Opioids are important, but imperfect, tools to manage chronic pain. Part of their imperfection is due to physical dependence with chronic use that can make getting off opioids such a miserable experience. Remember that physical dependence does not indicate addiction, it simply means that withdrawal symptoms will occur if the medications are stopped abruptly. Withdrawal symptoms can also occur if opioids are tapered too quickly.
Opioid withdrawal symptoms include:
Nausea, vomiting, diarrhea
Sweats, chills, fast heart rate
Anxiety, restlessness, insomnia
Acute withdrawal usually lasts 4-10 days. Some patients experience extended withdrawal symptoms of depression, anxiety and poor focus for several weeks to several months after acute symptoms have subsided. However there are some herbal options that can improve both acute and extended withdrawal symptoms. Discovering CBD, passionflower and corydalis has really revolutionized my medical practice around tapering opioids, and I wish more health care providers and patients knew about these options.
Herbal Options to Lessen Opioid Withdrawal
The three botanical agents that have research supporting their use in opioid withdrawal are CBD, passionflower and corydalis. Clinically I have been so impressed with these herbs that I included them in an herbal tonic designed to use in conjunction with CBD to make tapering opioids easier.
Cannabidiol (CBD), a non-psychoactive component of cannabis, can lower opioid-seeking behavior in physically dependent rats. In this study CBD showed a long-acting effect, with benefits starting at 24 hours after administration and lasting up to two weeks. The behavioral changes were paralleled by brain alterations in the glutamate and endocannabinoid system. The study authors concluded “CBD may be a potential treatment for heroin craving and relapse”. Another rat study found that CBD activated serotonin receptors in the brain that blocked reward mechanisms around opioids.
Passionflower (Passiflora incarnata) is a flowering vine traditionally used for insomnia and anxiety. One study found that passionflower eased the mental symptoms of opiate withdrawal. The authors concluded that “the passiflora plus clonidine group showed a significant superiority over clonidine alone in the management of mental symptoms. These results suggested that passiflora extract may be an effective adjuvant agent in the management of opiate withdrawal.”
Corydalis yanhusuo is one of traditional Chinese medicine’s chief herbs for relieving pain. Its active ingredient l-tetrahydropalmatine was found to improve mood, lessen insomnia and drug cravings, and increase abstinence rates in opioid users.
Of course, talk with your health care provider about your specific case, but here is what I typically do for my patients that I am trying to get off or down to lower dosages of opioids.
Reduce opioid dosage by 5% - 10% every month
Use prescriptions (such as anti-nausea medications) if needed to address any physical symptoms of acute withdrawal
Add CBD 5-30 mg up to four times daily
Add Frida Botanicals Herbal Taper Tonic No. 2 start with 0.5 ml three times daily, and as you taper down on the opioids, slowly increase up to 2ml three times daily.
If coming completely off opioids, continue CBD and Taper Tonic No. 2 for 1-2 months after stopping to lessen any mood disturbance from extended withdrawal.
As I have said many, many times, until we have better tools I strongly believe opioids must stay in the chronic pain toolkit. However I also recognize they are very imperfect medications due to potential risks of addiction and accidental overdose. I advocate for using opioids as safely as possible, which means screening for signs of misuse or addiction, using the lowest effective dosage while maximizing non-opioid treatments. I also think that opioids are best used only as needed for pain flares rather than daily use, as they rapidly become less effective when used that way due to development of tolerance. But my view is atypical, and many pain patients are being forced to drastically lower or come off opioids as a knee-jerk response to the rising rates of opioid overdoses. This has resulted in a new epidemic of undertreated chronic pain, and added the misery of opioid withdrawal to the lives of many chronic pain patients. My hope is that other health care providers will learn about these herbal options that can ease opioid withdrawal symptoms.