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Opiate Addiction Withdrawal Symptoms and Treatment

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opioid withdrawal

Opiates—sometimes interchangeably referred to as opioids and narcotics—are a broad class of drugs. They are widely used legally and abused illicitly, and include many substances that are synthesized from a handful of opiate precursors found in the opium poppy, such as:1,2

In medical settings, prescription opiates are used for the following:1

  • Treating pain.
  • Reducing coughs.
  • Pre-surgical or procedural sedation.
  • Managing diarrhea.

Dangers of Opioid Use

Opiate use carries a risk even when the drugs are used as prescribed. Unwanted side effects like nausea, vomiting, constipation, and slowed activity levels may lead some people to end their use. Others may wish to quit opiates due to the risk of overdose associated with them. According to the CDC, more than 28,000 people died in 2014 as a result of opioid or opiate overdose, which includes overdoses on heroin and prescription pain medications.

Quitting opiates can be challenging—attempts to slow or abruptly stop use often precipitate the onset of extremely unpleasant withdrawal effects, which often drive the user into immediate opioid relapse.

What Is Opiate Withdrawal?

Among people who struggle with opiate addiction or have otherwise developed physiological opioid dependence, a phenomenon known as acute opiate withdrawal frequently arises when the offending drug is sharply reduced in dose or completely eliminated. Opioid withdrawal is a complex topic that involves aspects of tolerance, physical dependence, and addiction. Through a series of complicated physiological processes, the prolonged interaction of the substance with the body primes an individual to experience withdrawal when the drug is no longer used.2,4

When opiate drugs are used, they are eventually shuttled to the brain via the bloodstream. Once there, the opiate molecules cling to and activate opioid receptors in the brain. This biochemical interaction serves to mediate the analgesic effects of these drugs and is also secondarily associated with a triggering of the release of a neurotransmitter called dopamine. Dopamine offers a rewarding, pleasurable sensation that reinforces the drug use behavior which led to the release in the first place and thereby encourages a person to keep using. Dopamine also suppresses the release of another neurotransmitter called noradrenaline (norepinephrine), which normally increases alertness and energy, so when it is suppressed, an opioid user may feel more calm and sleepy.4

Tolerance and Dependence

Over time, a person’s brain begins adapting to increased dopamine availability and lower noradrenaline levels. With time, the brain transitions to functioning normally when a substance is present and abnormally when it is unavailable. This need to use a substance is called physical dependence.4

As part of this adaptation, the brain will begin to register less of a dopamine response when an opiate is used than it did initially. A person will need to consume higher doses of a substance more often to produce the same level of wanted effects. This tendency of the brain to respond less is called tolerance.4

Even a person using an opiate as prescribed can experience these adaptations. With tolerance driving increasing patterns of use and physical opioid dependence, someone who suddenly attempts to end use will experience a combination of very low dopamine levels and very high noradrenaline levels. This out-of-balance neurotransmitter combination helps to explain some of the unpleasant opiate withdrawal symptoms that begin to arise.4

Since people develop tolerance and dependence at unique rates, it is difficult to know who will experience opioid withdrawal until symptoms present.2

Is Withdrawal Dangerous?

Opiate withdrawal is not usually medically dangerous or directly life-threatening. It can be extremely uncomfortable, though. The severity of the discomfort of withdrawal is influenced by a number of factors, such as:1

  • The specific drug(s) used.
  • Dosages taken.
  • The frequency of use.
  • The total time spent using.
  • Physical health status.
  • Mental health status.

medical detox from opiates

Someone who has used higher doses, more frequently, or for longer periods of time will likely have stronger, more uncomfortable withdrawal symptoms.1

During withdrawal, indirect dangers of opiate withdrawal can emerge, including strong cravings for more drugs and severe depression.1 If someone restarts opioid use due to cravings, they put themselves at greater risk of a fatal overdose—especially if their opioid tolerance has decreased significantly over the abstinent period. Also, the severe depression related to the later stages of withdrawal can place the individual at risk of self-injury or suicide.

Symptoms and Signs of Opioid Withdrawal

Opiate withdrawal symptoms grow and change over time. Early symptoms of opioid withdrawal may include:1,2,5

  • Watery eyes.
  • Runny nose.
  • Sweating.
  • Running.
  • Anxiety or irritability.
  • Poor sleep.
  • Muscle pain.

These early symptoms give way to later opiate withdrawal symptoms that include:1,2,5

  • Cramping.
  • Diarrhea.
  • Vomiting.
  • Increased heart rate and blood pressure.
  • Restlessness.
  • Shakiness.
  • Chills.
  • Sweating.
  • Gooseflesh skin.
  • Dilated pupils.

How Long Does Opioid Withdrawal Last?

On average, these opioid withdrawal symptoms can begin between 12 and 30 hours after last use and will last for between 4 and 10 days in most situations, although someone withdrawing from a longer-acting opioid drug like methadone will require up to 21 days to end this acute withdrawal phase.6

The symptoms of opiate withdrawal do not necessarily end here, though. In some instances, an extended withdrawal period may continue long after the substance has been physically processed by the body and acute symptoms have all but disappeared. These persisting symptoms are known by many names, like post-acute withdrawal syndrome (PAWS), protracted withdrawal, and chronic withdrawal.6

American Addiction Centers maintains a strong partnership with a large group of insurance companies at our addiction treatment facilities. Start the journey to recovery and find out instantly if your insurance provider may be able to cover all or part of the cost of rehab and associated therapies.

Can Medications Help With Opioid Withdrawal?

Opioid Detox MedicationMedications can be used to assist with the treatment of opioid abuse, addiction, and dependence throughout different stages of recovery, as determined by the attending doctor. Several opioid withdrawal medications have demonstrated effectiveness in their ability to reduce the unwanted effects of opiate withdrawal while increasing comfort:7,8

  • Methadone. A long-acting opioid, methadone is an often-used medication in opioid withdrawal treatment. This medication will aid the recovering user by alleviating withdrawal symptoms and reducing cravings without inducing a marked addictive and euphoric high.
  • Buprenorphine. Like methadone, buprenorphine is an opioid that can activate opioid receptors to limit opioid withdrawal syndromes. Since this medication is a partial opioid agonist, it is also less capable of eliciting the euphoria or sedation found with abused opioids. This medication is usually available as a pill or sublingual film and may be administered in combination with naloxone, an opioid antagonist, in a branded formulation known as Suboxone.
  • Probuphine. A recently approved version of buprenorphine, Probuphine is a unique implant of the medication that steadily releases a low dose of the medication over a 6-month period. This method of use is meant to encourage treatment compliance and prevent abuse.9
  • Clonidine. Originally used for the treatment of high blood pressure, this medication can help reduce certain symptoms of opiate withdrawal. Since clonidine is not an opioid itself, it has little or no potential for abuse.

Methadone, buprenorphine, and another medication called naltrexone—which blocks the effects of opioids to discourage abuse—can be used after withdrawal symptoms have subsided to maintain recovery and minimize cravings.7 Naltrexone is available as a pill or as a monthly injection (Vivitrol).

Opiate Detox Programs

Detoxification generally refers to the body’s natural ability to break down and remove toxins from the system. In the field of substance abuse treatment, detoxification is the group of strategies used to manage acute intoxication, if necessary, and ease withdrawal symptoms. The medical model of detox employs a treatment team of doctors, nurses, and clinicians to assist in the withdrawal and detox process. Frequently, some combination of the aforementioned medications and other supportive interventions is used to reduce uncomfortable symptoms.8

Many people detoxing from opiates will benefit from a medically assisted detox period to evaluate their status, stabilize their symptoms, and refer them for additional substance abuse treatment services at the conclusion. Opioid detox can be provided as an inpatient or outpatient service, depending on the person’s:8

  • Intensity of withdrawal symptoms.
  • Level of supports and stressors.
  • Previous detox and treatment attempts.
  • Living situation and transportation availability.

Detox Typesgroup therapy

A somewhat controversial option for detox from opiates is called rapid or ultrarapid detoxification. This process involves an individual being given a medication like naltrexone to bring about withdrawal symptoms quickly while sedative medications are administered. Here, the goal is to shorten the withdrawal process and keep the person sedated during the most uncomfortable segments. However, studies show that this style of opioid detox does not significantly benefit the individual. In fact, it could trigger other complications, like symptoms of delirium.8,10

Depending on the substance and level of use, detox may focus on slowly weaning a person off an opioid or switching to another opioid like methadone or buprenorphine as a form of medication-assisted treatment.

Tips to Handle Cravings

Many treatments focus on responding well to cravings when they emerge. Helpful strategies can be separated into three types, including:11

  • Behavioral. These interventions focus on changing behaviors to limit relapse. Delaying your reaction to the craving, distracting yourself from the urge, and deciding not to use are examples of behavioral strategies.
  • Cognitive. These plans are based on acknowledging and changing self-talk before, during, and after cravings. By speaking positively about your ability to manage cravings, the risk of relapse shrinks.
  • Relaxation. Relaxation skills, such as deep breathing and guided imagery, can reduce cravings by reducing stress.

How to Find Treatment for Opiate Abuse or Addiction

If you or someone you know is currently struggling with opiate use, abuse, or dependence, taking steps toward treatment can be a great decision. Professional addiction treatment can start anyone battling substance misuse on the path to a happier and healthier life. Rehab programs are located throughout the U.S., and many offer specialized treatment that can cater to individual needs. You can use SAMHSA’s Behavioral Services Locator to search for opioid treatment centers. Many state government websites will also provide local drug and alcohol resources to those in need. To find your state government’s website, do a web search for your state name and ‘.gov.’ Once your state website is located, substance use resources shouldn’t be hard to find, and they should provide further phone contacts for your assistance.

American Addiction Centers (AAC) is a leading treatment provider and has trusted rehab facilities across the country. For advice on the best way to withdraw from opiates, to learn about opioid withdrawal treatment options, or to enquire about inpatient rehab, please contact AAC free at today. There are also free drug abuse hotline numbers you can call.

Opiate Addiction Treatment Levels of Care

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Eric Patterson, MSCP, NCC, LPC, is a professional counselor who has been working for over a decade to help children, adolescents, and adults in western Pennsylvania reach their goals and improve their well-being.

Along the way, Eric worked as a collaborating investigator for the field trials of the DSM-5 and completed an agreement to provide mental health treatment to underserved communities with the National Health Service Corp.

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