I. The Basics of Painkiller Rehabilitation

This guide was written to provide an overview of the painkiller rehabilitation process as well as to offer helpful resources for persons recovering from painkiller addiction.

Suddenly stopping painkiller use is rarely a realistic first step in the recovery process. Many people abusing painkillers must gradually reduce their use in a process called tapering to avoid severe, potentially dangerous withdrawal symptoms. The appropriate time frame for opioid tapering varies by person and the medication(s) being abused. Even with tapering, painful withdrawal symptoms may occur. Withdrawal is part of the detox process and why medication-assisted treatment is often recommended from the start. Detoxification isn’t the same as treatment and isn’t sufficient on its own to help someone recover from painkiller addiction.

Behavioral therapy and/or counseling must be combined with pharmaceutical treatments as part of the recovery process. Therapy/counseling may be delivered individually and in group formats. A residential painkiller use disorder treatment program is routinely recommended for severe or long-term abuse. Opioid addiction is a complex health condition that often requires long-term treatment, which may include extensive outpatient counseling and self-help groups like Narcotics Anonymous or SMART Recovery.

Description of the Four Steps of the Rehab Process

For more information, read our guide to the rehab process.

What Makes Painkiller Rehabilitation Difficult?

Opioid-based prescription painkillers are Schedule II (2) controlled substances because they’re considered narcotics with a high potential for abuse but approved for medical uses. Schedule II substances include oxycodone, hydrocodone, fentanyl, codeine, morphine, hydromorphone, meperidine, and methadone. An estimated 53 million people aged 15-64 worldwide, or 1.1% of the global population, used opioids at least once in 2017, with about half using heroin and opium. The highest prevalence of nonmedical opioid use occurred in North America, with nearly 4% of the populations aged 15-64 misusing these drugs. Pharmaceutical opioids, including hydrocodone, oxycodone, codeine, and tramadol, were the primary concern. Opioids use in Australia and New Zealand was much higher than the global average, with prevalence also high in Asia.

Someone suffering from pain reliever use disorder becomes physically dependent and may continue using painkillers despite their commitment to stop. Fear of experiencing severe withdrawal symptoms may be a substantial block to quitting use, as well as fear of the pain returning. Slowly tapering use may help deter or dampen withdrawal symptoms, and admission to a detox program may be necessary. The chronic, neurobiological disease associated with opioid abuse can cause intense drug cravings and frequent relapse. The presence of a psychiatric disorder, such as depression, can significantly hinder treatment and its effectiveness if not adequately addressed. It can also increase the risk of suicide during the struggle to overcome addiction.

The Unique Struggle of Painkiller Addicts
Painkillers…
  • create euphoric feelings that increase the likelihood of addiction
  • containing opioids may cause changes in the brain and make it harder to quit
  • can cause severe withdrawal symptoms when stopped abruptly
  • may require slow tapering to prevent severe withdrawal symptoms
  • can cause withdrawal symptoms can be very uncomfortable and lead to relapse
  • combined with psychiatric disorders like depression can hinder treatment effectiveness and increase the risk of suicide

Painkiller Rehabilitation Statistics

Opiates Treatment Admissions by Gender

52.7% Male
47.3% Female

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates:

  • 9,948,000 people ages 12 or older – 3.6% of the population – misused pain relievers in 2018
    • Hydrocodone: 5,502,000 – 2%
    • Oxycodone: 3,374,000 – 1.2%
    • Tramadol: 1,455,000 – 0.5%
    • Codeine: 2,393,000 – 0.9%
    • Morphine: 486,000 – 0.2%
    • Fentanyl: 269,000 – 0.1%
    • Buprenorphine: 718,000 – 0.3%
    • Oxymorphone: 237,000 – 0.1%
    • Demerol: 54,000 – 0.0%
    • Hydromorphone: 229,000 – 0.1%
    • Methadone: 256,000 – 0.1%
    • All other prescription pain relievers: 788,000 – 0.3%
  • 1,694,000 people ages 12 or older – 0.6% of the population – had a pain reliever use disorder in 2018
  • 735,000 people ages 12 or older – 19.7% of those requiring treatment – received pain reliever use treatment in 2018

Demographics of Individuals Seeking Treatment for Painkiller Addiction

According to the 2017 SAMHSA report that charts admissions to and discharges from publicly funded substance use treatment facilities, men are more likely to seek treatment for opiate abuse, which includes prescription painkillers containing opioids. The gender breakdown of treatment admissions for opiates was 52.7% male and 47.3% female. While painkiller addiction occurs in all age groups, the most common age group admitted to a treatment facility for opiates use was individuals aged 25-34, with 35 being the average age of individuals from all age groups seeking rehabilitation.

Opiates Treatment Admissions Percentages by Age Group, 2017
Age at the Time of Treatment Admission Percentage of Treatment Admissions for Other Opiates (not including Heroin)
12-17 .4%
18-24 10.4%
25 – 34 44.9%
35 – 44 25.4%
45-54 12.1%
55-64 5.9%
65+ 0.9%

II. Painkiller Detoxification & Withdrawal Process

Detoxification is the body’s way of removing a harmful substance, which occurs after a person stops using the substance. If a person is tapering off opioid-based painkillers, they experience an ongoing detox process as they slowly withdraw from the drug. Even with tapering, a person may experience withdrawal symptoms, but withdrawal symptoms begin quickly and are more severe without tapering. The length and severity of withdrawal symptoms vary based on the painkiller(s) used, daily intake, frequency of doses, and how long the drug(s) were being abused. It can take days or sometimes weeks for withdrawal symptoms to subside. Opioid withdrawal can be dangerous, so it should only be done under a doctor’s care.

Everyone experiences painkiller withdrawal differently, and it further varies if more than one painkiller is being misused. The half-life of the drug(s) used and a person’s mental and physical health can impact how soon symptoms appear. A doctor may prescribe certain medications to help a person get through withdrawal.

Withdrawal Symptoms

Body Mind
Short-Term Symptoms Muscle aches
Watery eyes
Runny nose
Excessive sweating
Frequent yawning
Agitation
Anxiety
Insomnia
Long-Term Symptoms Abdominal cramping
Diarrhea
Nausea
Vomiting
Appetite loss
Dilated pupils
Tremors
Sweating
Chills alternating with hot flashes
Rapid heartbeat
High blood pressure
Muscle, joint, and bone pain
Drug cravings
Restlessness
Irritability
Severe depression

Rapid tapering or sudden discontinuation of painkillers is dangerous

The Department of Health and Human Services doesn’t recommend sudden reduction or discontinuation of opioids unless there’s some indication of a life-threatening issue, such as warning signs of a probable overdose. Physically dependent individuals who rapidly taper or suddenly quit taking opioid-based painkillers risk severe withdrawal symptoms, heightened pain, serious psychological distress, and suicidal thoughts.

Painkiller withdrawal can increase the risk of suicide

Studies have shown that some people are at greater risk of suicide after stopping opioids regardless of how long they took them. However, this risk increases the longer the person was taking opioids before they stopped. Furthermore, it takes between three and 12 months before this risk decreases.

Detox during painkiller withdrawal increases accidental overdose risk

The biggest complication surrounding painkiller withdrawal is going back to drug use. During withdrawal, an individual’s body goes through detox, meaning it’s getting rid of the drugs, and tolerance decreases. Most painkiller overdose deaths occur shortly after someone has detoxed and relapses. Typically, a person who relapses takes the same amount they did before detox, but now it’s too much for the body to handle, and overdose is likely.

Painkiller Detoxification Medications

The Food and Drug Administration approves medications for medication-assisted treatment (MAT) of opioid use disorders with treatment programs tailored to meet a person’s unique needs. Buprenorphine, methadone, and naltrexone may be used to treat oxycodone, hydrocodone, codeine, and morphine use disorders. Doctors may prescribe these medications to block the euphoric effects of opioids, normalize brain chemistry, relieve painkiller cravings, and reduce withdrawal symptoms. Clonidine or lofexidine may also be prescribed for medically supervised withdrawal. Each of these medications is effective when taken appropriately.

For more information about withdrawal, read our guide on Painkiller Addiction.

 

III. Treatment for Painkiller Addiction

Painkiller addiction affects brain function and behavior, but it’s a treatable disease. Although no single treatment is right for everyone, counseling and behavioral therapies combined with medication-assisted treatment are effective at treating opioid-based painkiller use disorder and may even help some people maintain recovery. Buprenorphine, methadone, and naltrexone have proved to be safe and effective in combination with counseling and psychosocial support for the treatment of opioid dependence.

Rehabilitation Settings

Within either an inpatient or outpatient setting, treatments such as detoxification services, behavioral therapies, and medication-assisted treatments are offered for varying lengths of time.

Inpatient treatment involves living full-time (including overnight) at a treatment facility for a set period of time. Outpatient treatment involves scheduled appointments at a facility in which you are free to come and go. Within each category, there are several distinctions.

Painkiller Treatment Programs
Setting Type of Treatment Description Duration Time Commitment
Inpatient Short-Term Residential Intensive treatment, sometimes in a hospital setting. Therapies offered are extensive. Medication-assisted treatment is available to those who qualify. 14-30 days Hours Per Day:
24
Days Per Week:
7
Long-Term Residential Intensive treatment in a non-hospital setting, most often a therapeutic community with other patients. Therapies offered are extensive. Medication-assisted treatment is available to those who qualify. 3-12 months Hours Per Day:
24
Days Per Week:
7
Partial Hospitalization Intensive treatment in a hospital setting. Patients do not stay overnight. Considered inpatient due to the hospital setting. Extensive services are provided and require a near full-time commitment every week. Medication-assisted treatment is available to those who qualify. 14-30 days Hours Per Day:
6-8
Days Per Week:
5
Outpatient Intensive Day Treatment Extensive services of an inpatient program but patients return home each day following treatment. After completion, patients often transition to less intensive counseling. Therapies offered are extensive. Medication-assisted treatment is available to those who qualify. 3-4 months Hours Per Day:
2-4
Days Per Week:
3
Counseling Both individual counseling and group counseling focus on short-term behavioral goals to develop coping strategies. Therapies offered are moderate. Medication-assisted treatment is not available. As long as desired Hours Per Day:
1-2
Days Per Week:
1-3
Support Groups Self-help groups center on maintaining abstinence after another form of treatment. Typically meet one day a week for 1-2 hours. As long as desired Hours Per Day:
1-2
Days Per Week:
1

Behavioral and Medication-Assisted Therapies

Behavioral therapy for substance addiction seeks to identify and manage addictive behaviors that lead to use and prevent relapse. Behavioral therapy is based on the concept that all behavior is learned, and, thus, unhealthy behavior can be changed through learning coping skills and increasing awareness of negative thoughts and beliefs that contribute to substance abuse.

Buprenorphine and methadone target the same areas of the brain as opioids to suppress withdrawal symptoms and reduce cravings. Naltrexone blocks the effects of opioids but should only be used after a person has detoxed. All three medications help reduce drug-seeking behavior and help individuals become more open to behavioral therapies.

Behavioral Therapies for Librium Addiction
Type of Therapy Definition
Cognitive Behavioral Therapy

Further reading:

Cognitive-behavioral therapy helps individuals learn to recognize, avoid, and cope with situations in which they’re most likely to use painkillers.

Several CBT techniques are used to treat Librium addiction and other substance use disorders. One of these techniques, known as a motivational interviewing, helps individuals explore why they’re ambivalent about stopping their Librium use. This technique aims to help individuals change their behavior, making it more likely that a user will comply with other treatment approaches.

Contingency Management and Motivational Incentives

Further reading:

Contingency management uses positive reinforcement, including rewards for staying drug-free, taking MAT medications, and attending/participating in counseling sessions.
Motivational Enhancement

Further reading:

Motivational enhancement therapy uses strategies to encourage people to become internally motivated to change their behavior instead of just guiding them through the recovery process.
12-Step Facilitation Therapy

Further reading:

12-Step Facilitation Therapy is a community-based mutual support therapy used in outpatient settings. It follows the guidelines of 12-step self-help programs, including peer support that helps participants learn to cope with their addiction and avoid triggers that might lead to relapse.
Medication-Assisted Treatment for Painkiller Addiction
Type of Medication for Treatment Definition
Buprenorphine

Further reading:

Buprenorphine is a partial agonist drug that decreases opioid cravings and withdrawal symptoms. It can also shorten the length of painkiller detox and can be used for long-term maintenance to suppress cravings.
Methadone

Further reading:

Methadone is an agonist drug that helps with painkiller detox by reducing opioid cravings and relieving withdrawal symptoms. It can also block the euphoric effects of opioids and can be utilized as a long-term maintenance medicine.
Naltrexone

Further reading:

Naltrexone is an antagonist drug that suppresses painkiller cravings and helps prevent relapse by dulling the euphoric and sedative effects that normally occur when taking opioids.
Clonidine and Lofexidine

Further reading:

Clonidine and lofexidine are approved for treating opioid withdrawal. Both help with physical symptoms, including anxiety, muscle aches, cramping, runny nose, and sweating. Neither help reduce cravings. Clonidine is more commonly used, but lofexidine has less of an impact on blood pressure.

IV. How to Find Help

Finding a Rehabilitation Center for Painkiller Addiction

Prescription painkillers effectively treat moderate to severe pain, but their opioid-based ingredients can be highly addictive, especially when misused. Opioids affect the reward center of the brain, causing some users to feel high, which may lead to abuse. Long-term use can cause a person to develop a tolerance that leads to taking higher and/or more frequent doses to receive the same effect. Tolerance can lead to dependence, which can lead to a painkiller addiction that’s difficult but possible to overcome.

Choosing a reputable rehabilitation center that combines medication-assisted therapy with counseling and behavioral therapies using an individualized approach can help people overcome their painkiller addiction. Treatment may include inpatient and/or outpatient programs and continuing care through long-term medication-assisted maintenance and self-help peer support groups to help ensure lasting recovery.

Our Directory

Our directory of rehab programs includes a comprehensive list of available treatment centers and programs as provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). In the directory, you will find tools to filter the programs by setting, price, and location.