Demerol Addiction, Withdrawal, and Treatment

 

Demerol is a prescription opioid pain medication. It is a brand name version of meperidine—a synthetic opioid agonist. Though generic meperidine is available in several formulations, including oral tablets and syrup, Demerol is presently only available as an injectable solution.1 Demerol may be used in clinical settings to manage relatively severe pain that is uncontrolled via alternative treatments. It is indicated for use as a preoperative analgesic and adjunct to anesthesia as well as an obstetrical analgesic.2

Because of the risks of abuse, misuse, and addiction associated with meperidine, Demerol injections should be reserved for therapeutic use in patients who have not responded to alternative treatment interventions (i.e., non-opioid analgesia or opioid combination painkillers).2

The primary active component of Demerol—meperidine—is a Schedule II controlled substance and may be subject to diversion and nonmedical misuse for its rewarding physiological effects.2 The compulsive patterns of drug seeking and drug use that may develop as part of an opioid use disorder involving Demerol can be treated via a number of medical and behavioral health interventions for addiction treatment.

Drug Effects of Demerol

Like all opioid painkillers, Demerol interacts with opioid receptors throughout the central nervous system to alter pain signaling and perception.3 In addition to this therapeutic purpose, the pharmacologic effects of Demerol can give rise to certain side effects, including:2,4

  • Changes in mood or sense of wellbeing: Depending on the individual, both acute euphoria and dysphoria can result from opioid use.
  • Changes in levels of consciousness: Sedation, lightheadedness, and dizziness may accompany Demerol use. Any of these developments and could increase the risks of loss of consciousness, falls, or other causes of injury.
  • Visual changes: Opioids can result in pupillary miosis, or contraction, even in the dark. Additionally, blurred or double vision are potential side effects of Demerol.
  • Gastrointestinal changes: Opioids like Demerol may increase smooth muscle tone in the gastrointestinal tract, leading to decreased gastric motility and constipation. Opioid use may also make people experience episodes of nausea and vomiting.

Demerol also impacts other systems in the body, even when taken as prescribed in regular doses. Potential symptoms include:2,4

  • Dry mouth.
  • Diminished cough reflex.
  • Dilated blood vessels.
  • Low blood pressure.
  • Skin flushing and itching.
  • Sweating.
  • Respiratory depression.

Signs of Addiction

As addiction to Demerol develops, certain characteristic signs, symptoms, and changes in the user’s behavior and emotional state may be recognizable. In addition to the aforementioned side effects, several Demerol addiction-related health risks may also be present, including that of overdose as well as the development of dependence and associated withdrawal.

Changes in Behavior and Emotions

In some cases, opioid use disorders are associated with a significant increase in risky and often dangerous behavior, such as driving while intoxicated. As compulsive drug use continues, an individual may be less able to maintain positive social relationships. Previously enjoyed activities may decrease in frequency, and a person’s ability to meet work, school, and familial obligations may begin to suffer.5

People compulsively misusing opioids like Demerol may take more work absences and sick days than their counterparts.6 This may lead to job loss or loss of income, and ultimately serious financial issues. In addition, interpersonal relationships may suffer, as substance abuse becomes the primary focus of a person’s life.

Ever-Present Overdose Risks

Overdose is always a serious concern with problematic opioid use. Signs of an overdose include:2,7

  • Progressive somnolence.
  • Loss of consciousness.
  • Unresponsiveness.
  • Constricted or “pinpoint” pupils.
  • Breathing trouble (e.g., slowed, labored).
  • Respiratory arrest.
  • Bluish tint to the fingernails and lips.
  • Clammy skin.
  • Low blood pressure.
  • Slow pulse.
  • Coma.

If untreated, overdose can result in death. Naloxone, an injectable or intranasal medication, can be administered to reverse an opioid overdose; however, it must be followed by immediate medical treatment.2

Physiological Dependence and Demerol Withdrawal

Even regular use at therapeutic doses may be associated with the development of some physical dependence.2 Nonmedical misuse or use that otherwise exceeds prescribed guidelines can increase the risk of significant dependence and the likelihood of experiencing an unpleasant opioid withdrawal syndrome.

Acute Demerol withdrawal may include symptoms such as: 2,8

  • Insomnia.
  • Irritability.
  • Aches and pains.
  • Restlessness.
  • Runny nose and watery eyes.
  • Sweating.
  • Chills.
  • Rapid heart rate.
  • Increased blood pressure.
  • Gastrointestinal upset.
  • Diarrhea.

The Benefits of Medical Detox

People may be advised against attempting to abruptly quit Demerol on their own because of the likelihood of unpleasant withdrawal.2,9 Though seldom life-threatening, these symptoms can be incredibly uncomfortable and present an enormous challenge to early recovery when not managed. Uncontrolled withdrawal may drive people to immediate relapse with Demerol or other opioids to mitigate symptoms.

With medical detox, clients have 24-hour care and supervision from medical professionals. Withdrawal symptoms can be managed with medications (e.g., opioid agonists, clonidine) and supportive therapies, helping to ensure that clients make it through the entirety of the withdrawal process safely and even comfortably.9

Maintenance medications such as buprenorphine have become the standard of care at many opioid addiction treatment centers and detox programs. Buprenorphine is a partial opioid agonist. When used for treating opioid use disorders, It interacts with opioid receptors to stabilize someone in withdrawal—minimizing withdrawal symptoms and cravings—without eliciting a reinforcing opioid high of its own. This may allow person in recovery to better focus on their therapeutic process. Buprenorphine therapy may be maintained in the longer-term, or the treatment drug may be slowly discontinued over time, when the recovering individual is ready.


The decision to use any medications during detox and recovery is best determined on an individual basis by the supervising physician in consultation with the individual client. What may be appropriate for one person may not be right for another. Again, individualized care is essential.


Opioid Recovery Beyond Detox

Detox, while a key component of early recovery, commonly precedes additional rehabilitation—whether it be on an inpatient or outpatient basis. Though each individual will have different needs and circumstances, inpatient treatment programs are commonly sought by those with relatively severe addictions and addiction-related issues.

One of the benefits of an inpatient or residential program is that the controlled environment may decrease the access that those in treatment may have to Demerol or other opioids. In addition, the 24-hour supervision and support provided by inpatient treatment gives those new to recovery a firm foundation before they return to life in the outside world.

In ideal situations, those in recovery have strong, healthy support systems at home in the form of family and friends who want to see them succeed in sobriety. But not everyone has this type of support system already in place, and treatment is often about building that support network. Group therapy and peer support groups such as 12-step meetings help individuals to meet others who are similarly struggling with addiction. In these settings, those in recovery can offer and receive support from people who truly understand what they’re going through. Once a person completes formal treatment, they can continue attending meetings in the community and access this support system whenever they need it.

In some instances, people may not be able to step away from life for weeks or months to attend inpatient opiate addiction treatment. For these people, outpatient addiction treatment is an option. Though outpatient care doesn’t offer the 24-hour supervision and complete focus on recovery that inpatient care does, it may still provide recovery benefits for those unable to attend residential care. Certain programs, such as intensive outpatient programs (IOPs), still offer rigid structure and a relatively intensive level of care, but clients return home each night to sleep.

 

Get Help Today

Demerol is an addictive opioid drug, and its abuse comes with serious risks that reach into every area of life. No matter how long a person has been abusing Demerol, recovery is possible.

With comprehensive treatment that is tailored to meet each person’s specific needs, opioids do not have to rule a person’s life. With treatment help, opioid addiction can be effectively managed on a long-term basis. Call for more information about Greenhouse’s treatment options for opioid use disorders involving Demerol or any other drug.

References

  1. U.S. Department of Health and Human Services—Food & Drug Administration. (2020). Drugs@FDA: FDA-Approved Drugs: Meperidine.
  2. U.S. Department of Health and Human Services—Food & Drug Administration. (2019). Labeling-Package Insert—Highlights of Prescribing Information: Demerol.
  3. Brenner, G.M., & Stevens, C.W. (2018). Brenner and Stevens’ Pharmacology, Fifth Edition. Philadelphia: Elsevier.
  4. U.S. National Library of Medicine—MedlinePlus. (2018). Meperidine Injection.
  5. Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  6. Mistry, C. J., Bawor, M., Desai, D., Marsh, D. C., & Samaan, Z. (2014). Genetics of Opioid Dependence: A Review of the Genetic Contribution to Opioid DependenceCurrent psychiatry reviews10(2), 156–167.
  7. U.S. National Library of Medicine—MedlinePlus. (2019). Meperidine Hydrochloride Overdose.
  8. U.S. National Library of Medicine—MedlinePlus. (2018). Meperidine.
  9. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.