Opioid withdrawal is a challenging experience that can occur when someone who has become dependent on opioids suddenly reduces or stops their use. It’s important to know that opioid withdrawal is a sign of physical dependence, not necessarily addiction, although addiction is a serious concern.
Opioid withdrawal can be extremely uncomfortable and, in some cases, can lead to serious complications. Seeking professional medical help is crucial for managing withdrawal symptoms safely and effectively. The information on this page is for educational purposes only and is not a substitute for medical advice. Always consult with a qualified healthcare provider.
What is Opioid Withdrawal?
Opioids, such as heroin, oxycodone, hydrocodone, and morphine, bind to opioid receptors in the brain and body, reducing pain and producing feelings of euphoria. With prolonged use, the body adapts to the presence of opioids, leading to physical dependence and tolerance. When opioid use is reduced or stopped, the body experiences withdrawal symptoms as it readjusts to functioning without the drug. You may feel this because your body has depended on it. You will need to use other methods.
Opioid Withdrawal Symptoms: A Detailed Overview
Opioid withdrawal symptoms can vary in intensity depending on the type of opioid used, the duration of use, the individual’s overall health, and other factors. Common symptoms include:
Physical Symptoms:
- Muscle Aches and Pains: Often described as deep, aching pains in the muscles and joints.
- Bone Pain: Similar to muscle aches but felt more deeply in the bones.
- Sweating: Often profuse and unrelated to physical activity or environmental temperature.
- Runny Nose (Rhinorrhea): Excessive nasal discharge.
- Watery Eyes (Lacrimation): Increased tear production.
- Goosebumps (Piloerection): Small bumps on the skin caused by muscle contractions around hair follicles (sometimes referred to as “cold turkey”).
- Yawning: Frequent and uncontrollable yawning.
- Fever: Elevated body temperature.
Psychological Symptoms:
- Anxiety: Often intense and overwhelming, with feelings of worry, fear, and apprehension.
- Irritability: Easily agitated or angered.
- Restlessness: Inability to sit still or relax.
- Insomnia: Difficulty falling asleep or staying asleep.
- Difficulty Concentrating: Impaired focus and attention.
- Craving for Opioids: An intense and overwhelming urge to use opioids.
Gastrointestinal Symptoms:
- Nausea: Feeling sick to your stomach.
- Vomiting: Expelling stomach contents.
- Diarrhea: Frequent and loose bowel movements.
- Stomach Cramps: Painful muscle contractions in the abdomen.
Other Symptoms:
- Increased Heart Rate: May be significantly elevated.
- Increased Blood Pressure: Can be dangerously high.
- Dilated Pupils: Enlarged pupils of the eyes.
Opioid Withdrawal Timeline: What to Expect
The timeline of opioid withdrawal can vary depending on the type of opioid used:
Short-Acting Opioids (e.g., Heroin, Oxycodone):
- Symptoms Begin: Within 6-12 hours after the last dose.
- Peak Intensity: Around 1-3 days.
- Symptom Duration: Most symptoms subside within 5-7 days.
Long-Acting Opioids (e.g., Methadone, Buprenorphine):
- Symptoms Begin: Within 24-72 hours after the last dose.
- Peak Intensity: Around 3-5 days.
- Symptom Duration: Can last for 2 weeks or longer.
Risk Factors for Severe Opioid Withdrawal
Certain factors can increase the risk of developing severe opioid withdrawal symptoms:
- High levels of opioid use
- Long duration of opioid use
- Use of long-acting opioids
- Co-occurring medical conditions (e.g., heart disease, lung disease)
- Co-occurring mental health conditions (e.g., anxiety, depression)
- History of previous severe withdrawal experiences
Diagnosing Opioid Withdrawal
Opioid withdrawal is typically diagnosed based on a physical examination, a review of the individual’s opioid use history, and the presence of characteristic symptoms. Assessment tools such as the Clinical Opiate Withdrawal Scale (COWS) are often used to quantify the severity of withdrawal symptoms. A healthcare professional will also want to rule out other causes for your symptoms.
Treatment for Opioid Withdrawal: Medically Assisted Treatment (MAT)
Medically assisted treatment (MAT) is a common form of treatment for opioid withdrawal and addiction. It involves using medications to reduce withdrawal symptoms and cravings, while also providing behavioral therapies and supportive care. MAT is proven to:
- Reduce withdrawal symptoms
- Decrease cravings
- Improve treatment retention
- Reduce the risk of overdose
Medications commonly used in MAT include:
- Buprenorphine: A partial opioid agonist that reduces cravings and withdrawal symptoms without producing the same level of euphoria as full opioid agonists.
- Naltrexone: An opioid antagonist that blocks the effects of opioids, preventing euphoria and reducing cravings. It comes in tablet and injectable formulations.
- Methadone: A long-acting opioid agonist that reduces cravings and withdrawal symptoms (typically used in specialized clinics with strict regulations).
- Lofexidine: An alpha2-adrenergic agonist that helps manage some of the non-opioid related withdrawal symptoms such as high heart rate, sweating and anxiety .
MAT is most effective when combined with behavioral therapies such as cognitive-behavioral therapy (CBT), contingency management, and motivational interviewing. This may lead to higher results when done in combination.
Other Strategies for Managing Opioid Withdrawal (Under Medical Supervision)
These should ONLY be implemented under the guidance and supervision of a medical professional.
- Over-the-counter medications for pain relief (e.g., acetaminophen, ibuprofen)
- Anti-diarrheal medications (e.g., loperamide)
- Anti-emetic medications (e.g., promethazine) for nausea and vomiting
- Comfort measures such as rest, adequate hydration, and warm baths
Finding a Treatment Program
If you or someone you know is struggling with opioid addiction and considering treatment, it’s important to seek professional help. Here are some resources for finding accredited addiction treatment programs that offer MAT:
- SAMHSA Behavioral Health Treatment Services Locator
- National Institute on Drug Abuse (NIDA)
- American Society of Addiction Medicine (ASAM)
Potential Complications of Opioid Withdrawal
Highlight the potential complications, even with medical supervision:
- Dehydration
- Electrolyte Imbalances
- Aspiration Pneumonia (due to vomiting)
- Relapse and Overdose (Relapse after a period of abstinence can be particularly dangerous due to reduced tolerance).
Although suicide is not a typical side effect, it may occur due to underlying conditions. Contact with a psychiatrist is important for those battling mental health challenges.
Prevention: Reducing the Risk of Opioid Withdrawal and Addiction
- Emphasize that the best way to prevent opioid withdrawal is to avoid opioid dependence.
- Promote responsible opioid prescribing practices by healthcare providers.
- Encourage individuals who are prescribed opioids to take them only as directed and for the shortest duration possible.
- Advocate for increased access to addiction treatment and prevention services.
Disclaimer:
The information provided on this page is for educational purposes only and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health or treatment. The absence of a warning should not be interpreted as a claim of safety. I am not a doctor and this is general information to be considered not medical. I urge you to seek counsel with your doctor for any advice.