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Opioid Withdrawal

It usually takes about one week to withdraw from opioids. The detox process is accompanied by flu-like symptoms. Find out how medical treatment can help you ease withdrawal, come down off of opioids safely, and avoid side effects.

13
minute read

ARTICLE SUMMARY: Opioid withdrawal can feel like a really bad flu. Learn how symptoms are addressed medically here. Then, we invite your questions at the end.


ESTIMATED READING TIME: 10 minutes


TABLE OF CONTENTS:


Quitting Opioids Can Save Your Life

Drug dependent?  Considering quitting?

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KNOW THIS: Quitting opioids like Fentanyl, Vicodin, OxyContin, codeine, tramadol, hydrocodone, or oxycodone on your own can be hard. Extremely hard. In fact, going through withdrawal alone can lead unnecessary pain. Or, it can lead to relapse and a return to drug use.

Why go through opioid withdrawal and detox alone? Medical centers can help you overcome your dependency in a SAFE and RISK-FREE way. Here, we review the medical protocols typically used during opioid withdrawal. We’ll walk you through common symptoms, side effects, and their duration.

Then, we invite your feedback or questions at the end. In fact, if you leave us a personal question, we try to answer it promptly! More here on what to expect during opioid withdrawal.

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What is Withdrawal?

Opioid withdrawal is a series of symptoms that appear when you stop or significantly reduce your dose of pain reliever medicine. Why does withdrawal happen?

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The body is always trying to maintain a state of balance. When your body has become accustomed to opioids. the system triggers has to “speed up” to balance out the depressant effects of the drug. But take away the drug, and it takes time for the “stimulant” symptoms to resolve.

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Dependence or Addiction?

Many times the terms “physical dependence” and “addiction” are used to describe the same condition. To be more precise, addiction involves the body AND mind while physical dependence involves the body. Physical dependence on opioids manifests as withdrawal symptoms after you abruptly lower doses, stop use, or miss a dose.

So how does a person become dependent?

Physical dependence on opioids is an expected outcome after regular long term use of these drugs for pain relief. With repeated use your body becomes accustomed to the presence of opioids. Plus, as you take your painkiller dose day by day, your body starts responding less and less to the effects. This condition is known as “opioid tolerance”.

Drug tolerance happens when your body no longer responds to dosing like it once did. When your body becomes opioid tolerant it means that it has actually adapted, or got used to them, decreasing their effectiveness. When that happens, it is necessary to either increase the dosage or switch to another type of opioid medication to maintain pain relief.

If you do not stop the intake of opioids after a physical dependence has taken place you’ll begin to slowly lose control over your use and physical dependence will progress into a condition called “addiction”. Wondering how can physical dependence on opioids be recognized? It’s easy.

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Addiction is a neurobiological disease with a genetic, psychosocial, and environmental factors. It is characterized by one or more of the following behaviors:

  1. Compulsive opioid use.
  2. Continued use of opioids despite physical, mental and/or social harm.
  3. Cravings for opioids.
  4. Loss of control over your opioid use.

There is also another term widely used among doctors to describe people’s behaviors whose pain is not adequately treated. These people develop a syndrome called “pseudoaddiction” Patients who are desperate for pain relief may watch the clock until time for their next opioid medication dose and do other “drug seeking” behaviors, such as taking medications which haven’t been prescribed to them, and/or taking illegal drugs.

So what is the difference between “pseudoaddiction” and real addiction?

The difference is that people’s drug seeking behaviors with pseudoaddiction stop when their pain is treated effectively.

Psychoactive Effects Of Opioids

Drugs like opioids work because they closely resemble molecules that occur naturally within the body. For example the Central Nervous System (CNS) includes a remarkable capacity to reduce pain through the release of natural neurotransmitters known as “endorphins”. Opioid drugs resemble these natural molecules. They stimulate the endorphin receptors, artificially activating the body’s system for pain relief and euphoria.

Opioids act on several brain and nervous system regions such as:

  1. The limbic system responsible for emotions. Here, opioids create feelings of pleasure, relaxation, and contentment.
  2. The brainstem, responsible for automatic responses such as breathing. Here, opioids slow breathing, stop coughing, and reduce pain.
  3. The spinal cord, which receives sensations from the body before sending them to the brain. Here opioids decrease feelings of pain, even after serious injuries.

Addiction Liability

Opioids are highly addictive. How long it takes to become addicted to opioids will depend on:

  • Frequency of your use.
  • How quickly the drug makes changes in the brain’s limbic reward system.
  • The amount of opioid you use.
  • The type and potency of the opiate.
  • Use of multiple drugs.
  • Whether you are using a legally prescribed opiate for pain relief, or you abuse an illegal opiate to experience euphoria and high.

Even people who are taking pain killers for therapy can become addicted to them! So, what’s the way forward?Medical treatment can greatly reduce, or eliminate most of the symptoms of withdrawal. Let’s take a look at them now.

Most Common Symptoms

The average time needed to completely detox is around week. Withdrawal usually includes the following symptoms:

  • Abdominal cramping
  • Diarrhea
  • Dilated pupils
  • Goose bumps
  • Insomnia
  • Muscle aches
  • Nausea
  • Runny nose
  • Sweating
  • Vomiting
  • Yawning

Levels Of Opioid Withdrawal?

In order to determine the intensity and severity of opioid withdrawal symptoms medical practitioners use “The Clinical Opiate Withdrawal Scale (COWS)”. This scale is designed to help both people in detox and clinicians determine whether opioid withdrawal symptoms are mild, or have taken a serious course and became severe. This will also help doctors to find out when to intervene and prescribe people in withdrawal with a medication to ease dangerous symptoms and prevent health complications.

COWS can be used in both, inpatient and outpatient settings to reproducibly rate common signs and symptoms of opiate withdrawal and monitor them. The summed score for the complete scale can be used to help clinicians determine the stage or severity of opiate withdrawal and assess the level of physical dependence on opioids. You can find The Clinical Opiate Withdrawal Scale (COWS) here.

Opioid Withdrawal Is Highly Individual

Despite the general categorization of opioid withdrawal, each person’s experience with this process is individual. The progress and dynamics of detox will manifest differently at different people. The uniqueness of the withdrawal experience is influenced by the following factors:

  1. The length of time you’ve been using opioids.
  2. The amount and the type of opioid you’ve been taking.
  3. Whether you combined opioids with other drugs.
  4. Your general/overall physical health, age, gender.
  5. Your unique body response and metabolism of opioid.
  6. Presence of co-existing physical or psychological health conditions.

Timeline

Acute opiate withdrawal is the period during which your body will suffer from severe to mild mental and physical pain. Opiate detox develops with the following dynamics:

1-3 DAYS. Opiate withdrawal usually begins after 12 hours of discontinuation. Once the withdrawal fully begins, muscle aches and pain are the first noticeable symptoms. Along with the pain, it is also likely that you’ll sweat a lot, have diarrhea, experience loss of appetite and be unable to sleep. Other common symptoms at the start of opioid withdrawals include anxiety and extreme irritability frequently followed by panic attacks.

4-6 DAYS. Opiate withdrawal symptoms usually peak during the first week. These days are the most difficult to get through where symptoms are most intense and during which many people relapse. By this point, the worst of the pain should be over, but not completely gone. What’s most important during this week is to eat a lot of vegetables and drink a lot of water to remain hydrated. Most common symptoms during this period are: vomiting, diarrhea goosebumps, and severe abdominal cramps.

7TH DAY and longer. Once pass the first week and reach the 7th day, you’ll start to experience little victories, but your body is still fragile and withdrawal is not quite over yet. Some people might still find it difficult to eat and may experience nausea and anxiety at the last stage. However, this is a period of overall stabilization.

Post Acute Withdrawal. There is a group of people who detox even longer than the general timeframe. For them, withdrawal symptoms do not end here. An extended withdrawal period may continue long after opiates have been eliminated by the body, and acute symptoms have disappeared. These persisting symptoms are known as post-acute withdrawal syndrome (PAWS). They can last for months and can include:

  • Anxiety
  • Depression
  • Fatigue
  • Irritability
  • Poor sleep

Is Cold Turkey Opioid Withdrawal A Good Idea?

There are endless debates on the subject of which method is better for opioid discontinuation.

“Cold turkey” is considered a drastic method which provokes intense withdrawal symptoms and increases the chances of relapse. Trying to quit opioids abruptly, however, can bring on the following health complications:

  • Extreme fatigue
  • Increased heart rate
  • Restlessness
  • Severe headaches
  • Vomiting

Medical professionals DO NOT recommend stopping painkillers abruptly on your own. Going cold turkey can result in unnecessary pain. Instead of risking your health, doctors recommend that tapering off doses of the opioid you are taking over the course of few weeks. Your prescribing doctor will monitor your progress and adjust doses according to the reactions of your body. Doses are usually decreased by 10% of the original dose per week. Some people can be tapered more rapidly without problems during the course of 6 – 8 weeks.

Pre-Tests

At the beginning of your opiate withdrawal journey your doctor will ask questions about your medical history and drug use. Before you undergo detox, you’ll pass through several testing procedures such as:

  • Urine or blood tests to screen for drugs and confirm opiate use.
  • Blood chemistries and liver function tests such as CHEM-20.
  • CBC blood tests.
  • Chest x-ray.
  • EKG, an electrocardiogram heart trace
  • Testing for hepatitis C, HIV, and tuberculosis (TB).

Safety During Opioid Withdrawal

If you’ve been on opioids longer than a couple of weeks and have tried quitting on your own, you probably struggled with pain. This might have lead you back to using. If you want to get out of this repeated cycle, then you’re a  candidate for medically assisted opiate detox.

Professionally monitored opiate detox is performed in a safe and comfortable environment. A controlled, drug and stress free environment is an essential element for a persons state of mind. If you have access to your home, family, and work-life, the odds are greater that you’ll fall back into similar patterns and eventually relapse.

Removing yourself from these triggering situations increases the chance of creating a foundation on which to build and develop long term sobriety. During the process of medical opiate detoxification, you’ll be able to participate in counseling session with a therapist, and enroll in a group therapy with others who recover from opiate dependence as well. Additionally, medicines can be prescribed to address withdrawal symptoms as they occur.

 

Medications and Medical Experts

Several medications have demonstrated effectiveness in their ability to reduce the unwanted effects of opiate withdrawal. These medicines are usually only available during inpatient detox. So, you’ll need to seek help through a detox clinic. Medicines used to address withdrawal symptoms include:

1. Methadone. A long-acting opioid that alleviates withdrawal symptoms and reduces cravings without causing addiction and euphoric high.

2. Buprenorphine (Suboxone). This medication activates the opioid receptors to limit withdrawal syndrome. Buprenorphine acts as a partial opioid agonist, this makes it less capable of producing euphoria or sedation.

3. Clonidine. Originally used for treatment of high blood pressure, this medicine can help reduce certain symptoms of opioid withdrawal. Since this is not an opioid itself, there is little to no potential for abuse.

Starting out the right way will help you quit for good. Isn’t that why you want to get sober in the first place? Medically assisted detox can help you get rid of opioids. But who can you go to for help?

When in need of professional help, seek advice from:

  • A licensed clinical counselor/psychologist
  • Addiction doctor (an MD specialist)
  • Addiction treatment center
  • A Drug detox clinic
  • A Family doctor
  • A Psychiatrist

Tips For Getting Through Opioid Withdrawal

Withdrawal requires that you are physically mentally and emotionally prepared. One of the most important things that can help you go through detox is the ability to calm down naturally. An inner calm will help you achieve and maintain self-control.  The following tips can help you establish stronger self-control during detox. The idea is that you can finish the process successfully!

TIP #1. Believe in the possibility of recovery and use affirmative language. Having faith in yourself can motivate you to direct all your energy and strength towards sobriety. Changing the way you think and implementing statements such as “It is possible”, “I’m going to do my best to succeed” have a powerful influence over your subconscious mind.

TIP #2. Talk to someone when crisis strikes. Whether it is a friend, family member, your doctor, or individuals in a self-help group, talking to someone about your expectations, fears and thoughts can greatly relieve your tension and anxiety. Psychological and emotional support are somthing you need! Having someone to discuss your feelings with can help you avoid relapse and remain engaged in the process.

TIP #3. Rest and get plenty of sleep. Sleep is one of the most important aspects of helping you get through withdrawal. Whether you are in the first stages or the last, it is important that you get at least eight hours of sleep when you can. Cramps, nausea, vomiting, diarrhea, and other issues require strong physical energy.

TIP #4: Drink lots of water. Drinking water and other liquids will help you replenish and rehydrate your body during vomiting and diarrhea. You will also sweat a lot during withdrawal which can dehydrate you. Therefore, make sure to stock up on juices and water.

TIP #5: Reward yourself. Choose something as a reward and celebrate each day of your sobriety. The reward can include anything starting from a chocolate or other things that might cheer you up. This ritual of rewarding yourself will boost up your confidence and help you stick through withdrawal till the end.

How To Help A Loved One In Opiate Detox

Detox can be traumatic and stressful. Withdrawal can make one so self-absorbed that it is common for people to focuse on pain, frustration, and feelings of helplessness. Here are some suggestions on how you can support someone during the distressing withdrawal period.

  1. Focus on what’s positive. Let your loved one know that you admire their courage. Sometimes when people feel week, others need to tell them how much they believe in their capacity. Let your loved one know you’re proud of their willingness to start a new life, you might get surprised of the outcomes.

2. Offer reassurance. Reassure your loved one that he/she will eventually reach sobriety. More than anything, people in withdrawal need reassurance that recovery is taking place. Hope is one of the most valuable coping tools and your attitude can make a big difference.

3. Take care of yourself. Get emotional support for yourself, as well. Caring for someone in withdrawal can be mentally and emotionally draining. This is why you need to take care of your own emotional needs and receive adequate support. It can be very helpful to have a trusted friend or a relative with whom you can discuss your fears, needs, and feelings.

4. Keep in touch with your loved one every day. Withdrawal symptoms often come in “waves” and you may mistake a period during which the symptoms temporarily subside for complete recovery. Many people are devastated when the symptoms resurface and this is when you may be needed the most.

5. Remember that everything in life is temporary. Acknowledge the efforts of your loved one and reassure them that this difficult situation is temporary, that they will get better and that life for all of you will eventually return to normal.

Coping With Fear Of Opioid Withdrawal

The greatest fear people in opioid withdrawal face is that they will start the process and won’t be able detox to the end. The fear is that if they fail, their loved ones will become disappointed and will consider them weak. Others may fear the symptoms that occur.

The truth is that withdrawal can be difficult.

But there is a resolution for this problem, as well. Many detox centers offer counseling right alongside detox. Regardless of you fears about entering opiate detox keep in mind that the consequences of continuing your (ab)use are far worse than attempting to quit.

Get over your fear of being sober by facing it head on. Remember that you will have caring professionals to back you up as you start your first days. You will not be left alone. You’ll have someone to guide you on each step

What’s most important is to get started.

Call us to learn more.

Reference Sources: WHO: Information sheet on opioid overdose
Drug Abuse: Drug Addiction Treatment in the United States
NIH: The Neurobiology of Opioid Dependence: Implications for Treatment
Drug Abuse: How Do Opioids Work?
MedLine Plus: Opiate and opioid withdrawal
Health Utah: Strategies for Tapering & Weaning
Drug Abuse: National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
SAMHSA: Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
U.S. Food and Drug Administration. (2016). FDA Approves First Buprenorphine Implant for Treatment of Opioid Dependence FDA Approves First Buprenorphine Implant for Treatment of Opioid Dependence.
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.

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