Xanax For Opiate Withdrawal: The Ultimate Guide

Xanax is known to help reduce symptoms during acute opiate withdrawal. However, a number of precautions should be taken while using Xanax to alleviate opiate withdrawal symptoms.

Note that Xanax is never used by physicians in an inpatient setting to manage symptoms of opiate withdrawal because it is too short-acting. Longer-acting benzodiazepines like Valium (diazepam) are preferred.

About Opiate Withdrawal

Opiate withdrawal is characterized by the following signs and symptoms:

  • Restlessness, agitation, and dysphoria (low mood)
  • Nasal congestion and excess production of tears
  • Muscle pain and joint pain
  • Nausea, vomiting, diarrhea and abdominal cramping

The opiate withdrawal timeline is about 72 hours for short-acting opiates. Short-acting opiates includes nearly everything except methadone, which is long-acting.

For short-acting opiates, withdrawal symptoms will begin 6-12 hours after the last dose (or immediately if induced by an opioid antagonist), peak a number of hours later, and subside after 72 hours. The opiate withdrawal timeline is prolonged for methadone and can last up to two weeks.

What Medications Are Used For Opiate Withdrawal?

If you were to visit the emergency room for inpatient management of acute opiate withdrawal, what kinds of medications would doctors give you to help manage the symptoms?

  • Methadone - Useful for naturally occurring withdrawal. Not recommended for acute withdrawal induced by an antagonist like naloxone or naltrexone

  • Clonidine - For restlessness, anxiety, dysphoria, elevated blood pressure and heart rate

  • Diazepam - Anxiety, restlessness, dysphoria, insomnia, muscle cramping

  • Promethazine - Nausea, vomiting, restlessness, insomnia

  • Diphenhydramine - An antihistamine available OTC as Benedryl

  • Hydroxyzine - Antihistamine

  • Loperamide - Useful for diarrhea, stomach cramps

  • Acetaminophen - Pain

  • Baclofen - Muscle cramping

Xanax For Opiate Withdrawal

Xanax effectively eases the extreme discomfort of opiate withdrawal, but it is not the ideal medication for this purpose.

Xanax is a short-acting benzodiazepine. Benzodiazepines decrease brain activity by activating the GABA(A) receptor. This tends to reduce anxiety, seizures, agitation, psychosis and other symptoms associated with hyperactivity in the brain.

Benzodiazepines are used for anxiety, restlessness, dysphoria, insomnia and muscle cramping caused by opiate withdrawal.

Why Doctors Would Never Use Xanax For Opiate Withdrawal

Emergency room doctors routinely use diazepam to manage the acute symptoms of opiate withdrawal. Why wouldn’t they use Xanax, which is also a benzodiazepine?

Xanax is among the most rapid-acting benzodiazepines. It’s duration of effects is about 4 hours. The timeline of opiate withdrawal for short-acting agents (everything except methadone) is about 72 hours.

Because Xanax doesn’t last very long, re-dosing every couple of hours would be required to maintain constant levels of the benzodiazepine. Diazepam is much longer-acting and would not require re-administration every couple of hours.

Abuse Potential of Xanax

Another disadvantage of Xanax (vs other benzodiazepines) in the treatment of acute opiate withdrawal is that Xanax is highly addictive. Xanax is one of the most habit-forming benzodiazepines simply because it is short-acting. There tends to be an inverse relationship between duration of action and abuse liability.

Rapid onset and offset of psychological effects makes a substance more addictive. This is partly why Vyvasne is less addictive than Adderall.

The time it takes for a substance to reach the brain is also related to abuse potential. For example, the most addictive route of administration is intravenous, followed by inhalation (e.g., smoking cigarettes), follow by insufflation, followed by oral administration. These difference reflect bioavailability but also the time it takes the substance to reach the brain.

Don’t Get Hooked On Benzodiazepines!

By taking benzodiazepines like Xanax during opiate withdrawal without the supervision of a physician, you might end up substituting one drug habit for another.

There’s a lot of literature out there about benzodiazepine and opiate co-dependence. It turns out that benzodiazepine co-dependence markedly exacerbates opiate withdrawal. Consider the following report( ref):

Patients dependent only on opiates (n = 39), and patients dependent on both opiates and benzodiazepines (n = 22), were recruited from consecutive admissions to an in-patient drug treatment unit. Quantity and duration of prior opiate use was similar for both groups. Patients completed daily self-ratings of opiatewithdrawal (SOWS) for the duration of a standard in-patient detoxification treatment. Co-dependent patients were detoxified from benzodiazepines and opiates concurrently. Co-dependent patients reported a more severe withdrawal symptoms than patients withdrawing from opiates alone. Co-dependent patients had significantly more severe opiate withdrawal symptoms.

De wet C, Reed L, Glasper A, Moran P, Bearn J, Gossop M. Benzodiazepine co-dependence exacerbates the opiate withdrawal syndrome. Drug Alcohol Depend. 2004;76(1):31-5.