When someone dependent on opioids suddenly stops or cuts back their usage, they can face a range of withdrawal symptoms that affect both the body and mind. Physically, these might feel similar to having the flu—think nausea, throwing up, diarrhea, muscle pains, and excessive sweating.
On the mental side, feelings of anxiety, crankiness, inability to sleep, and deep unhappiness are common. How long these symptoms last depends on what kind of opioid was being used and how bad the opioid use disorder was.
To help deal with these challenging symptoms safely and start on the path to recovery, interventions, detox under medical supervision, or using specific medications designed to ease withdrawal (known as medication-assisted treatment or MAT) are recommended so that no life-threatening risks are present.
What Are the Symptoms of Opioid Withdrawal?
In most cases, opioid withdrawal is much like a nasty flu. This phase is often uncomfortable and incredibly difficult, which is one primary reason why many continue using it. (1)
As a disclaimer, most individuals who experience opioid withdrawal will not showcase fatal symptoms; death can occur. For most, the symptoms of opioid withdrawal will be both uncomfortable and painful. The severity of one’s symptoms will depend on several factors, including the length of time an addict was using.
Sadly, many never receive the help they need, and among those who do, it can be years, sometimes decades, of drug use they need to work through. These are the lucky ones, as prolonged opioid use and substance use disorders significantly increase your chances of early death.
The list of opioid withdrawal symptoms is long, and no two people will have the same experience. These symptoms are both physical and psychological, creating an unpleasant cycle that reinforces drug use. This is why health information is important when it comes to substance abuse. (2)
The most common symptoms are referred to as “flu-like” symptoms and include: (2)
- Irritability
- Insomnia
- Runny nose
- Restlessness
- Anxiety
- Nausea
- Sweating
- Muscle aches
- Diarrhea
- Vomiting
- Dilated pupils
More severe symptoms include: (2)
- Tremors
- Muscle, joint, and bone pain
- Gastrointestinal issues
Opioid withdrawal can become fatal following excessive vomiting and diarrhea. There have been cases where individuals became dehydrated, and heart failure occurred following elevated blood sodium levels. Several documented cases from the late 1990s showcase this possibility, all in jail settings. (3)
Cardiac arrest can lead to hypoxic brain damage, which means your brain doesn’t get enough oxygen. (4) The important thing to note here is that these instances are preventable when given appropriate medical care.
Opioid Withdrawal Symptoms, Timeline & Detox Treatment Options
The United States is currently facing an opioid crisis. According to the National Institute of Health, in 2019, nearly 50,000 people in the United States died from opioid-related overdoses. (5)
Opioid addiction is plaguing the nation and no longer only applies to street drugs like heroin. The misuse of prescription opioids, including codeine and fentanyl, contributes to growing rates of abuse and dependence.
Many individuals struggling with opioid addiction avoid treatment because of the associated withdrawal symptoms. These symptoms are uncomfortable, painful, and even dangerous when left unsupervised.
To address opioid withdrawal syndrome, you must seek professional clinical support at the emergency department or an addiction treatment center.
Not only will this make the withdrawal process more manageable and safer, but it will also set you up with the tools you need to ensure long-term recovery. Remember, addiction is a complex disorder that requires an individualized, holistic approach with the help of public health professionals.
What Causes Opioid Withdrawal?
Opioid withdrawal begins with opioid tolerance and dependence. (6)
Opioid addiction is complex. Tolerance, dependence, and addiction are manifestations of brain changes resulting from chronic opioid abuse. Chronic opioid or oxycontin use leads to changes in the brain and is the underlying cause of opioid dependence and addiction.
This dependence creates the need to keep taking opiates to avoid withdrawal symptoms, whereas addictions cause intense drug cravings and compulsive use. (6)
These brain abnormalities typically resolve once the detoxification is complete. However, the complexities of addiction are not that black and white. Environmental variables, psychological conditioning, and a genetic predisposition contribute to one’s addiction.
Whether triggers include ongoing stress or social variables, therapy is often required to ensure long-term success. The ongoing treatment process gives users the tools and support they need to remain sober since relapse can occur years later when the user is no longer opioid-dependent.
From a clinical perspective, opioid withdrawal is one of the most powerful factors driving opioid dependence and addictive behaviors. Following repeat exposure to increasing doses of opioids, the brain begins to function normally when the drugs are present and abnormally when they are not. Opioid tolerance is directly linked to opioid dependence, and tolerance must develop for you to experience withdrawal symptoms. (7)
Over time, opioid tolerance develops because brain cells with opioid receptors become less responsive to stimulation. Based on these changes, users begin taking more and more of the drug to experience a level of stimulation comparable to previous drug-taking episodes.
While focusing specifically on withdrawal symptoms, an area at the base of the brain is why specific symptoms develop known as the locus coeruleus (LC), this brain area is home to neurons that produce the brain chemical known as noradrenaline (NA). When distributed to other brain areas, this chemical influences breathing, blood pressure, wakefulness, and other key functions. (7)
When taking opioids, this drug class suppresses the release of NA. As a result, users experience:
- Slowed respiration
- Drowsiness
- Low blood pressure
If you continue taking opioids over time, this increased exposure causes the LC neurons to adjust. Activity is heightened to help offset the effect of opioids.
However, once opioids are no longer present (during the initial stages of withdrawal), excessive amounts of NA remain, leading to:
- Anxiety
- Cramping
- Diarrhea
- Jitters (7)
How Long Does Opioid Withdrawal Take?
The initial onset of withdrawal symptoms will depend on your drug of choice. For example, if you’re dependent on short-acting opioids, such as heroin, the onset of symptoms typically occurs within 8-24 hours after your last dose.
Symptoms will continue for 4-10 days. In contrast, long-acting opioids, such as methadone, will initiate withdrawal symptoms within 12-48 hours following the last dose. These symptoms will last anywhere between 10 and 20 days. (1)
Although the timeline for opioid withdrawal varies depending on the drug of choice and other variables, peak withdrawal symptoms typically surface around 72 hours.
To determine timelines for specific opioids, you can turn to the half-life of a drug. Half-life helps predict when cravings will begin, as this is the time it takes for the body to eliminate half a dose. Most opioids have a fairly short half-life of just a few hours. For example, oxycodone has a half-life of 3-5 hours.
Then there are opioids, such as methadone, which have a half-life of 8-60 hours. Symptoms will get worse hour after hour. This is the early stage of withdrawal. At this time, users may manage their symptoms with distraction depending on the severity of the symptoms. (8)
It is the peak stage when more intense symptoms surface. As mentioned, 72 hours is when these symptoms typically become the most prominent. However, you could experience intense symptoms as early as 30 hours after your last dose. During this time, you face the highest risk of relapse.
The late stage is when symptoms gradually reduce, with noticeable changes occurring within approximately a week. The physical symptoms subside, but this is when the work begins for many.
Ongoing support is essential, especially when there are underlying pain conditions to treat, or users suffer from a mental health disorder. At this point, users will begin to work with their care team to develop a plan for ongoing support.
To reduce withdrawal symptoms among patients taking prescribed doses, clinicians develop a tapering plan. The goal of these plans is to develop an individualized approach to minimize opioid withdrawal symptoms.
A similar approach is often taken in medical detoxification programs. The key is to avoid abrupt tapering or sudden discontinuation — although some users take a cold turkey approach. (9)
The complete timeline concerning opioid withdrawal will vary, especially when considering the psychological implications. As discussed, opioid addiction is not as simple as riding the body of drugs.
There is no one-size-fits-all approach or timeline, which is why it’s so beneficial to work with professional treatment facilities that understand the complexities of opioid addiction and the overall recovery process.
How to Safely Manage an Opioid Detox
Withdrawal management refers to the psychological and medical care of patients experiencing withdrawal symptoms after ceasing or reducing their dependence on drugs. In this case, dependence on opioids.
To safely detox, you should be medically supervised. Researchers suggest you be monitored regularly (3-4 times daily). That way, your symptoms and potential complications can be treated in a way that makes you as comfortable and safe as possible. (1)
Clinical Opiate Withdrawal Scale
The Clinical Opiate Withdrawal Scale (COWS) exists to help monitor patients experiencing opioid withdrawal. Clinicians administer this 11-item scale in both inpatient and outpatient settings.
The summed score helps healthcare teams determine the severity of the patient’s withdrawal symptoms to assess the level of dependence and the required next steps. (10)
Some examples include:
- Resting pulse rate is a four-point scale, ranging from 80 or below to a pulse rate greater than 120.
- Bone or joint aches, on a four-point scale, ranging from zero, not present, to four, the patient cannot sit still because of discomfort.
- Tremor is a four-point scale observed via outstretched hands. A score of zero means no tremors, while four represents significant tremors or muscle twitching.
Medications Are Available to Help Reduce Symptoms of Withdrawal
For severe withdrawal, medications are administered. For example, clonidine is often prescribed to help curb many physical symptoms associated with opioid withdrawal, including sweating, vomiting, cramping, tremors, insomnia, etc.
However, this medication should not be given in conjunction with an opioid substitution. Again, this is why it’s important to seek the support of a professional medical team.
New support mechanisms continue to develop regarding opioid withdrawal treatment. For example, in 2018, the FDA approved the first non-opioid treatment to help individuals better manage opioid withdrawal symptoms. (11)
Lucemyra helps facilitate the abrupt discontinuation of opioid use in adults. Of course, this treatment option is not a magical solution — it may not completely prevent symptoms and is only approved for treatment up to 14 days.
Today, two of the most popular medications to assist during detoxification include methadone and buprenorphine (Suboxone). The research concerning these two medications is so strong that they were added to the World Health Organization’s list of essential medications.
To access these medications, recovering addicts must come to specialized clinics. However, there are potential side effects, so they should never be taken without proper medical supervision. (12)
Today, buprenorphine is often the preferred option concerning opiate replacement. This medication has been shown to cut overdose deaths in half, allowing people to live productive lives.
Suboxone combines buprenorphine and naloxone, which binds to opiate receptors. (13) By doing so, Suboxone blunts intoxication and reduces cravings. However, this medication is only prescribed once a user stops taking opioids and no longer shows signs of withdrawal.
Remember, opioid detox is not an end-all solution. Most people will continue taking opioids unless they receive further help.
When to Contact a Medical Professional
Working with an American team of mental health and substance abuse healthcare providers will ensure you get the treatment you need to succeed — not just today but for years to come.
The fear of withdrawal should not stop you from seeking a healthy, fulfilling life. The withdrawal process may be a significant barrier, but it represents a small window while focusing on the big picture. With the help of a professional care team, you will remain safe and comfortable. You can begin building a brighter future once you overcome the physical symptoms that hold you back. You deserve that.
Take the first step. You no longer need to fear opioid withdrawal. Support is available every step of the way. Give Zinnia Health a call at (855) 430-9439.
Citations
- https://www.ncbi.nlm.nih.gov/books/NBK310652/
- https://www.ncbi.nlm.nih.gov/books/NBK553166/
- https://pubmed.ncbi.nlm.nih.gov/28438097/
- https://www.ncbi.nlm.nih.gov/books/NBK537310/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9517221/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275643/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/
- https://www.ncbi.nlm.nih.gov/books/NBK562216/
- https://www.cdc.gov/drugoverdose/pdf/clinical_pocket_guide_tapering-a.pdf
- https://nida.nih.gov/sites/default/files/ClinicalOpiateWithdrawalScale.pdf
- https://www.fda.gov/news-events/press-announcements/fda-approves-first-non-opioid-treatment-management-opioid-withdrawal-symptoms-adults
- https://www.health.harvard.edu/mind-and-mood/treating-opiate-addiction-part-i-detoxification-and-maintenance
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517938/
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