainstem that is responsible for modulating stress. It almost exclusively utilizes the neurotransmitter norepinephrine. Norepinephrine stimulates the hypothalamic-pituitary-adrenal axis in response to stress-related activity.

The role of the LC is very complex, but too much activity in the LC is the basis of pathological responses to stress, such as those that occur with PTSD. It is also believed that overactivity in the LC occurs during opiate withdrawal.

How Can Xanax Help?

Opioids inhibit the activity of the neurons in the LC. When a person with an opioid use disorder is unable to use their drug of choice, there is an increase of activity in the neurons in the LC that contribute to the symptoms of withdrawal.

Xanax may be useful as an adjunct medication to reduce anxiety, manage insomnia, and lessen restlessness, irritability, and agitation.

A recent research study found that a significant proportion of individuals who were seeking treatment for opioid use disorder also abused benzodiazepines. The researchers believed that this was an attempt to modulate or lessen withdrawal symptoms associated with their opioid abuse.

Xanax is not a solution to the discomfort that occurs during opioid withdrawal, but it can assist some first-line treatments. It may help some people in recovery, particularly in the initial stages of withdrawal.

Because Xanax is also a serious potential drug of abuse, its use should be strictly monitored in people recovering from opioid use disorders.

Should Xanax Be Self-Administered?

No. If you have been abusing opiates and want to stop, you should discuss this with a licensed physician who is experienced in the treatment of addictive behaviors (a psychiatrist or an addiction medicine physician).

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Xanax can be a dangerous drug of abuse, and it is also possible to overdose on Xanax.

Xanax alone will not address symptoms of opiate withdrawal despite any anecdotal information you may have read online.

In some cases, it may be prescribed as part of a comprehensive addiction treatment program. Your doctor will be able to advise if it’s right for you.

Sources

(May 2018) Opiate and Opioid Withdrawal. MedlinePlus. Retrieved March 2019 from https://medlineplus.gov/ency/article/000949.htm

(February 2019) Information about Medication-Assisted Treatment (MAT). U.S. Food and Drug Administration. Retrieved March 2019 from https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm600092.htm

(October 1996) Effect of alprazolam on opiate withdrawal: a combined behavioural and microdialysis study. European Journal of Pharmacology. Retrieved March 2019 from https://www.ncbi.nlm.nih.gov/pubmed/8905331

(February 2014) Pharmacological strategies for detoxification. British Journal of Clinical Pharmacology. Retrieved March 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014033/

(September 2016) Reasons for benzodiazepine use among persons seeking opioid detoxification. Journal of Substance Abuse Treatment. Retrieved March 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955948/

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