Opioid Withdrawal and Detox

Quitting opioids suddenly can bring on severe withdrawal symptoms, including pain, nausea, sweating and anxiety. The experience is so grueling that it often deters people from getting help. Medical detox can ease the process and start you on the path to recovery from opioid addiction.
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People who use opioid painkillers for an extended period of time, whether they’re treating pain legally or using opioids illicitly, risk becoming physically dependent on the drugs.

Dependence develops over time. It is characterized by tolerance, which requires people to take increasingly larger amounts of the drug to feel the same effects. When the drug isn’t present in the body, people who are dependent go through withdrawal.

During this debilitating process, people don’t feel normal. They experience uncomfortable withdrawal symptoms, such as nausea, sweating and muscle aches. It’s often compared to having a bad case of the flu, though people may feel like they are dying.

While people rarely die from opioid withdrawal, it can be so miserable that it deters many with opioid addiction from seeking care.

But being dope sick, as it’s sometimes called, doesn’t have to stand in the way of recovery. Detox facilities can help you overcome withdrawal safely and effectively, and opioid treatment and rehab can minimize the risk of relapse.

Opioid Withdrawal Symptoms

The severity of opioid dependence and withdrawal can range from mild to moderate to severe depending on the type of opioid, how much you’re taking and how long you’ve been taking it.

A person using 50 milligrams or less of oxycodone per day, for instance, would likely experience milder withdrawal symptoms than a person using 50 to 100 milligrams of the drug each day. An individual using more than 100 milligrams of oxycodone daily would likely have a severe withdrawal reaction.

Early symptoms of opioid withdrawal include:

  • Anxiety
  • Agitation
  • Muscle aches
  • Tearing from the eyes
  • A runny nose
  • Insomnia
  • Sweating
  • Yawning

Late withdrawal symptoms include:

  • Dilated pupils
  • Goose bumps
  • Abdominal cramping
  • Nausea and vomiting
  • Diarrhea

Other acute withdrawal symptoms can include general aches and pains, moodiness, hot or cold flashes, difficulty concentrating, increased sensitivity to pain and intense drug cravings.

Opioid Withdrawal Timeline

The onset of withdrawal can vary depending on the type of opioid, but symptoms generally begin around the time that people would have normally taken their usual dose.

Short-acting opioids wear off sooner than longer-acting opioids. As a result, people who are dependent on short-acting opioids, such as morphine, oxycodone and heroin, usually experience withdrawal symptoms six to eight hours after the last dose. The symptoms peak in two to three days and typically resolve within a week.

With longer-acting opioids, such as methadone, withdrawal symptoms may not occur until one to three days after the last dose. Symptoms peak in about 10 days, but they can linger for up to three weeks.

That said, there is no set timetable for how long opioids stay in your system and how long the withdrawal process will last. The duration of withdrawal may also vary depending on how long a person has been using opioids and what dose he or she has been taking.

Withdrawal Complications

While opioid withdrawal is rarely life-threatening, complications can occur.

People who are vomiting can accidentally inhale their stomach contents. This is known as aspiration, and it can lead to pneumonia. Severe vomiting and diarrhea can also cause dehydration, which can result in electrolyte disturbances, irregular heartbeat, kidney injury and other serious problems.

The greatest dangers during opioid withdrawal are relapse and overdose.

Because opioid withdrawal is so grueling, people often return to drug use to alleviate their symptoms. Unfortunately, the risk of an accidental opioid overdose is much greater after a period of abstinence.

Tolerance drops rapidly during sobriety, so the same dose a person was accustomed to taking may prove fatal.

Managing Opioid Withdrawal

With a strong support system and medications, some people may be able to overcome withdrawal at home.

The internet is littered with various home remedies for opiate withdrawal, ranging from vitamins and supplements to special diets and exercise.

Increasing numbers of Americans have also been turning to an herb called Kratom for relief from opioid withdrawal. But according to the Food and Drug Administration, the substance is just as addictive as opioids and can be deadly.

Many people — particularly those with severe withdrawal symptoms or other medical conditions — require treatment at a detox facility. Opioid detoxification can be done in an inpatient or outpatient setting depending on your needs and situation.

As an inpatient, you will be monitored around the clock. Medical staff will ensure that you stay hydrated and nourished. They can also administer medications as needed to relieve pain, nausea, anxiety or other troubling symptoms.

Outpatient treatment does not require you to stay at a rehab facility, but it can also include medications. Because extensive monitoring is not provided in outpatient detox, it is more suitable for patients experiencing mild withdrawal.

People who have intense drug cravings or suicidal thoughts during withdrawal should be monitored in an inpatient setting.

Medication-Assisted Treatments for Withdrawal

Methadone and buprenorphine are common therapies approved by the Food and Drug Administration for treating opioid withdrawal symptoms and reducing cravings.

Methadone, which has been used to treat opioid dependence for decades, is a long-acting opioid that can reduce cravings and alleviate withdrawal symptoms. It does not cause the euphoric and sedating effects of most other opioids. A person going through withdrawal will typically take increasingly smaller doses of methadone over six to 10 days.

Subutex (buprenorphine) works similarly to methadone and should be started once a person is in mild or moderate withdrawal. If it’s started too early, the treatment can trigger immediate and intense withdrawal symptoms.

This severe reaction is known as precipitated withdrawal. It can be avoided by waiting at least eight hours after your last opioid dose before starting buprenorphine.

Another prescription drug used to relieve opioid withdrawal symptoms is clonidine. The sedative, which is also used to treat high blood pressure and attention-deficit/hyperactivity disorder, can reduce withdrawal symptoms by 50 to 75 percent.

Although clonidine can relieve anxiety and muscles aches associated with withdrawal, it does not reduce cravings. It is significantly less effective than buprenorphine for opioid detoxification, according to research conducted by the National Drug Abuse Clinical Trials Network.

Anti-nausea medications, muscle relaxers, sedatives, sleep aids and antihistamines may also be prescribed to treat withdrawal symptoms. Over-the-counter pain relievers, such as Tylenol (acetaminophen) and Advil (ibuprofen), can ease aches and pains. Imodium and similar medications can reduce diarrhea and abdominal cramping.

Long-Term Withdrawal

Even after detox is complete, a person may continue to feel unwell for weeks or months after quitting opioids. This phase is sometimes called protracted withdrawal or post-acute withdrawal syndrome.

Common symptoms of protracted withdrawal include feeling generally ill and having strong cravings for opioids.

Other long-term withdrawal symptoms can include:

  • Depression
  • Inability to feel pleasure (anhedonia)
  • Fatigue
  • Insomnia
  • Trouble concentrating
  • Sleep problems

Because of these challenges and the likelihood of relapse, detox is only the first step toward overcoming opioid addiction. Long-term sobriety depends on continued treatment focused on understanding the disease of addiction and learning how to cope with cravings.

People with opioid addiction often benefit from a treatment plan that combines medication, counseling and other behavioral therapies. This approach, which is known as medication-assisted treatment, is the best option for treating opioid use disorders, according to the Centers for Disease Control and Prevention.

If you or someone you love is showing the signs and symptoms of opioid addiction, help is available to stop the vicious cycle. Call today to learn more information about treatment options and how to start down the road to recovery.

Author
Amy Keller, RN, BSN
Content Writer, DrugRehab.com
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.
@DrugRehabAmy
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