Treating 'Skin Crawling’ (Formication) During Opioid Withdrawal

June 9, 2022

Table of Contents

“Skin crawling” is a common symptom of opioid withdrawal. The medical term for “skin crawling” is “formication.” People who experience formication often feel the false sensation of insects crawling on or under the skin. Formication can be a very unsettling experience for people who are going through opioid withdrawal

Formication, along with all other withdrawal side effects from discontinuing opioids, is uncomfortable but not dangerous or life threatening. You cannot die from opioid withdrawal. 

Formication can be prevented or minimized by taking buprenorphine/naloxone (Suboxone). One of the key benefits of taking buprenorphine /naloxone (Suboxone) and related medications is that they prevent or significantly lessen withdrawal symptoms, including formication.

how to deal with skin crawling during opioid withdrawal

What is ‘Skin Crawling’ (Formication)?

‘Skin crawling’ (also known as “formication”) results from central nervous system hyperactivity that occurs during opioid withdrawal. It can also occur as a result of stimulant drug use. The name “formication” comes from the term for a type of ant, called “Formica ants.” It is different from the sensation of “itchiness”, which is a common side effect of opioids themselves. With formication, the individual has the delusion or sensation of something actually crawling under the skin. It can be a very uncomfortable and unnerving sensory experience and is part of the other symptoms experienced during opioid withdrawal.

Symptoms of Formication 

Formication is just one of the withdrawal symptoms associated with OUD. Other withdrawal symptoms, like insomnia, irritability, cramps, and sweating (to name just a few), often occur at the same time

The intensity and duration of formication (and other withdrawal symptoms) depends on several factors, including whether the individual has started Medication for Addiction Treatment (MAT) or not. The factors include the following: 

  • How long the person struggled with opioids
  • What type of opioid they take
  • What other health conditions they might have 

Formication is more likely to occur during early, acute stages of withdrawal. Acute opioid withdrawal. It may persist anywhere from hours to days or even weeks.

What Percentage of People Experience Formication During Suboxone Treatment?

Very rare. Formication is more common in people who are withdrawing from opioids rather than those who take Suboxone or another maintenance medication. Because Suboxone is a lot less potent than full opioids, formication as a symptom is also very rare after discontinuing Suboxone.

Is Itching the Same as Formication?

No - Itching is different from formication. Opioids and opioid medications, including Suboxone (although to a lesser extent than full opioids like heroin or oxycodone) cause itching. In fact, itching is a relatively common side effect of opioid use. 

If you experience itching while taking opioids or Suboxone, an antihistamine may help[1]. Slightly more than 2% of the general population is allergic to opioids, including partial opioid agonists l[2] If you know that you have a sensitivity or allergy to either chemical in Suboxone, talk to your doctor before beginning Suboxone treatment. As long as you have not experienced anaphylaxis or another life-threatening allergic reaction to the medications, your symptoms may abate with time, or can even be treated with a prescribed antihistamine.

How Can Formication Be Treated/Alleviated?

Formication is fundamentally  caused by hyperactivity in the central nervous system. Therefore, medications that decrease central nervous system activity can help reduce these symptoms.  If a patient does not want to be on Suboxone or Methadone, certain “adjunctive’ medications like Clonidine can be used to decrease CNS activity and decrease formication symptoms. However, by far the most effective medications for formication and other withdrawal symptoms are MAT, including methadone and Suboxone. 

At Bicycle Health, our health care providers have specialized training on how to treat opioid use. This includes training on how to treat formication and other withdrawal symptoms.

The team at Bicycle Health is committed to fast response times. Telehealth appointments with our healthcare providers are usually available in under 24 hours. If you are currently experiencing withdrawal symptoms (including formication), or if you would like to talk with a health care provider about your options for stopping opioid use, please get in touch with us. To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment, call us at (844) 943-2514 or schedule an appointment here

Photo by Ximena Mora from Pexels.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Buprenorphine Sublingual and Buccal (Opioid Dependence). MedlinePlus. https://medlineplus.gov/druginfo/meds/a605002.html. January 2022. Accessed February 2022. 
  2. Opioid Allergy, Pseudo-allergy, or Adverse Effect? Pharmacy Times. https://www.pharmacytimes.com/view/opioid-allergy-pseudo-allergy-or-adverse-effect. March 2018. Accessed February 2022. 
  3. Naloxone Hypersensitivity. American Academy of Allergy, Asthma, & Immunology (AAAAI). https://www.aaaai.org/allergist-resources/ask-the-expert/answers/old-ask-the-experts/naloxone. March 2019. Accessed February 2022.

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