Author: Ruben Bermea, LPC

Demerol is an opioid medication classified by the U.S. Drug Enforcement Administration (DEA) as a Schedule 2 narcotic. Known generically as meperidine, Demerol has a high potential for misuse and addiction, and can lead to strong psychological or physical dependence.¹ Fortunately, a variety of options are available for Demerol addiction treatment.

In This Article:

• Demerol Uses and Its Decline as a Treatment of Choice
• Demerol Side Effects
• Signs You May Need Demerol Addiction Treatment
• Demerol Overdose Risks
• Types of Treatment for Demerol Addiction
• Therapies for Demerol Addiction Treatment
• Ongoing Recovery Support

Demerol Uses and Its Decline as a Treatment of Choice

Demerol is a synthetic opioid, meaning it is made in a laboratory to have the same properties as natural opioids such as morphine.

Prior to the 1990s, Demerol was the most commonly prescribed drug to treat post-operative pain.² However, newer opioids became available with superior pain relief, making Demerol uses less favored. ² The problem with Demerol is how it is metabolized in the liver.³ Some of the drug is converted into normeperidine, a potentially toxic metabolite that accumulates in the body, often overstimulating the central nervous system.³

A review of more than 60 clinical studies involving Demerol concluded that other, newer opioid medications offer similar or superior pain relief with fewer side effects.³ Because of its toxicity, multiple drug interactions, and poor efficac­y, Demerol has been replaced in most situations by other opioids for treatment of severe pain.⁴

Today, Demerol uses are limited to treating postoperative shivering and drug-induced tremors.³ It may also be used for short-term pain management in individuals who cannot tolerate other opioids.³ In no cases should Demerol be used to treat chronic pain.²

Demerol Side Effects

Like other opioid medications, Demerol affects how your brain responds to the sensation of pain.⁵ As with morphine, immediate effects are pain relief, along with relaxation and a feeling of euphoria.⁵

Demerol use also comes with a high risk of side effects. Use of Demerol for just a few days can result in tremors, nervousness, muscle twitching, delirium, seizures, and altered mental state.^2,3 These effects are more pronounced in elderly patients or people with renal dysfunction.² Demerol also causes more sedation and respiratory depression than other opioid medications.² It is also known to cause serotonin syndrome in individuals using anti-depressant medications, which can be life-threatening.³

Other side effects that can result from Demerol use include:⁶

• Cardiac arrest
• Chest pain
• Coma
• Difficulty breathing
• Rapid or unstable heart rate
• Constipation
• Vomiting
• Nervousness
• Nausea
• Dizziness or faintness
• Sleepiness
• Depression or brain fog

Because of how the liver processes Demerol, side effects from this medication can be more severe than from other opioid drugs.³ If you experience any severe side effects from taking Demerol, discontinue use and call 911 for emergency assistance.

Signs You May Need Demerol Addiction Treatment

Using opioid medications such as Demerol can easily lead to physical or psychological dependence.¹ If you become dependent on Demerol and try to stop using it on your own, you may experience uncomfortable withdrawal symptoms.⁷

If you misuse Demerol to avoid withdrawal symptoms, you are at risk for opioid addiction, clinically known as opioid use disorder.⁷ Misuse includes taking a substance in larger amounts or more frequently than prescribed.

Other signs of Demerol abuse include:⁷

• Spending lots of time seeking out this medication
• Needing lots of time to recover from Demerol misuse
• Not being able to stop using this medication despite the harm it causes
• Using Demerol in dangerous situations
• Giving up on hobbies, relationships, and other important areas of your life because of Demerol use
• Needing more Demerol to get the effects you desire
• Crushing Demerol tablets into powder for injection purposes

According to the American Psychiatric Association, certain factors may put a person at higher risk of Demerol addiction. These include: ⁷

• History of illegal substance use
• History of prescription medication misuse
• History of overdose
• History of depression
• Prior diagnosis of any other mental illness

If you or a loved one has signs of Demerol addiction, help is available. Call 800-934-1582(Who Answers?) to speak with an addiction treatment specialist.

Demerol Overdose Risks

An overdose, intentional or unintentional, poses one of the most serious potential risks of Demerol abuse.⁸ Misusing opioids can impact the part of your brain that allows you to breathe normally. If you take more of this medication than your body can handle, you may experience an overdose which could lead to death.

People are particularly at risk of overdosing on opioid drugs when they try to stop using them. If you stop using this medication for a short time, your tolerance to Demerol may quickly decrease, and your sensitivity to its effects may increase.⁹ Then if you relapse and start using Demerol again, you may face a higher risk of overdose. The sensitivity you have developed at this stage may strengthen Demerol’s effect on your body with potentially fatal consequences.^{8, 9}

Naloxone, a medication that is available over-the-counter in some states, can help manage the life-threatening effects of opioid overdose.^2,10 Talk with your doctor about accessing naloxone where you live. Be sure that instructions are provided to you and anyone else in your home who may need to use it. If naloxone is administered during an overdose, emergency medical assistance is still required.

Types of Treatment for Demerol Addiction

If you show signs of opioid misuse, an assessment by a qualified professional can help clarify your needs for Demerol addiction treatment. Substance use recovery and treatment most often begins with withdrawal management, or detox, before transitioning to other types of rehabilitation.¹⁰

Detoxing from Demerol

Withdrawal management, also known as detox, can take place in different settings.¹⁰ Some people may benefit from outpatient care during the withdrawal process. Others may require more frequent monitoring due to the severity of their withdrawal symptoms. When Demerol addiction compromises a person’s physical and psychological health, they may need the support and safety of medical supervision in a residential rehab or hospital setting.¹⁰

Opioid withdrawal symptoms that may affect someone experiencing Demerol addiction may include:^7,8

• Anxiety
• Mood changes
• Agitation
• Insomnia
• Teary eyes
• Runny nose
• Sweating
• Muscle aches

Before withdrawing from Demerol use, be sure to taper off its dosing gradually. Abruptly quitting this medication can lead to severe withdrawal symptoms, including the risk of suicide.¹¹

During withdrawal and throughout your recovery, your treatment providers may recommend medications to ease uncomfortable symptoms. Some medications used in the treatment of opioid use disorders include:¹²

• Buprenorphine and methadone for withdrawal symptoms
• Methadone, naltrexone, and buprenorphine to manage cravings and opioid effects

Only a qualified prescribing professional can help you identify the best medication for you. Different phases of the recovery process, risk factors, and other health considerations can influence the efficacy of these medications.¹² Taking these medications and attempting to discontinue Demerol use without medical supervision can pose serious health risks.

Withdrawal management is the first step of Demerol addiction treatment. Case management at this stage of recovery may include developing a treatment plan for your needs moving forward.

Inpatient Rehab

Inpatient or residential rehab programs can provide you with comprehensive treatment for substance use recovery.¹⁰ Inpatient hospitalization programs use medical management techniques to treat the most severe symptoms of Demerol addiction. Residential treatment facilities and other inpatient programs may combine social and medical interventions to address your treatment needs.

You may benefit from inpatient or residential treatment if you experience:¹⁰

• A need for distance from people, places, or things that could trigger relapse
• Symptoms so severe that they may require crisis intervention
• Multiple severe substance use or mental health concerns

Outpatient Treatment

Outpatient treatment is an option for treating less severe cases of Demerol addiction. The intensity and frequency of treatment services will vary depending on the type of program you choose.

Outpatient treatment options may include:¹⁰

• Partial hospitalization program
• Intensive outpatient program
• Standard outpatient treatment

Individuals who may benefit from outpatient care include those:^8,10

• Seeking long-term treatment after withdrawal management
• With a strong support system
• With medical stability
• Who can safely manage OUD symptoms outside of a residential or inpatient care setting

An assessment by an addictions specialist can help you determine whether inpatient care or outpatient treatment will best serve your needs.

Therapies for Demerol Addiction Treatment

Whether you choose inpatient or outpatient are, your healthcare providers will develop a treatment plan for you that meets your unique needs. You’ll work with your provider to identify the challenges you want to address in your life while reviewing your strengths, resources, relationships, skills, and abilities.¹⁰

Different aspects of treatment may include:¹⁰

• Professional counseling
• Family therapy
• Group therapy
• Crisis management
• Case management
• Medication Management
• Physical healthcare maintenance
• Mutual support groups
• Aftercare planning

A few of the therapeutic approaches used in rehabilitation programs include:¹⁰

• Motivational interventions
• Cognitive-behavioral therapy
• Mindfulness and meditation training
• Development of coping skills
• Contingency management and reward-based approaches

The types of therapy offered will depend on the rehab program you choose and your recovery needs. You may receive treatment involving several of the above approaches, or others.

Therapy can help you develop skills to:¹⁰

• Safely respond to family conflict
• Manage stress
• Work with difficult emotions
• Respond to cravings
• Prepare to manage potential relapse triggers
• Respond to unhelpful thoughts
• Relate to others effectively
• Manage other mental health concerns

Holistic Interventions

An integrated approach to care considers the aspects of your life that make you a whole person.¹⁰ A holistic treatment program addresses the psychological, biological, spiritual, and social parts of your health and wellness.

The “spiritual” components of treatment can involve more than a religious perspective. During treatment, you can reflect on what it means to be human. Examining your relationship with yourself and others can foster insight into yourself as a whole person.

A holistic approach to treatment may include complementary treatment practices. Complementary interventions that may be offered in a substance use treatment program include:^{13, 14}

• Meditation
• Massage Therapy
• Dance and Movement Therapy
• Art Therapy
• Expressive Therapy
• Yoga
• Osteopathic Interventions

These methods may work better for some individuals than others. While complementary practices may support addiction recovery, they cannot replace the full range of treatment approaches discussed in this article.

Ongoing Recovery Support

Recovery does not end with rehab. Maintaining the changes you made in substance use treatment can improve your overall health and reduce your risk of relapse.⁷ Developing a plan to respond to triggers and prevent relapse can help you focus on the aspects of your life that you value the most. Maintaining a relationship with treatment providers for medication, therapy, and physical wellness can ensure you continue to receive support as you step into long-term recovery.¹⁰

Mutual support groups like Narcotics Anonymous (NA), Self-Management and Recovery Training (SMART), and LifeRing Secular Recovery exist to help you develop recovery-oriented relationships with your peers. ¹⁰ Sober living programs also represent a form of peer-based support used in recovery from substance use.

If you or someone you know has suffered from Demerol addiction, connect with someone who can help you. Call 800-934-1582(Who Answers?) today to speak with a treatment specialist about your options for substance use recovery.

References

1. U.S. Drug Enforcement Agency. Drug Scheduling.
2. Weissman, D. (2015). Meperidine for Pain: What’s All The Fuss? Palliative Care Network of Wisconsin.
3. Dobbins, E. (2010). Where has all the meperidine gone? Nursing, 40(1), 65-66.
4. Latta, K.S., Ginsberg, B., & Barkin, R.L. (2002). Meperidine: A Critical Review. American Journal of Therapeutics, 9(1), 53-68.
5. Kosten, T.R., & George, T.P. (2002). The Neurobiology of Opioid Dependence: Implications for Treatment. Science & Practice Perspectives, 1(1), 13-20.
6. meperidine (Rx).
7. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
8. S. National Library of Medicine. (2020, May 10). Opiate and opioid withdrawal. MedlinePlus.
9. Hoey, N.M. (2019). Overdose. Salem Press Encyclopedia of Health. Salem Press.
10. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating addiction: A guide for professionals (2nd ed.). The Guilford Press.
11. S. National Library of Medicine. (2021, March 31). Label: Demerol – meperidine hydrochloride tablet.
12. Substance Abuse and Mental Health Services Administration. (2021). Medications for Opioid Use Disorder, Treatment Improvement Protocol 63.
13. National Center for Complementary and Integrative Health. (April 2021). Complementary, Alternative, or Integrative Health: What’s In a Name? S. National Institute of Health.