Opioid Withdrawal

Opioids make up a class of synthetic and semisynthetic drugs, which are derived from morphine. Morphine itself is a semisynthetic drug derived from the opium poppy, and it is a potent painkiller prescribed in rare instances of severe, chronic, or end-of-life pain. Other opioid medications, typically based on oxycodone or hydrocodone, are widely prescribed to treat moderate or severe pain. This pain can be chronic, such as from arthritis, fibromyalgia, cancer, or an injury, or it could be a short-term prescription to treat postsurgical or injury-related pain, such as from wisdom tooth removal or a work injury.

Another type of opioid drug that is widely found, but illegal, is heroin. This illicit drug is very potent and fast-acting, which makes it highly addictive.

Opioid Addiction Epidemic

The United States is currently suffering an opioid addiction epidemic, in large part because liberal prescribing practices in the early 2000s led to thousands of people becoming addicted to prescription painkillers. As lawmakers and doctors changed prescribing practices and made painkillers more difficult to obtain, many people struggling with prescription painkiller addiction turned to heroin and other illicit versions of painkillers sold on the black market.

In 2014, according to the American Society of Addiction Medicine, 1.9 million people struggled with prescription opioid addiction, and 586,000 people struggled with heroin addiction. Drug overdose is currently the leading cause of accidental death in the US, primarily involving opioids. Between 2000 and 2014, notes the Centers for Disease Control, about a half-million people died from opioid overdoses, which is about 78 people every day.

People who struggle with opioid addiction may, at some point, decide to end their addiction. At this time, it is important to seek professional help. Opioid withdrawal symptoms are rarely dangerous, but they can be very uncomfortable. With help, this discomfort can be treated and overcome, but it is, unfortunately, often enough to force a person back into taking opioids.

Dependence vs. Addiction

Withdrawal symptoms are caused by the body’s dependence on opioids. Dependence can occur even if a person takes their opioid prescription as directed, under medical supervision. The body becomes used to the influx of opioid drugs, which attach to receptors on neurons to relieve pain, and stimulate the release of dopamine. Without this influx of chemicals, the person’s body goes through withdrawal.

Some people are more prone to addiction than others due to a complex relationship between genetics, family history, environment, and mental health. Opioid use in some individuals can stimulate the risk/reward system, which involves dopamine; this can drive them to take more of the drug, because the brain experiences reward for taking the drug. Over a long period, the brain becomes dependent on the drug to feel normal, and removing opioids can seem like a threat to a person’s life, which stimulates intense cravings, fear, anxiety, and compulsive ingestion, even when the individual does not want to take opioids anymore.

How Long Does Opioid Withdrawal Take?

The length of time a person experiences withdrawal can vary, depending on which opioid they abused. If a person took a large dose of opioid drugs, struggled with addiction for a long time, or both, they could experience withdrawal symptoms longer than a person who took small, controlled doses of the drug supervised by a physician. Long-acting opioids like methadone can lead to longer withdrawal processes than short-acting drugs like Percocet.

Withdrawal symptoms will typically begin between six hours and two days after the last dose, depending on the drug’s half-life. For example, heroin withdrawal begins within 12 hours after the last dose, while methadone withdrawal begins about 30 hours after the last dose. The most intense withdrawal symptoms pass after two weeks; however, some people may experience post-acute withdrawal syndrome, or PAWS, which can extend psychological symptoms of withdrawal for several more weeks.

Timeline for Opioid Withdrawal

There are three basic stages of opioid withdrawal. These can last for different amounts of time, depending on the factors listed above.

  1. Early stageThis is the first stage of withdrawal, and it can begin within the first day after the last dose. Symptoms may feel like a cold or the flu and include sweating, runny nose, muscle aches, goosebumps, twitching, and watery eyes. Psychological symptoms include agitation, restlessness, anxiety, insomnia, and cravings. Some people experience localized pain, including in the legs, stomach, and back.
  2. Peak stage: Opioid withdrawal symptoms feel the most intense within 36-72 hours after the final dose. Much of the physical symptoms, including abdominal upset and muscle aches, are the strongest. The person may experience nausea, vomiting, diarrhea, rapid breathing and heartbeat, and fever. However, these symptoms begin to resolve within three days.
  3. Late stage: Physical symptoms overwhelmingly resolve within 10 days. The person may continue to experience cravings and psychological side effects, such as anxiety or depression, depending on how long they struggled with addiction to the opioid. Some physical symptoms, including muscle weakness or fatigue, can remain or reappear, but this is rare.

Opioid Withdrawal Complications

Protracted withdrawal, or PAWS, is a potentially serious complication associated with opioid withdrawal. Although many people who detox from opioids can continue to feel sluggish or depressed after withdrawal, for the most part, their physical symptoms will dissipate; however, with PAWS, physical symptoms can remain for weeks, sometimes months. Symptoms of PAWS include:

  • Insomnia or sleep disturbances
  • Fatigue, anhedonia, or dysphoria (inability to feel pleasure or feeling emotionally blunted)
  • Decreased cognitive abilities
  • Inability to focus
  • Cravings
  • Increased sensitivity to physical pain

It is important to get medical supervision for opioid detox to avoid these potential complications.

How Medical Supervision Can Help Opioid Withdrawal

Medical supervision for detox is a very important first step in overcoming an addiction to narcotics. Doctors can work with their patients in different ways to safely withdraw from opioid drugs. Sometimes, over-the-counter medications, such as anti-nausea drugs and painkillers, are used to ease withdrawal symptoms. Other people may need prescription replacement therapies, also called maintenance therapies.

One of the most championed maintenance drugs right now is buprenorphine, a partial opioid-agonist that binds to opioid receptors and relieves withdrawal symptoms. Once a person receives a buprenorphine prescription, their doctor will work with them to taper the prescription slowly over time, which eases the body off physical dependence on the opioid. Buprenorphine is a long-acting medication, so people who habitually take opioids several times a day can also work to overcome that habit.

Using maintenance therapies to detox from an opioid addiction can stretch the withdrawal process by several months or even years. However, the point of these therapies is help a person end their physical dependence on opioids and reduce the potential for relapse into abuse. When a person does not experience serious physical complications from opioid withdrawal and has social support along with medical supervision, they are less likely to relapse and overdose on opioids.

About The Contributor

Editorial Staff
Editorial Staff

Editorial Staff, American Addiction Centers

The editorial staff of Greenhouse Treatment Center is comprised of addiction content experts from American Addiction Centers. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed... Read More

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