OxyContin Detox - Abbeycare

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KEY TAKEAWAYS

OxyContin (oxycodone hydrochloride controlled-release or OXY HCI CR) detox works by:

Administering 2 – 32mg Buprenorphine for 10 – 14 days to mitigate aching muscles, hot flashes, and rebound emotional sensitivity developing within 24 – 72 hours of cessation

Symptomatically treating restless legs and diarrhoea with medication (e.g. 75µg clonidine or 8mg loperamide) as needed

Abbeycare does not use Methadone to treat opioid use disorder (OUD), and withdrawal symptoms (e.g. nausea, sweating, anxiety) are managed with Buprenorphine or Suboxone and symptomatic medications (e.g. 40mg propranolol, 8mg Ondansetron) as needed.

IMPORTANT: Below, we discuss possible approaches that meet the specific detox needs around OxyContin. Not all treatment centres will provide these specific interventions.

For an overview of the Abbeycare programme contents for OxyContin detox, click here.

How Is OxyContin Detox Done?

Using Buprenorphine/Suboxone

Buprenorphine or a 4:1 ratio of Buprenorphine to Naloxone (Suboxone) is used in OxyContin detox because:

Cravings are reduced by 57% within 8 weeks after Buprenorphine displaces full opioid agonists from the mu (μ) receptor due to a binding affinity 120 times higher than Oxycodone’s [1][2]
Administering 2/0.5mg of Suboxone reduces the severity of abdominal cramps, sweating, and piloerection by 48% within 1 hour in patients who withdraw after abusing up to 60mg of tablets daily [5]

Patients are typically inducted using 2 – 8mg Buprenorphine monotherapy 48 hours after last using a long-acting opioid, and then stabilised with up to 32/8 mg Suboxone for 10 – 14 days [3][4].

The Clinical Opiate Withdrawal Scale (COWS) is typically administered every 6 hours during detox, and once symptoms stabilise (COWS score < 5), the current Buprenorphine dose is reduced by 2 - 4 mg daily until discontinued [3][4].

Using Methadone

Methadone may be used to detox from OxyContin as an alternative to Buprenorphine or Suboxone because:

92% of patients also abuse other opioids (e.g. heroin), and a full μ agonist (methadone) is required over a partial μ agonist (buprenorphine) to mitigate severe withdrawal symptoms (COWS > 36) [6]
Methadone can be administered on a short-term (< 30 days) or long-term (30 - 180 days) basis using an initial daily dose (e.g. 20 – 40mg), followed by a maintenance dose (e.g. 60 – 120mg) to suppress drug cravings for 24 - 36 hours at a time [7]

Methadone doses are reduced by 5 –10% every 1–2 weeks once opioid withdrawal symptoms are stabilised, although some patients may be transferred to Buprenorphine once the daily dose reaches 30mg [4][7].

Symptom Management

Symptom management protocols used in OxyContin detoxification include:

75 – 150 μg Clonidine every 6 – 8 hours to manage anxiety and hypertension (BP = 140/90 mmHg) as needed by decreasing systolic and diastolic blood pressure by 21 - 24 mmHg and nervousness by 47% within 2 hours [4][8]
2 - 8mg Loperamide and Ondansetron daily to treat diarrhoea and nausea during the first 1 - 3 days of cessation, alongside 6-hourly COWS assessments to establish the severity of gastrointestinal symptoms (e.g. 2 = nausea or loose stools) [3][4]

OxyContin Detoxification Timeline

	Buprenorphine /Suboxone	Methadone
Timeframe of first use	48 hours after last use	8+ hours after last use
Dose	2 - 32mg or 2/0.5 - 32/8mg daily	20 - 120mg
Dosing Schedule	Day 1: 2mg + 6mg if symptoms persist after 1 hour Typically stabilised on 12-24mg or 12/3 - 16/4mg daily until COWS score < 5 [4]	Day 1: 20 – 30mg + 5 - 10mg if symptoms persist after 2 - 4 hours Maintenance dose = 60 - 120mg daily [7].
Detox Duration	10 - 14 days + 3 - 6 days for Buprenorphine taper [4]	30 - 180 days
Effective in treating withdrawal symptoms?	Yes, 2mg reduces sweating, chills, and stomach cramps by 48% within 60 mins [5]	Yes, daily treatment reduces anxiety and dysphoria by 25 - 33% within 14 days [9]
Ideal patient for this medication	Daily abuser experiencing moderate withdrawal symptoms (e.g. COWS = 13 - 24)	Abuser of OxyContin + other opioids (e.g. heroin) with severe symptoms (COWS >36)

	Tapering OxyContin
Timeframe of first use	24 hours after the last use
Dose	Daily dose is tapered until 0mg is reached
Dosing Schedule	Gradual taper = reduced by 5 - 20% monthly Fast taper (< 3 months use) = reduced by 10 - 25% weekly [10]
Detox Duration	6+ months (depending on starting dose)
Effective in treating withdrawal symptoms?	No, requires symptomatic medication (e.g. 8mg loperamide) and ongoing monitoring
Ideal patient for this medication	Taking OxyContin as prescribed, no polydrug use or mental instability

Physical Symptoms Of OxyContin Withdrawal

Prolonged Withdrawal Duration

Prolonged withdrawal duration is a physical symptom of detoxing from OxyContin because the drug's 12-hour extended release mechanism and elimination half-life (t½) of 6.5 hours lead to [11]:

A delay in the onset of withdrawal symptoms (e.g. dilated pupils) to 24 – 72 hours after last use, compared to 6 – 12 hours for immediate release (IR) oxycodone due to a shorter duration of action (4 – 6 hours) and elimination half-life (t½ = 3 hours) [4][11]
A peak in symptom severity during days 3 – 8 of detox and a 2-3-week average withdrawal duration, whereas symptoms (e.g. diarrhoea) peak after 36 – 72 hours of cessation from short-acting opioids (e.g. heroin) and typically last 5 – 10 days [4][11]

Deep Muscle Aches

Deep muscle aches are a physical symptom of discontinuing OxyContin because:

Somatic pain originating from the skin and deeper tissues (e.g. joints, muscles) is no longer suppressed due to the deactivation of μ receptors during abstinence, leading to diffuse body pain within 24 - 72 hours of cessation [4].
OxyContin reduces pain intensity by 39% for up to 12 hours at a time, whereas Oxycodone has a weaker effect (e.g. 21% for 4 - 6 hours), leading to a stronger rebound of previously inhibited pain signals that exacerbate aching muscles during cessation [12]

Quattlebaum et al. (2021) studied a woman with "pain all over” (intensity rating = 6/10) during a medically supervised OxyContin withdrawal after initially receiving a prescription and abusing pills bought from friends to manage chronic shoulder and neck pain [5].

COWS is used daily to evaluate the severity of muscle pain during detox (e.g. 4 = rubbing muscles/joints + unable to sit still due to discomfort) because somatic pain is exacerbated by a 31% reduction in pain tolerance within 7 - 14 days of opioid cessation [13].

Alternating Chills And Hot Flashes

Alternating chills and hot flashes are a physical symptom of detoxing from OxyContin because the deactivation of μ receptors induces hyperthermia (> 38°C) during cessation to compensate for periods of hypothermia (< 35°C) during intoxication, leading to:

Impaired thermoregulatory responses (e.g. sweating, shivering) due to autonomic hyperactivity during withdrawal as the hypothalamus attempts to restore the body’s core temperature (37°C)
Sweating, piloerection, and up to 1 week of chills “from head to toe”, as some patients claim “Your body cannot regulate its body temperature at all. It’s impossible going hot to cold.” [4][14]
Lying in bed whilst shaking due to cold chills and sweating, applying ice and heat packs for 1 – 2 hours at a time, and having 3 – 4 hot showers a day to cope with impaired thermoregulation after abstaining from heavy use (e.g. 320mg daily) [14]

The Subjective Opioid Withdrawal Scale (SOWS) is used to gauge the severity of thermoregulatory dysfunction by asking OUD patients to score statements (e.g. “I have goose flesh” or “I am perspiring”) using a 5-point scale (e.g. 0 = not at all vs 4 = extremely) [4].

Psychological Symptoms Of OxyContin Withdrawal

Anxiety, Depression, And Mood Fluctuations

Depression is a psychological symptom that occurs in up to 66% of patients during OxyContin cessation after 12 months of daily use because dopamine is no longer increased by 88% after the μ receptors are deactivated by abstinence [15][16].

Anxiety and depression typically emerge within 3 days of discontinuing controlled-release OXY HCI tablets and are likely to be intensified in 51% of patients who have pre-existing symptoms (e.g. low mood) before entering treatment because [4][6]:

10 - 80mg tablets are typically abused ≥ 3 times weekly for 1 – 9 years, and using prescription opioids for > 180 days increases the risk of depression by 50% due to striatal dopamine imbalances [6][17]
OXY HCI CR users are more likely to experience anxiety (14% vs 8%) or a major depressive episode (22% vs 16%), and require mental health treatment (23% vs 18%) within 12 months compared to users of IR opioid analgesics (e.g. codeine) [18]

Quattlebaum et al. (2021) found that the severity of anxiety symptoms (e.g. intermittent chest pains, irritability, restlessness) decreased by 48% within 24 hours of receiving clonidine and 20mg Buprenorphine during addiction treatment for OXY-HCI CR dependence [5].

Rebound Emotional Sensitivity

Rebound emotional sensitivity is a psychological symptom that occurs during the detox process for OxyContin because:

Glutamate receptors (e.g. GluA1-3, GluN2a-c) are upregulated for around 31 days after abstaining from Oxycodone-based drugs due to the loss of μ-receptor stimulation [19]
Irritability and anxiety are heightened within the first 72 hours of withdrawal because excitatory neurotransmission in brain regions (e.g. amygdala) responsible for emotional processing is no longer suppressed by taking 60mg tablets every day [4][5]
Psychological withdrawal symptoms (e.g. extreme restlessness) are exacerbated by a 60% increase in emotional distress after abusing oxycodone-based drugs daily for up to 9 years [20]

Obsessive Fear Of Original Pain Returning

Obsessive fear of original pain returning is a psychological symptom of detoxing from oxycodone hydrochloride CR caused by anxiety sensitivity (ASI-3 score = 39) and catastrophic thinking in relation to pain (PCS score = 43) after abstaining, resulting in [21]:

Some patients feeling unable to cope without taking a daily dose of 80 - 400mg that was initially prescribed to reduce the intensity of lower back pain by 39% within 10 days of administration [12]
Excessive worrying, rumination, magnification, and helplessness, e.g. “I worry that something serious may happen” or “When I feel pain in my chest, I worry that I’m going to have a heart attack.”

22% of patients addicted to OXY HCI CR are initially prescribed the drug for chronic pain and typically experience more anxiety during withdrawal than patients without pain (e.g. STAI scores = 37 vs 35) due to fear of initial pain returning after discontinuation [6][22]:

“It terrified me to come off opiates, and that fear would stop people from getting off of it because it’s almost unfathomable to think that the pain could even go away because it’s so chronic.”
“I thought it was arthritis, I thought it was degenerative something or other that had come on and come on strong.” - a 34-year-old whose “throbbing” and “aching” deep tissue pain in the right knee returned after detoxing from Oxycodone [23]

Positive Signs Of Detoxing From Oxycodone Hydrochloride Controlled-Release

Reduction In Pain Sensitivity

A 58% decrease in pain scores is a positive sign of OXY HCI CR recovery because opioid-induced hyperalgesia gradually resolves within 9 days of abstaining from taking 1200mg tablets daily due to the recovery of the endogenous opioid system [13][24].

Rieb et al. (2018) found that a 34-year-old woman who previously abused 150mg OXY-HCI tablets daily was pain-free 7 months after initially experiencing intense pain (8/10) during the first 30 days of cessation, and moderate pain (4/10) in the following 14 days [23].

Mall (2018) found that ex-OxyContin users experienced pain sensitivity for around 2 weeks after the last heavy use (320mg), and some patients felt that taking NSAIDs every 4 - 6 hours provided relief for body pains, aches, and inflammation during withdrawal:

“You hurt so bad you can feel your hair hurting, so bad that initially, the first couple of days, I'll throw up. My bones would hurt in my legs, and if I put a shirt on or something, it would hurt”
“The first like three days would be the worst, and then it would subside a little bit. The lower back is where it always hurts, and the legs are the worst. All of your joints hurt”
“I had not been feeling any normal aches and pains, and so those were going to seem worse. You can take ibuprofen to make your joints feel better. You are going to feel bad, but sticking it out is so worth it.” [14]

Stabilisation Of Late Onset Withdrawal Symptoms

A 48% decrease in diffuse body pain, restless legs, sweating, chills, and abdominal cramping is a positive sign of OXY HCI CR recovery because 2mg Buprenorphine is used to change COWS scores from 25 (moderately severe) to 13 (moderate) within 24 hours [5].

Late onset symptoms of withdrawal (e.g. nasal stuffiness or unusually moist eyes, frequent shifting or extraneous movements of legs/arms) typically stabilise within 2 weeks of receiving up to 32/8 Suboxone daily during OUD addiction treatment [4]:

“You kind of start feeling achy and have a runny nose. The restlessness doesn't let you sit still. The only thing that really has helped was the Suboxone”
“Really intense withdrawals lasted about a week, and then getting my appetite back, not having diarrhoea, not throwing up, leg cramps probably lasted about 10 days to two weeks. About two weeks to get where you feel okay.” [14]

Murata et al. (2021) found that one patient no longer had dilated pupils (5mm), tearfulness, loose stools, and chest pains within 48 hours of taking 20/5mg Suboxone during treatment after previously abusing 60mg of extended-release oxycodone tablets daily [5].

Reduction In Anxiety

A 48% reduction in emotional distress within 8 weeks is a positive sign of OXY HCI CR recovery because anxiety and excessive worrying diminish once GluA1-3 and GluN2a-c activity stabilise after being upregulated during the first 30 days of abstinence [2][19].

Katt et al. (2012) found that symptoms of anxiety (e.g. restlessness, irritability) decreased by 48% within 1 month of receiving 4 – 16mg Suboxone during treatment in patients who previously abused up to 240mg of OXY HCI CR tablets daily for 4 years [25].

Catastrophic thinking decreases by 18% within 11 days of abstaining from prescription painkillers because 0.4mg clonidine is administered daily during treatment to control anxiety, shakiness, and chest pains experienced by up to 51% after 5 years of use [26].

Alcohol And OxyContin Addiction Altering Detox Protocols

Being addicted to alcohol and Oxycodone hydrochloride controlled-release tablets changes addiction treatment because:

Alcohol withdrawal symptoms (e.g. tremors, hallucinations) begin 6 – 24 hours after last drinking, compared to 24 – 72 hours for OXY HCI CR and typically peak after 1 – 2 days rather than 3 – 8 days of cessation [3]
300mg daily doses of thiamine may be required for 1 – 2 weeks to mitigate the 14-fold increased risk of developing Wernicke’s Encephalopathy in 69% of patients who abuse CR oxycodone ≥ 3 times weekly and heavily drink (e.g. >6 drinks daily) [3][6][27]
The Clinical Institute Withdrawal Assessment for Alcohol is required alongside COWS to assess withdrawal severity (e.g. severe = CIWA-Ar > 20 vs COWS > 36) and adjust monitoring frequencies accordingly (e.g. severe = hourly vs mild = 4 – 6 hourly) [3]

Medication regimes are developed on a case-by-case basis for patients addicted to prescription painkillers and alcohol because taking benzodiazepines (e.g. diazepam) and opioids (e.g. buprenorphine) increases the risk of respiratory depression by 4-fold [28]:

Buprenorphine is administered 48 hours after the last use of opioids to manage overlapping symptoms (e.g. stomach cramps) when a fixed-dose tapering or symptom-triggered diazepam regimen is not required for mild alcohol withdrawal (AWS < 4) [3][4]
Up to 80mg of Diazepam (max 7 days) is provided as an alternative to opioid substitution therapy (e.g. buprenorphine, methadone) to prevent/treat delirium tremens within the first 5 days of moderate to severe alcohol withdrawal (e.g. AWS > 4) [3]
Both are administered at the lowest dose for the shortest duration of time possible (e.g. 2mg Buprenorphine + 2mg Diazepam for 5 days) with up to 14 days of ongoing monitoring for signs of respiratory depression when AWS > 14 and COWS > 36) [29]

Neuropathic Pain Altering Oxycodone Hydrochloride Controlled-Release Detox Protocols

Neuropathic pain changes treatment protocols because OXY HCI CR doses are rapidly titrated (e.g. +50% in 12-hour intervals) because the desensitisation of dorsal horn μ-opioid receptors after nerve injury reduces opioid efficacy (e.g. < 20% reduction in pain intensity), leading to [30][31]:

Higher doses (e.g. 1200mg vs 320mg daily) of OXY HCI CR compared to non-nerve pain patients, requiring a 5 – 20% 4-weekly taper to mitigate severe symptoms of withdrawal (COWS > 36), lasting up to 6 months rather than 14 days [24][14][10]
Assessments using the Neuropathic Pain Questionnaire (NPQ) to establish the severity of burning, stabbing, or electric shock-like sensations whilst liaising with GPs or neurologists about the use of non-opioid medications for pain relief (e.g. venlafaxine)

Neuropathic pain patients have higher rates (67% vs 58%) of moderate to severe pain (intensity ≥4/10) compared to nociceptive pain patients, and the rebound of numbness, tingling, or throbbing during cessation changes OUD treatment because [32]:

Intense pain during recovery is associated with a 4-fold increase in opioid cravings and a 3-fold increased risk of relapse within 6 weeks, requiring higher buprenorphine doses (e.g. 32mg) to reduce cravings by up to 57% in 2 months [2][22]
Antidepressants (e.g. 50mg sertraline) are required in some cases to address the 33% increase in depressive symptoms (e.g. hopelessness, low energy, suicidal ideation) experienced by patients with pain (>4/10) during opioid withdrawal [22]

OxyContin Detox At Abbeycare

A detox for OxyContin at Abbeycare is:

Typically, a 14-day process that involves medically managing withdrawal symptoms (e.g. chills) using Buprenorphine or Suboxone during a 4-week rehab programme, although medication schedules are established on a case-by-case basis
Conducted by medical professionals (nurses, physicians, addiction specialists) in a calm environment, as patients reside in the detox wing for the first 7 days of treatment to be regularly monitored (e.g. every 30 minutes) during the first stage of recovery
All medication regimens are prescribed by medical professionals
Symptomatically treated using medications such as 100 µg clonidine, 8mg ondansetron, or 16mg loperamide as needed to manage restlessness, sweating, nausea, and diarrhoea developing 1 – 3 days after discontinuing Oxycodone hydrochloride CR

References

[1] Volpe, Donna A., et al. “Uniform Assessment and Ranking of Opioid Mu Receptor Binding Constants for Selected Opioid Drugs.” Regulatory Toxicology and Pharmacology, vol. 59, no. 3, Apr. 2011, pp. 385–90. Accessed 24 June 2025.“Table 2.”
[2] Kang, Jung Hun, et al. “Efficacy of Transdermal Buprenorphine Patch for Managing Withdrawal Symptoms in Patients with Cancer Physically Dependent on Prescription Opioids.” The Oncologist, vol. 29, no. 11, Oxford University Press (OUP), July 2024, pp. 1593–603. Accessed 24 June 2025.“The mean COWS score reduced from 5.5 to 2.8 (P < .001, Figure 4C), indicating the successful management of withdrawal symptoms. The mean NRS score for the desire to use opioids decreased from 7.0 to 3.0 (P < .001, Figure 4D), indicating reduced craving for opioids among the participants.”
[3] NSW Ministry of Health. Management of Withdrawal from Alcohol and Other Drugs Clinical Guidance. Aug. 2022. Accessed 24 June 2025. “Buprenorphine may precipitate withdrawal in an opioid dependent person who has used short acting opioids (e.g. heroin) in the previous 12-24 hours or long acting opioids (e.g. methadone) in the previous 48 hours or longer."
[4] Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. 2004. Accessed 24 June 2025.“Figure 4-1 - 4-5.”
[5] Quattlebaum, Thomas H. N., et al. “A Case of Buprenorphine-Precipitated Withdrawal Managed with High-Dose Buprenorphine.” Family Practice, vol. 39, no. 2, June 2021, pp. 292–94. Accessed 24 June 2025.“The patient reported sweating, chills, diffuse body pains, abdominal cramping, loose stools, restless legs and intermittent chest pain that she attributes to anxiety and depression. Her corresponding COWS was 25, ... Our team gave the patient 2–0.5 mg of buprenorphine-naloxone after discussing her case with an addiction specialist. One hour later, the patient’s COWS score improved to 13.”
[6] Carise, Deni, et al. “Prescription OxyContin Abuse among Patients Entering Addiction Treatment.” American Journal of Psychiatry, vol. 164, no. 11, Nov. 2007, pp. 1750–56. Accessed 24 June 2025.."Ninety-two percent (N=1,242) of individuals categorized as “users” of OxyContin reported using the medication with one or more other opioid.”
[7] Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series 43. 2005. Accessed 24 June 2025.“Regulations specify two kinds of detoxification with methadone: short-term treatment of less than 30 days and long-term treatment of 30 to 180 days, ... methadone suppresses withdrawal and drug craving for 24 to 36 hours in most patients who are opioid addicted.”
[8] Kleber, H. D., et al. “The Use of Clonidine in Detoxification from Opiates.” PubMed, vol. 32, no. 2, National Institutes of Health, Jan. 1980, pp. 1–10. Accessed 24 June 2025.“Systolic blood pressure was significantly reduced ( P<.01) from a pre-treatment mean of 128.5 ± 3.6 to 104.4 ± 4.0 mm Hg, as was diastolic blood pressure which decreased from a pre-treatment mean of 88.6 ± 3.7 to 67.4 ± 3.2 mm Hg at 120 minutes after clonidine administration, ... there were significant ( P<.01) decreases in self-rated nervousness (59.5 ± 2.5 sem to 32.0 ± 2.0 sem at 120 minutes) and irritability (51.5 ± 2.5 to 27.5 ± 2.3 sem at 120 minutes).”
[9] Salehi, M., et al. “Tramadol versus Methadone for the Management of Acute Opioid Withdrawal: An Add-on Study.” Directory of Open Access Journals, July 2006. Accessed 25 June 2025.“Table 2.”
[10] Therapeutic Goods Administration (TGA) . Clinician Information Sheet on Opioid Analgesic Tapering: Summary. 2 Oct. 2020. Accessed 25 June 2025.“When stabilised, the opioid analgesic dose should be reduced slowly by 5 to 20% oMEDD each month, ... If tapering after a short (< 3 month) period of opioid analgesic treatment or opioid analgesic trial, reduce dose by 10 to 25% oMEDD every week.”
[11] Therapeutic Goods Administration (TGA) . PRODUCT INFORMATION OxyContin ® Tablets (5 Mg, 10 Mg, 15 Mg, 20 Mg, 30 Mg, 40 Mg and 80 Mg). 25 Nov. 2010. Accessed 25 June 2025.”The absorption of oxycodone from OxyContin tablets is biphasic, with an initial absorption of approximately 40% of the active drug (TΩ = 0.6 hrs) providing onset of analgesia within 1 hour in most patients, followed by a more controlled absorption, which determines the 12 hour duration of action (TΩ = 6.2 hrs). The mean apparent half-life of OxyContin tablets is 6.5 hours and steady-state is achieved in about one day.”
[12] Salzman, Robert T., et al. “Can a Controlled-Release Oral Dose Form of Oxycodone Be Used as Readily as an Immediate-Release Form for the Purpose of Titrating to Stable Pain Control?” Journal of Pain and Symptom Management, vol. 18, no. 4, Oct. 1999, pp. 271–79. Accessed 27 June 2025.“Table 4.”
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[14] Mall, Eliza. The Lived Experiences of Opioid Withdrawal: A Phenomenological Study. 2018. Accessed 26 June 2025.“Then I got introduced to OxyContin, and I got hooked pretty much instantly and got up to like 320 mg a day, ... . You just want to lay in bed while you are shaking and the cold chills, but you are sweating.”
[15] Mannes, Zachary L., et al. “Prevalence and Correlates of DSM-5 Opioid Withdrawal Syndrome in U.S. Adults with Non-Medical Use of Prescription Opioids: Results from a National Sample.” The American Journal of Drug and Alcohol Abuse, vol. 49, no. 6, Taylor & Francis, Nov. 2023, pp. 799–808. Accessed 30 June 2025.“Table 1.”
[16] Yuen, Jason, et al. “Oxycodone-Induced Dopaminergic and Respiratory Effects Are Modulated by Deep Brain Stimulation.” Frontiers in Pharmacology, vol. 14, Frontiers Media, June 2023. Accessed 30 June 2025.“Oxycodone rapidly increased tonic dopamine levels within 10 min from 157.7 ± 41.4 nM to 296.9 ± 82.8 nM, ... this robust oxycodone-induced increase in NAcc dopamine concentration was associated with a sharp reduction in respiratory rate (111.7 ± 2.6 min−1 vs. 67.9 ± 8.3 min−1; pre- vs. post-oxycodone; p < 0.001).”
[17] Scherrer, Jeffrey F., et al. “Prescription Opioid Analgesics Increase the Risk of Depression.” Journal of General Internal Medicine, vol. 29, no. 3, Oct. 2013, pp. 491–99. Accessed 30 June 2025.“We observed that longer duration of opioid prescription was associated with increased risk of development of depression. Patients using for 90– 180 days had a 25 % increased risk of depression, and those using for more than 180 days had a more than a 50% increased risk.”
[18] Martins, Silvia S., et al. “Correlates of Extramedical Use of OxyContin® versus Other Analgesic Opioids among the US General Population.” Drug and Alcohol Dependence, vol. 99, no. 1-3, Jan. 2009, pp. 58–67. Accessed 30 June 2025.“Table 2-3.”
[19] Salisbury, Aaron J., et al. “Prolonged Withdrawal from Escalated Oxycodone Is Associated with Increased Expression of Glutamate Receptors in the Rat Hippocampus.” Frontiers in Neuroscience, vol. 14, Frontiers Media SA, Jan. 2021. Accessed 30 June 2025." GluA1 mRNA expression was significantly upregulated [F(3, 30) = 3.730, p = 0.0217] (Figure 2B) in the LgA-H group compared to the ShA group and saline controls at 31 days. GluA2 mRNA expression also showed significant increases [F(3, 30) = 7.685, p = 0.0006] (Figure 2E) in both LgA groups compared to the ShA group and saline controls at 31 days."
[20] Hudak, Justin, et al. “Neurophysiological Deficits during Reappraisal of Negative Emotional Stimuli in Opioid Misuse.” Biological Psychiatry, vol. 91, no. 12, June 2022, pp. 1070–78. Accessed 30 June 2025.“Table 1.”
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[22] Tsui, Judith I., et al. “Chronic Pain, Craving, and Illicit Opioid Use among Patients Receiving Opioid Agonist Therapy.” Drug and Alcohol Dependence, vol. 166, Sept. 2016, pp. 26–31. Accessed 1 July 2025.“Table 1.”
[23] Rieb, Launette Marie, et al. “Linking Opioid-Induced Hyperalgesia and Withdrawal-Associated Injury Site Pain: A Case Report.” PAIN Reports, vol. 3, no. 3, May 2018. Accessed 30 June 2025.“Table 1.”
[24] Baron, MD, MPH, Michael J., and Paul W. McDonald, PhD. “Significant Pain Reduction in Chronic Pain Patients after Detoxification from High-Dose Opioids.” Journal of Opioid Management, vol. 2, no. 5, Sept. 2006, p. 277. Accessed 1 July 2025.“All patients were grouped and their pre- and post-pain reports were compared using the NRS. Patients’ mean pain scores prerehabilitation were 8.00 ± 0.30 (N = 23) compared to a post-treatment report of 3.35 ± 0.33 (N= 23).”
[25] Katt, Mae, et al. “Feasibility and Outcomes of a Community-Based Taper-To-Low- Dose-Maintenance Suboxone Treatment Program for Prescription Opioid Dependence in a Remote First Nations Community in Northern Ontario.” International Journal of Indigenous Health, vol. 9, no. 1, June 2013, p. 52. Accessed 2 July 2025.“Table 2.”
[26] Drossman, Douglas A., et al. “Diagnosis, Characterization, and 3-Month Outcome after Detoxification of 39 Patients with Narcotic Bowel Syndrome.” The American Journal of GASTROENTEROLOGY, vol. 107, no. 9, Sept. 2012, pp. 1426–40. Accessed 1 July 2025.“There was significant decrease (improvement) in the catastrophizing coping score (before: 19.9±8.6, after:16.4±8.3, P = 0.025), ... The detoxification duration is between 4 and 11 days.”
[27] Rasiah, Roshaani, et al. “Hospital Outcomes in Medical Patients with Alcohol-Related and Non–Alcohol-Related Wernicke Encephalopathy.” Mayo Clinic Proceedings. Elsevier., vol. 99, no. 5, Dec. 2023, pp. 740–53. Accessed 2 July 2025.“Table 2.”
[28] Boon, Martijn, et al. “Combining Opioids and Benzodiazepines: Effects on Mortality and Severe Adverse Respiratory Events.” Annals of Palliative Medicine, vol. 9, no. 2, Mar. 2020, pp. 542–57. Accessed 2 July 2025.“Figure 4.”
[29] Medicines and Healthcare products Regulatory Agency. Benzodiazepines and Opioids: Reminder of Risk of Potentially Fatal Respiratory Depression. 18 Mar. 2020. Accessed 2 July 2025.“If co-prescribing of these drugs is considered necessary, the lowest effective doses should be used and for the shortest duration. Monitoring should continue for at least 2 weeks following initiation or changes to prescribing.”
[30] Xiao, Xiaoguang, et al. “Patient-Controlled Subcutaneous Analgesia with Hydromorphone versus Oral Oxycontin for Opioid Titration of Cancer Pain: A Prospective Multicenter Randomized Trial.” Journal of Pain Research, vol. 17, Dove Medical Press, Apr. 2024, pp. 1441–51. Accessed 2 July 2025.“The dose of oxycontin tablets was increased by 50–100% if the NRS >3 or the frequency of Btp >3 at 12 hours after the titration.”
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About the author

Mischa Ezekpo

Mischa Ezekpo has a Bachelors degree in Psychology from Northumbria
University, and a Masters degree in Childhood Development and
Wellbeing, from Manchester Metropolitan University. Since 2018, Mischa
has written and published work on Addiction, Mental Health, Depression, and Eating Disorders. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: February 20, 2026