Opioids are a classification of drugs derived from opium that are generally used to treat pain. With continued opioid use, dependency will form. The opiate withdrawal process can cause distressful symptoms and needs to be managed with medical oversight to ensure safety.
Opioid withdrawal may result after a person who has been taking pain medication for a prolonged period, such as in the cases of injuries or chronic conditions, stops taking their medication. Withdrawal may also occur in cases where a person is using illegal opiates, such as heroin, and is unable to access the drug for any reason.
The U.S. Drug Enforcement Administration classifies different opiates under different schedules based on their potential for addiction and misuse. This is because different forms of opiates may have a higher potential for abuse and addiction due to their relative potency.
Withdrawal symptoms associated with opiate use are one factor that contributes to their addictive properties. People who have become dependent on them experience a return of painful symptoms, along with other symptoms such as anxiety and cravings, which are then relieved when the drug is taken again. Thus, opiates act on your central nervous system to create a cycle of pain and relief that contributes to the habit-forming nature of opioid medications or substances.
The American Society of Addiction Medicine reports that opiates are the major contributor to the overdose epidemic in the U.S. There were more than 33,000 deaths in 2015 from prescription painkillers and heroin.
Opiate withdrawal symptoms include:
The severity of these symptoms depends on the severity of the dependence on the opiate drug. A person who has been taking high doses of opiates for a long period will have a more severe reaction than a person who has only taken them for a couple of weeks because of an injury or surgery. In very severe cases of addiction, opiate withdrawal can even cause death if not managed properly because excessive vomiting, diarrhea, and the resulting dehydration can cause heart failure.
Therefore, it is important that people with opiate addictions receive the proper treatment and medical monitoring to reduce the severity of their symptoms and undergo a properly constructed detox protocol. The Mayo Clinic recommends tapering off opioids slowly to prevent severe withdrawal symptoms and to allow the body to gradually adjust to lower doses of opiates.
The length of an individual’s withdrawal symptoms also varies due to a variety of factors. In general, the longer a person has been dependent on opiates, the longer their withdrawal symptoms may last.
Another factor to consider is the half-life of an individual medication or drug, which is how long any particular substance takes to metabolize. Heroin is a shorter-acting form of opiate that is quickly absorbed and metabolized, and withdrawal symptoms may begin as soon as six to 12 hours after the last dose.
Forms of opiates that are longer-acting, such as methadone and buprenorphine, may not induce withdrawal for between one to two days after the last dose is taken.
In some instances, doctors who are managing detox for a patient addicted to opiates will assess the patient’s dosage and gradually step down to smaller dosages to manage withdrawal symptoms. Replacement medications like buprenorphine are often used during opioid withdrawal.
After the initial detoxification process, when acute withdrawal symptoms have started to subside, people with opiate addictions often still contend with longer lasting psychological symptoms including cravings and anhedonia. These symptoms can sometimes last for months or even years. Thus, recovery is a process that often involves medication management and behavioral therapy on a long-term basis.
Although every individual may experience variations in their symptoms, the following is a guide to what to expect day to day during the withdrawal process from opiate drugs.
The first couple days withdrawals are often the hardest. During this time, most people will experience muscle pain, diarrhea, loss of appetite, excessive sweating, anxiety or panic attacks, runny nose, or flu-like symptoms. The most challenging part of these first couple of days is managing the pain that is associated with withdrawal, which is why this is a highly sensitive time in which many people relapse if they are not under proper care. These symptoms might begin their onset within 12 hours if the opiate being used has a short half-life, such as heroin. If the drug has a longer half-life, the symptoms may not begin until 48 hours after the last dose.
During this time, the most painful symptoms will have subsided, and symptoms will be milder overall. People may still experience diarrhea, less severe pain, shivering or goosebumps, abdominal cramps, and some vomiting.
Those who are withdrawing from opiates with a shorter half-life will experience an improvement in their symptoms, while those who were on longer-acting medications may still be experiencing sweating, a lack of appetite, insomnia, and digestive problems. Muscle pain should begin to diminish at this time.
By this time, most people will begin to feel some relief from the pain and discomfort of withdrawal. Some symptoms may still be present, such as digestive troubles, nausea, and anxiety. These symptoms should be milder than the first few days and will continue to improve with time.
After the first week, the physical symptoms from withdrawal should be subsiding, but the psychological and emotional symptoms may still be present. Some physical symptoms, such as nausea, may still be mildly present for two to three weeks.
While the body may not be experiencing pain, the brain may still be craving the drug. The brain has been conditioned to demand more of the drug to stimulate its pleasure receptors. It may take some time before people feel like they can experience pleasure from the things they used to enjoy before their opioid abuse began.
The brain’s natural chemistry may take some time to respond to natural endorphins again, so this is a time when recovery support needs to be strong. It may take people one to three months and possibly up to a year before they feel the emotional and psychological symptoms are entirely at bay.
Because of the severity and distressful nature of opiate withdrawal, the process needs to be managed by medical professionals who can help keep patients safe and as comfortable as possible throughout the process. Most people who have opiate dependency need medical assistance to get through the withdrawal process to have a successful recovery. Studies have shown that there are effective medical therapies to help people withdraw from opiates safely and transition into a structured recovery plan.
Opiate withdrawal is managed by providing the patient with decreasing dosages of a replacement medication, such as buprenorphine, to slowly withdraw the patient from opiates. Without a slow withdrawal, symptoms may become dangerous and painful, potentially causing relapse or major health complications.
Recommendations for the length and course of treatment for opiate withdrawal will depend on the type of drug that was being abused, the amount of the drug that’s being taken, and the severity of the addiction.
Some people may be able to withdraw from opiates safely by simply following the instructions from their doctor about dosage decreases. An example of this may be a patient who received an opiate prescription after surgery and took the medication for a short period for their recovery.
These people may be able to work with their doctor to slowly decrease their dosage to prevent serious withdrawal symptoms and manage their pain after recovery from surgery. People who have been abusing an opioid need further assistance.
Some people with severe opiate addictions may need to be on a methadone or buprenorphine maintenance program for months to years, which is increasingly being recognized as the best standard of care for those with serious and prolonged addiction histories. The National Institute on Drug Abuse reports that methadone, buprenorphine, or naltrexone treatment combined with behavioral therapy present the best opportunity to help people recover from serious opiate addictions.
People who have been addicted to opiates for years, and who may have turned to illegal sources like heroin, may need a more prolonged detox protocol and additional support as they withdraw from opiates. Because of their prolonged exposure to opiates, the detox process will be longer and may involve medication management as well as long-term therapy.
If you or someone you care about is suffering from substance abuse and is ready to take first steps toward recovery and a better, sober tomorrow, California Highlands Addiction Treatment can help. We offer medical detox treatment with a seamless transition into ongoing care through to our post-treatment alumni program.
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(2016) Opioid Addiction 2016 Facts and Figures. American Society of Addiction Medicine. from https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
(2012) Maintenance Medication for Opiate Addiction: The Foundation of Recovery. Journal of Addictive Diseases. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411273/
Drug Scheduling. U.S. Drug Enforcement Agency. from https://www.dea.gov/drug-scheduling
(2018, August 21). Information sheet on opioid overdose. World Health Organization. from https://www.who.int/substance_abuse/information-sheet/en/
Opioid Addiction. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/pharmacotherapies
What to do when it's time to stop opioids. Mayo Clinic. from https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/tapering-off-opioids-when-and-how/art-20386036