Detoxing from Opioids: What Is Withdrawal Like?

In 2018, more than 67,000 Americans died from drug overdoses. Nearly 70% of those deaths involved either a prescription or illicit opioid. Opioid use remains a tragic epidemic. Without proper treatment, many people can’t quit their addictions.

But that doesn’t have to be you.

Detoxing from opioids may seem frightening, but it’s the first step of successful treatment. It’s important to know what to expect.

What To Expect During Opioid Withdrawal

Opioids act on the opioid brain receptors. Eventually, these receptors depend on you to keep using opioids, which can build up a tolerance. Tolerance means your body adapts to the drug, so it needs the drug to feel “normal.” Over time, you’ll need to take more of it to feel a sense of normalcy.

If you stop taking opioids, your body enters a withdrawal state, when it has to physically adjust to the sudden change of not having the drug anymore.

Withdrawal symptoms vary in intensity. For some people, they only feel mildly distressing. For others, the symptoms can seem downright unbearable. Withdrawal intensity can depend on:

The amount and frequency of opioid use
History of past detoxes
Co-occurring mental illness, like anxiety or depression
Medical complications
The presence of other substances in your body

When Does Withdrawal Start?

Withdrawal symptoms can emerge at different times. Some opioids are short-acting. Short-acting opioids include:

Immediate-release morphine
Hydrocodone
Hydromorphone (Dilaudid)
Tramadol
Opium
Codeine
Heroin

Withdrawal symptoms tend to occur 6 to 12 hours after the last dose.

Long-acting opioids include:

Morphine-controlled or extended-release (Oramorph, Kadian, Avinza)
Oxycodone-controlled or extended-release (OxyContin)
Fentanyl transdermal (Duragesic)
Oxymorphone extended-release (Opana)

Long-acting opioid withdrawal symptoms first emerge within one to two days. Most opioid withdrawal symptoms peak around 72 hours after the last dose. They tend to persist for about one week.

Opioid Withdrawal Symptoms

Initial withdrawal symptoms can happen quickly. They tend to feel mild at first, but they intensify within two to three days. Common initial symptoms include:

High cravings for opioids
Sweating and increased body temperature
Nausea, vomiting, and other gastrointestinal problems
Body aches and muscle pains
Anxiety
Depression
Flu-like symptoms like runny nose, chills, and night sweats

Around 72 hours, symptoms may also include:

Worse gastrointestinal distress
Hypertension
Intense mood swings
Severe body aches and pains

Symptoms tend to get less severe after a few days, but some symptoms persist for several weeks or months. This phenomenon is known as post-acute withdrawal syndrome (PAWS). Approximately 90% of recovering opioid users experience some PAWS symptoms. These symptoms can fluctuate over time. They may include:

Anger and cynicism
Depressed or apathetic mood
Difficulty with relationships with other people
Increased sensitivities to stress
Sleep problems.
Obsessive-compulsive issues
Issues with problem-solving, memory recall, or learning
Intensified panic and anxiety

Why Medical Detox Supports Opioid Withdrawal

In most cases, opioid withdrawal isn’t fatal. That said, complications can arise. Without medical treatment, these complications can result in life-threatening issues. Why? A couple of reasons:

Opioids can be extremely addictive. While many users want to stop using, lots find that they can’t do so on their own. Instead, they get trapped in a vicious relapse cycle. At the first sign of withdrawal, many return to the drug for immediate relief.

When you’re in medical detox, you live in a treatment facility. This reduces the triggers in your daily life. When you’re separated from your home environment, you don’t have access to the influencer of your friends or family; drug paraphernalia; or other common stressors, like work or school. Instead, your receive ongoing support and compassion.

Opioid users often combine substances. For example, some people regularly drink alcohol or take benzodiazepines while they’re on opioids. Withdrawal from some substances can be dangerous, so withdrawal from any combinations of drugs can be lethal.

The medical professionals in medical detox will assess you to understand your history with drugs and any others you may be taking in addition to opiods. They will also monitor you to keep you safe from dangerous opioid withdrawal symptoms.

Nearly 40% of people with addiction problems also have a mental illness. Mental illness can cause serious problems like:

Suicidal thoughts
Self-harm
Psychotic behavior (hallucinations or delusions)
Homicidal thoughts (wanting to hurt someone else)
Severe depression
Intense panic

Any of these symptoms can result in serious consequences. During detox, people are especially vulnerable. That’s why receiving medical and psychiatric support is so important.

What Medically Supervised Detox Is Like

Detox starts with a comprehensive assessment. You will discuss your medical and psychological history with a treatment professional. Many people feel weak when they first arrive, so you may need to spend extra time resting. You’ll be supported throughout your treatment.

All detox provides ongoing supervision. As you detox, you may meet with a case manager or therapist. They will help you with relapse prevention and they’ll coordinate aftercare. Detox is just the first step in recovery, when your body flushes out the toxins in your bloodstream. It isn’t a standalone treatment. Most people need ongoing care through inpatient or outpatient programs.

The length of time you spend detoxing depends on several things, like:

Your medical and mental health history
Substances present in the bloodstream
Previous detox episodes

Medications for Opioid Withdrawal

The FDA has approved several medications for opioid withdrawal.

Methadone: Methadone acts on opioid receptors, just like opioids do. That’s because it is an opioid, making this treatment method somewhat controversial. There is a possibility for misuse and addiction. Currently, clients can only receive methadone administered from specific programs.

Buprenorphine: Buprenorphine, which is known as Subutex, can help decrease drug cravings. If you relapse, it may block the positive sensations. Suboxone contains a combination of both buprenorphine and naloxone. The naloxone also blocks the positive effects of opioids, and it triggers a withdrawal state if someone attempts to inject their Suboxone. That means the naloxone can deter a relapse. Both medications can be habit-forming and must be taken as prescribed.

Naltrexone (Vivitrol): Naltrexone comes in injectable and tablet forms. It can help reduce cravings. It also blocks opioid action, and there is no potential for dependence.

Opioid withdrawal can be an uncomfortable process, but it’s short-lived. And the result is a body that’s free from opioids and the opportunity to start fresh. With the right support, you can get through this process and continue in the recovery track that’s right for you. No matter your history, we at Footprints to Recovery are here for you. Contact us to give yourself a chance at recovery today!

References

Medically Reviewed by Sierra Gabrys, M.Ed., LCPC, NCC, CCM