Co-occurring pain in a drug addict presents a challenging syndrome. Whenever possible, avoid opiates in addicted patients (including alcoholics). Follow WHO guidelines for pain control utilizing the weakest effective medicine to control pain. Addicts often have difficulty accepting non-opiate pain relievers. Typically, medicines used for medically monitored detoxification and withdrawal are: 1. Alcohol – Benzodiazepines e.g. diazepam 5-20 mg (Valium), oxazepam 15-60 mg (Serax), chlordiazepoxide 25-100 mg (Librium)) – Avoid Valium and Librim IM as the are poorly absorbed OR Barbiturates (phenobarbital 15-6- mg – (PO or IM) as needed. Use oxazepam (Serax) if liver disease is suspected since it is not metabolized by the liver. Use Phenobarbital if concurrent treatment of Benzodiazepine abuse/dependence. 2. Opiates – Clonidine plus PRN doses of methocarbamal (Robaxin) for muscle Cramps, dicyclomine (Bentyl) for stomach cramps, hydroxazine (Atarax) for sleeplessness and anxiety and phenobarbital as needed for anxiety/sleeplessness. A high dose of phenobarbital may be necessary for sleeplessness for a few days. Tramadol (Ultram) is used for the pain of withdrawal in doses of 50-100 mg q 4-6 hours as needed for pain. Buprenorphine (Subutex) is added if withdrawal symptoms are not relieved by the protocol 48-72 HOURS AFTER LAST DOSE OF OPIOID. *It is recommended that benzodiazepines be avoided in opiate withdrawal since they are often associated with drug seeking and craving 3. Stimulants – PRN benzodiazepines (short term) 4. Benzodiazepines – Avoid using benzodiazepines for benzodiazepine withdrawal because of the psychological dependence many benzodiazepine addicts experience. Gabapentin (Neurontin) 300 mg TID with Phenobarbital PRN anxiety works well. Continue gabapentin (Neurontin) for 2 weeks; wean off phenobarbital over 3-5 days. Valproic acid (Depakote) may also be used instead of gabapentin (Neurontin).
Las Vegas Recovery Center is an inpatient and outpatient addiction and chronic pain recovery center. We offer a range of services, including alcohol and drug detox and holistic recovery therapies. To learn more, please call our 24-hour admissions line to speak with an admissions counselor.