Suggest Ways To Manage Diarrhea After Abruptly Stopping Opiates

Posted on Wed, 29 Apr 2015

Question: I was on 40 mg of methadone for chronic pain, for about two and a half years, but was on other opiates prior to that for the past 10 years. I felt like I was in over my head, and needed to just see how I would be without any pain meds, so I went cold turkey on March 28. I had a Butrans 10mg patch leftover from a previous script, so I put that on for one week. I still felt awful, but I guess it must have helped some bc as soon as I took it off, I started getting really, really sick. I have severe diarrhea, I can't eat anything (if I try, it runs right through me immediately). I have a slight fever (99.4) and the dry heaves, since there is nothing to throw up. I have pain in my lower back and legs, but that is why I was originally taking the methadone (piriformis syndrome), but now it gets much worse at night. I don't have the shakes as bad as I did at first, but they do get worse at night. The main thing I am worried about is the diarrhea. It is very, very bad. I'm not very fond of water but I'm trying to drink as much as I can. I'm hungry but so scared to eat bc of the stomach cramps and diarrhea. Will Immodium AD help? How long will this symptom last, given that I have been on some form of opiate for the past 10 years? My doctor and I have a very co-dependent relationship, so it would not be good for me to go back to her. She will give me almost whatever I want, so if I have a moment of weakness, my hard work up to this point will be for nothing.

Answered by Dr. Manisha Gopal (21 hours later)

Brief Answer:
will take 7-10 days from when u stopped butran

Detailed Answer:
Hello,

I have read your query and it says that right now your main concern is opioids withdrawal symptoms, mainly diarrhoea.

You are already aware that diarrhoea, pain in legs and back, sleeping issues and anxiety, goose bimps etc.,are part and parcel of opioid withdrawal.

Though you stopped methadone from 28 March but for another one week you were on buorenorphine patch...so, technically you were completely abstinent from oipioids from 4 or 5 th April. That is now fourth or fifth day of withdrawal.

Ideally withrawal should be done under expert supervision. Usual time frame of withdrawal depends both on duration of drug abuse and on the dosage consumed.
Here, the diarrhoea can last somewhere between 7-10 days maximum. So, you can wait till this time. Continue to take enough water, juices , or liquid in any form to maintain hydration and electroyte balance. There are many electrolyte powders available in market which help a lot. ORS ( oral rehydration solution) can be another good option- available freely..

Immodium should be avoided as diarrhoea is a natural process of withdrawal and will take its own time to settle.. should not be stopped generally.

continue to eat and drink at present...dont worry, this will stop.
If you are scared or feel dehydrated - dry tongue or look weak or pulse or blood pressure goes down- please goto emergency.

We usually prescribe an antacid and pain killer and a good multivitamin for support.

Wish you speedy recovery.
please feel free to ask more questions for clarification.

Dr. Manisha Gopal
MD Neuropsychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Manisha Gopal (1 hour later)

Thank you very much for your thorough response to my questions, Dr. XXXXXXX Unfortunately, during the 24-hour waiting period for your response, I could not tolerate the diarrhea anymore, so a loved one did bring me some Immodium AD. I was doubled over in pain and having to run to the restroom every five minutes. I wanted to eat but even small bites of bread sent me running to the toilet, so I really only ate if I was starving, and even that didn't stop the problem. However, once I took a full 60 mL of Immodium AD, my stomach began to settle down. I also took Emetrol for the dry heaves/nausea but that was only minimally effective. I have been able to get a little more food in my stomach since the diarrhea stopped this morning, after taking the Immodium AD. I just don't think I can bear with that symptom of withdrawal. It is too painful. I'd rather have the dry heaves, pain, fever, shakes, and everything else, but not that. I couldn't take vitamins before because I couldn't get enough food in my stomach to keep them down, but hopefully I will be able to do that soon. I will ask someone to bring me some Gatorade or Powerade for the electrolytes. I still can't eat anything but bread and crackers right now, but at least my body is absorbing them now, more or less. Thank you very much again for your professional response.

Answered by Dr. Manisha Gopal (43 minutes later)

Brief Answer:
its ok, take liquids as sips every few minutes

Detailed Answer:
Hello,

I can understand that repetetive diarrhoea is very difficult and energy drainig ...patients do ask us for anti diarrhoeal drugs often, but best is to avoid them. However, now that you have taken it once and you are somewhat better, its ok. Try not to repeat it.

Gatorade is a good option and so is butter milk, lemon water with some salt and sugar in it..continue to take sips of that evey few minutes ( 2-4 sips every 10-15 min); avoid taking half or full glass at a time as this will give you urine and wont stay in body...so, just frequent sips..
take rest properly and no stress...

You have made a very big decision of your life ..just some more time and courage and you will be off methadone..!!

Good luck and speedy recovery!

please feel free to ask more queries for any clarification.
Dr. Manisha Gopal
MD Neuropsychaitry

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar