Is the itching caused by opioid use an allergic reaction?
One common adverse effect that occurs with opioid medication is pruritus, which is the medical term for an itch. People describe it as an itch sensation all over, after taking a prescription opioid.
For example, when morphine is given by IV in the hospital, some patients describe intense itching on the skin all over as an adverse reaction. While the effect is related to the immune system, it may not be considered to be a true allergy.
The intense itching caused by opiate pruritus is due to an effect on immune system mast cells. The mast cells release histamine, which causes the itching opioid reaction
Opioid induced pruritus is so common, often when a patient is prescribed opioid analgesics for chronic pain, the doctor may also recommend an antihistamine, such as Claritin, Allegra, or Benadryl.
When a patient complains about opioid induced pruritus, their doctor will likely tell them that they may continue treatment. If they considered it to be a true allergy, treatment would have to be changed.
If a patient has a true allergy to a drug, the drug must be discontinued, because the reaction may get worse with repeated use. With a drug allergy, it may start with itching, but the allergy can progress to full anaphylaxis.
An anaphylactic reaction can include the throat closing up. Breathing becomes difficult.
With a severe allergy, an epinephrine shot may be life-saving. Pruritus may be the early signs of an allergy, but the reaction can escalate with each use.
Does Suboxone make you itch?
Suboxone is an opiate drug that is used for addiction treatment for opioid addiction. It helps to prevent opiate withdrawal and opiate cravings.
Suboxone contains buprenorphine and naloxone. Patients who take Suboxone tend to have fewer issues with opioid drug abuse, opioid overdose, and opioid withdrawal symptoms.
Suboxone, and similar medications, is prescribed by online suboxone doctors, and also local clinics, to help people to quit opioids. Suboxone therapy has quickly become accepted as the gold standard of opioid addiction treatment.
Suboxone itching does occur as a side effect. This is because buprenorphine, the main ingredient, does work on the opioid receptor as an opioid.
What should a patient do if they have an addiction to heroin or a synthetic opioid, such as fentanyl, and they also have itching from Suboxone? Does Suboxone itchy skin mean they cannot take Suboxone for opiate addiction?
Fortunately, Suboxone and itching are not a major problem, because buprenorphine is only a partial agonist, so it is milder than many other opioids. While antihistamines may help in the beginning, there is a good chance the patient will overcome buprenorphine itching.
Is methadone a good alternative for someone who gets itching from Suboxone?
There are two opioid drugs used for substance abuse treatment for drug use involving opioids. These are buprenorphine and methadone.
Unfortunately, if a patient gets itching from one opioid, they will probably get it from another. And, methadone is a significantly more potent opioid, compared to Suboxone.
If a patient gets adverse drug reactions, such as itching, from Suboxone, they will likely also get opioid induced pruritus from methadone as well. It may even be more severe.
What alternatives are there to Suboxone and Methadone for people with opioid induced pruritus who do not want to deal with a chronic itch?
Itching is a form of mild pain on the surface of the skin. Why does scratching provide temporary relief?
Scratching an itch distracts your mind by causing a slightly more intense pain. Stimulating the pain receptors of the skin region helps to temporarily relieve the itch.
For someone struggling to overcome an opioid addiction, they may want to avoid this symptom altogether. In this case, naltrexone is an opioid receptor blocking drug which is approved for treating opioid dependence.
Naltrexone is available in a daily tablet form and also a monthly shot. The name of the monthly injection is Vivitrol.
How does someone with severe pain who gets an itch sensation from taking opioids deal with the itching symptom?
As stated earlier, various antihistamines may help to minimize the itching sensation caused by opiate pain drugs prescribed for pain relief. Also, soothing lotion may help. An Aveeno oatmeal bath may also be helpful.
In the case of antihistamines, and any other drug prescribed or recommended to ease the itching, people must be aware of the dangers of combining drugs with similar side effects. For example, antihistamines may be sedating, and opioids are also sedating.
It is important to always check with a doctor first before taking medications, especially multiple medications at the same time. This applies, even if one or more of the medications are over-the-counter, or even if they are natural supplements.
Of course, not taking opioids in the first place is an excellent way to avoid opioid side effects. If you don’t take an opiate, it can’t make you itch.
For example, many people expect to get an opioid pain reliever at the dentist, after a difficult procedure. It could be a root canal, implant, or extraction. Dentists often give oxycodone, hydrocodone, or Tylenol with codeine.
Surprisingly, as painful as a dental procedure may be, especially the recovery period, ibuprofen works quite well for many people. Naproxen is a similarly effective anti-inflammatory medication.
Non-opioids often work adequately for pain that we tend to think might require an opioid. Medical societies now encourage doctors to consider prescribing or recommending a non-opioid as the first line treatment for nearly any type of pain.
Is medical cannabis a good option for avoiding opioid itching?
For serious, severe chronic pain, Advil may not be the best solution. While there are a variety of non-medication pain treatments, if they do not help, it may be time to consider medical marijuana.
I do not recommend medical marijuana at all, but I have seen some people who have taken it and claim it works well, helping to make their chronic pain tolerable. There are doctors in the pain management field who no longer prescribe opioids, because they are committed to only recommending medical cannabis as a pain relief drug.
There are certainly patients who will not be able to tolerate cannabis at all. They may have negative feelings about the idea of taking what was, until very recently, a street drug.
Or, they may have had adverse reactions to cannabis in the past. Some people complain about feeling paranoid, dizzy, or excessively intoxicated from even a small amount of cannabis.
Is coffee a pain medication?
This seems like a silly question on the surface, but apparently, caffeine promotes the release of adenosine in the body, which acts in the central nervous system as a pain reliever. The problem with caffeine is that it is mild with respect to adenosine release, and it has obvious side effects at high doses.
I recently interviewed William Stilley the CEO of Adial Pharmaceuticals. He told me about a new drug they are researching that has the beneficial effects of caffeine on adenosine, but it is 200 times stronger, without the caffeine side effects.
So, while a cup of coffee is going to be minimally effective in helping with pain, there is a related drug that may soon be available. It is fascinating what is in development for treating pain without opioids.
Can psychedelics help with pain for people who get opioid itching or Suboxone itching?
Psychedelic drugs are all over the news now. Pharmaceutical companies are investing heavily in research and planning for manufacturing of psychedelic drugs to treat mental health issues, including PTSD, anxiety, depression, addiction, and chronic pain.
There is ibogaine, ayahuasca, DMT, psilocybin, LSD, MDMA, and more. One drug that is intriguing is MC-18, which is a safer derivative of ibogaine that has the benefits of ibogaine without the psychedelic drug intoxication.
Ketamine is a dissociative anesthetic drug that is considered to be a psychedelic. It is also the only drug in this class that is currently FDA approved and legal to use beyond research purposes.
There are ketamine nasal sprays, ketamine sublingual troches, and clinics performing off-label ketamine infusions. Ketamine has been used to treat pain, depression, and addiction.
While these drugs may be useful in the future for treating chronic pain and other conditions, it is still too early to recommend any of them. In some cases, ketamine may be used because it is a legal prescription drug.
Otherwise, people should avoid psychedelics for now. An exception is if a person is seeking to be included in a clinical trial on psychedelic drugs, and they are accepted into the trial. In that case, trial drugs may be administered under the controlled conditions of the study.
Is it possible that itching from opioids is a true allergy?
Yes, a person may have a true allergy to opioids. Any drug can illicit an allergic reaction in any person at any time.
Even if a person has never had an allergy to a drug, it is possible that they may develop an allergy later in life. It is important to distinguish non-allergy itching from a true allergy, because an allergy will be treated differently.
When a person is allergic to a drug, it is critical to avoid that drug. For example, if a person is allergic to morphine, they should avoid morphine, and probably any drug closely related to morphine.
If someone has a morphine allergy, can they take oxycodone, or hydromorphone without having a reaction? Is there cross-reactivity between these different opiates and opioids?
There is a higher likelihood of someone being allergic to other opioids if they are allergic to one particular opioid. Doctors should take care in prescribing an opioid to a patient who has had a definite allergic reaction to an opioid.
Is there medical treatment to get rid of an opioid allergy?
Allergies to medication can be treated by an allergist. It is possible to desensitize a person’s system to something they are allergic to.
The process must be done gradually, introducing small amounts of the substance that the person is allergic to. I do not know if this treatment is provided for opioids.
Desensitization treatments are done for antibiotics. For example, if a person is allergic to penicillin, and penicillin would be the ideal treatment for them, they can see an allergist for treatment to suppress the allergy.
It is unlikely that many allergists would be willing to do this type of work with opioids. It would involve administering or prescribing an opioid, which is probably not a part of most allergists’ practices.
Does a pruritic reaction to opioids reduce the chance of becoming addicted to opioids?
Opioid addiction can occur in anyone who takes opioids. While it is more likely if someone uses potent street opioids, such as heroin or fentanyl, it can happen with prescribed pain pills.
While the percentage of people who become addicted to pain meds that are prescribed to them is fairly low, it is a risk. The risk is higher for someone who has a past problem with addiction, or if addiction is a problem in their family.
Imagine what might happen when a person with a high risk for a substance use disorder takes an opioid and develops itching. Do they have a lower risk of becoming addicted?
Becoming addicted to a drug requires some enjoyment of the experience of taking the drug. This leads to repeated use, and eventually addiction.
If a person is unable to tolerate the drug experience, any enjoyment will be limited by the discomfort of a negative reaction. While it is possible that the drug high might overwhelm the feeling of itching, it is also possible that the person will not want to repeat the experience.
The itching may be uncomfortable enough that they choose to not continue with opioid use. Therefore, it is definitely possible that a pruritic reaction to opioids might save a person at risk for addiction from becoming addicted to opioids.
What should I do if I get itchy from opioids?
If a person fills a prescription for opioid pain pills and takes them as directed, and gets itchy all over, they must be careful going forward. They are likely having a pruritic reaction, that may or may not be an allergy.
Before taking more opioid medication, the person should contact their doctor and describe the reaction. The doctor may feel comfortable assessing the issue and determining if it is safe to continue taking the opioid.
If it is possible to tolerate the pain with another type of non-opioid treatment, it would help to avoid the issue altogether. It is always best, whenever possible, to avoid taking an opioid, when there is an alternative.
