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Reviewer Daniel Schimmel, LCSW, CADCII-CA
Editor Daniel Callahan MSW, CAP
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Demerol: Side Effects, Withdrawal and Detox

Demerol: Side Effects, Withdrawal and Detox

Demerol is part of the opioid analgesic drug class that is utilized to relieve moderate to severe pain. This medication is also commonly referred to by its active ingredient, meperidine. Demerol is not used as widely as it once was due to the short duration of pain-alleviating effects it has in comparison to other alternative opioids. In addition, this drug has potentially dangerous medication interactions and a long ledger of intense side effects.

Even with the decrease in demand, Demerol is still used for the treatment of acute pain. However, it is tightly regulated and done on a very limited basis. It is only used medically outside of a facility for a maximum of 48 hours. This drug is commonly used in hospital or outpatient surgical settings. These facilities utilize the medication to help enhance and amplify the effects of other sedation medications prior to a surgical or invasive procedure.

How Does Demerol Relieve Pain?

Meperidine falls within the same class of drugs that numerous other narcotic opioid prescription medications do; however, it does not work in the same way.

This medication has the unique property of applying its action on the central nervous system. Other opioid medications apply their action on the nerves themselves. They do so by inhibiting the ends of the nerves from sending pain messages to the brain. Meperidine, however, uses a sensation of what can only be described as euphoria to replace the pain signals before they are transmitted to the brain.

Other pain medications like morphine may produce a euphoric feeling when they are taken as directed, which is a relatively common occurrence. However, euphoria is merely a side effect of these other medications. With Demerol, the euphoric feeling is not a side effect: The euphoric feeling is actually the primary mechanism that makes meperidine work.

For that reason, the euphoric feelings associated with meperidine are strong, and they are a large factor in the misuse of the drug.

Are There Adverse Side Effects From Taking Demerol?

Aside from its high potential for inappropriate use, those who have taken meperidine have reported a myriad of other unpleasant side effects. The long list of these is actually one of the primary reasons that medical meperidine use has declined immensely. Many practitioners have come to favor the use of other, safer alternatives like the medications oxycodone and morphine.

The most common side effects that have been reported in those who take meperidine include:

  • Lightheadedness
  • Intense dizziness
  • Dramatic fall in blood pressure
  • Fast heart rate
  • Arrhythmia
  • Slow or abnormal breathing
  • Blurry vision
  • Excessive tremors
  • Seizure
  • Intense feeling of nausea
  • Vomiting
  • Intense drowsiness
  • Appetite loss
  • Feeling of weakness
  • Increased sweating
  • Dry mouth
  • Tendency to faint
  • Hallucinations

Another danger hides within the shadow of meperidine. When the liver metabolizes this medication, some of this substance is synthesized into an active metabolite called normeperidine. Meperidine itself has a half-life of between three and four hours on average while this active metabolite has a half-life of between 14 and 48 hours. This means that when Demerol is taken as prescribed or otherwise, the normeperidine levels in the body will begin to accumulate and compound.

As a consequence of this process, normeperidine toxicity may occur in the central nervous system. Normeperidine toxicity is a form of neurotoxicity that can result in serious complications such as severe seizure activity, coma, and even death.

It is a difficult challenge for medical physicians to pinpoint exactly how long it will take normeperidine levels to decline in the body. Everyone has a different level of kidney function, and that is one factor in determining how long it takes for normeperidine to properly metabolize.

Without an understanding and respect for this information in regards to this medication, a substance use disorder in taking meperidine is extremely dangerous.

Why Does Substance Use Disorder Happen With Demerol?

Perhaps one of the biggest concerns when it comes to meperidine prescriptions is the tendency for an individual to develop an addiction to it. Because this medication does not top the list of the deadliest prescription addictions, most individuals don’t recognize meperidine’s high addiction potential. Meperidine is considered to be a schedule II controlled substance by the Controlled Substances Act for these very reasons. Even with tighter regulations on the distribution of this medication, it can still be obtained for misuse.

The majority of people who develop a physical tolerance and substance use disorder with meperidine begin using the drug as prescribed for the management of pain. Rarely is an addiction to this medication developed from an individual using the medication inappropriately on purpose to get high.

After taking the medication for a period of time, meperidine starts to not work as well as it did before in the treatment of pain. When this medication no longer works adequately to treat pain at the prescribed dose, the individual has built up a physical tolerance to it.

Because meperidine has a low tolerance threshold, individuals taking the medication will begin to increase their dose little by little to relieve their pain. Doing so in this way does not seem harmful or dangerous because the increases are very small. However, by the time a physical dependence is developed, the individual may be unaware that they are on the road to psychological dependence as well.

That is how the process of meperidine substance use disorder occurs. Individuals become addicted to this medication without even realizing it.

How Is a Demerol Substance Use Disorder Identified?

When an individual starts to exhibit behaviors that are damaging to any aspect of their life in order to continue use of the medication, it is considered a substance use disorder.

Something as simple as continually oversleeping because of the use of Demerol that results in missing class or arriving late to work can become a huge problem. Many individuals may not see the impact that continuous meperidine use is actually having on their life.

One of the most telling indications of a meperidine substance use disorder is when an individual begins to habitually come up with excuses to obtain a continued prescription for the drug. Unfortunately, being creative with how you “lost” your medication, how it got stolen or how it got destroyed will often times get you a new prescription.

In addition, tablets of this medication that are meant for oral use can be consumed by other methods. Any chewing of tablets that are intended for oral consumption rather than swallowing may indicate the presence of a substance use disorder. This applies even more so for anyone who is crushing and then snorting tablets that are intended for oral use.

Additionally, the crushing of tablets, dissolving of that powder into a liquid and injecting that solution is a significant red flag of addiction to meperidine. The consumption of meperidine through any of those three methods is known to amplify its painkilling effects and properties. Using the drug in this way causes an individual to feel a potent rush of euphoria that is followed by extended sedation.

Another common indication of a problem is when money becomes an issue because of the use of this drug. It may feel justified to spend money on a drug to relieve your pain, but it should not make paying your normal bills difficult and unattainable.

What Happens When Demerol Use Is Stopped?

When this medication is used regularly over the long term, it causes brain receptors to change permanently. Because the drug has been used for so long to cope with pain, the brain forgets how to operate its natural mechanisms for doing so. The symptoms that happen upon stopping the use of meperidine are the brain attempting to re-adjust and re-learn how to function properly in the absence of the drug.

Usually, the symptoms that occur are not life-threatening on their own, however, that does not mean that they cannot become severe. Often, the symptoms that occur during the withdrawal period are what leads a person to relapse.

Withdrawal symptoms of meperidine can range in severity from mild to severely uncomfortable. These symptoms will begin to manifest typically within 24 hours of the last medication dose, and they may last for up to 10-15 days on average.

What Is the Demerol Withdrawal Timeline?

At some point between three and 24 hours after the last dose of meperidine, the first symptoms to manifest are excessive irritability, nausea, anxiety, and physical discomfort. The urges and cravings for the drug are intense during this time frame.

Between 48 hours and five days, most individuals will reach the peak of withdrawal. Feelings of fear, uneasiness, panic, and alarm will begin to manifest. Uncomfortable physical symptoms start to occur within this period such as muscle aches, vomiting, excessive nausea, and excessive sweating. Cravings for the drug will still be strong.

Between six and 14 days, the aforementioned physical symptoms begin to decrease while the mental and emotional symptoms may still remain prevalent. Cravings for the drug begin to decrease in intensity.

Beyond the point of day 15 since the last dose, most symptoms such as reduced appetite, irritability, anxiety, inability to focus, poor motivation, erratic sleep patterns, lack of feeling pleasure, restlessness, agitation, depression and mood swings should all begin to considerably diminish. Moderate to mild cravings for the drug can remain but will usually subside significantly over time.

Detox From Demerol

Anyone who is using Demerol with a prescription should talk to their practitioner before they stop using the drug. Meperidine is one of those drugs that should not be stopped abruptly or “cold turkey” because of withdrawal intensity. For anyone who wants to detox from this medication and does not have an active prescription, a consultation with a substance use disorder professional is recommended. This should be done prior to stopping Demerol use.

Professionals have a couple of ways of going about detoxing from meperidine. The first technique used is tapering down the medication dose of meperidine over several weeks. Another prevalent method of detox is using similar substances to make withdrawal safer and more comfortable.

Medications Used for Demerol Detox

Buprenorphine is an opioid agonist-antagonist drug that is known for its similar but weaker effects to those of other opioids. This drug has an inhibiting effect on other opiates, which means it helps block their effects. It helps reduce the severity of withdrawal symptoms and may reduce cravings.

Methadone is a drug that can stand in the place of meperidine to give an individual the cohesion that they need for treatment with more monitoring and safe dosage. Over the long term, the doses of methadone are gradually decreased to minimize withdrawal symptoms. Tapering off of methadone has shown to be more effective and feasible then tapering off other stronger opiates like Demerol.

Naltrexone is a medication that belongs to the opioid antagonist family. This means that it can be effective at stopping the euphoric and pleasurable effects of some opioids, including meperidine. This helps prevent relapse due to cravings.

Clonidine is a medication that is typically utilized to treat high blood pressure. It helps to decrease the intensity of several withdrawal symptoms during meperidine detox. It is most commonly combined with other drugs to help an individual through withdrawals.

The use of medications to navigate the detox and withdrawal process can only be done under the supervision of a medical professional, and rightly so. Some drugs utilized for this purpose may have addictive properties themselves and should always be monitored and adjusted by a physician.

The medical and the psychological fields have evolved in the last few decades when it comes to treatment of substance use disorder. Comprehensive research, safer and newer technology, and the accumulation of experience are all valuable tools that make withdrawal and detox easier and more effective when supervised by professionals.

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