People struggling with opioid addiction may have felt the effects of withdrawal at some point, but it’s crucial to understand that this condition could have more severe health consequences than first meets the eye.
This article breaks down the topic of opioid withdrawal and presents some crucial tips on how it can be effectively managed.
What Is Opioid Withdrawal?
Opioid withdrawal refers to a set of symptoms you may experience when you abruptly stop using opioids. While everyone can experience different signs, the opioid dose and the length of treatment can greatly influence the severity of your symptoms.
Opioids are generally deemed safe to use for short periods, but long-term abuse can lead to severe withdrawal because the substance has a direct impact on your brain chemistry. When you take opioids, the chemicals attach to receptors in the brain and other areas of your body, such as the spinal cord.
These opioid receptors will then alter the way your body responds to pain, but they can also cause the brain to release dopamine, a feel-good hormone that can lead to a general sense of well-being. Over time, the brain and body become used to the pleasant feeling of opioids and need even more doses, which is known as opioid dependence.
When you stop using opioids, your body will respond negatively to the absence of the drug, leading to withdrawal.
Opioid Withdrawal Symptoms
Opioid-dependent patients may experience any of the following symptoms:
- High blood pressure
- Stomach issues
- Runny nose
- Body aches
- Muscle cramps
- Vomiting and nausea
- Rapid heartbeat
- Mental and emotional issues such as anxiety
Opioid withdrawal symptoms can be vast, so to ensure quality of care, professionals will use the Clinical Opiate Withdrawal Scale to assess each patient and determine the severity of their withdrawal.
The Clinical Opiate Withdrawal Scale
This is essentially a checklist to allow doctors and nurses to monitor a patient’s opioid withdrawal. The tool is often used both in in-patient and out-patient rehab centers as well, and the assessment can be performed several times throughout the patient’s withdrawal.
The checklist focuses on the following areas:
- Resting pulse rate
- Gastrointestinal upset
- Pupil size
- Anxiety or irritability
- Bone or joint pains
- Goosebumped skin
- Runny nose
Each item will receive a score (between 0 and 5), depending on how strong the symptoms of opioid withdrawal are and taking into account possible alternative explanations. For example, if the patient has a cold, clinicians will not attribute a runny nose to opioid withdrawal.
Once each item has a score, the clinician makes a sum to determine the severity of the withdrawal symptoms based on this scale:
- Mild withdrawal: 5–12 points
- Moderate withdrawal: 13–24 points
- Moderately severe: 25–36 points
- Severe withdrawal: Over 36 points
Opioid Withdrawal Timeline
The opioid withdrawal timeline can vary depending on the type of drug the patient is taking. Short-acting opioids such as tramadol or heroin typically start showing withdrawal symptoms 8 to 24 hours after the last dosage and can last between 4 and 10 days.
People taking long-acting opioids like methadone or oxycodone can experience withdrawal symptoms around 12 to 48 hours after their last dosage, and the entire process can last between 10 and 20 days.
Even so, withdrawal symptoms will come in stages, no matter the type of opioid abused:
- Cravings: The first stage of withdrawal, which usually occurs a few hours after the last dosage. People may experience some physical symptoms, but this stage is most commonly characterized by feeling frustrated and anxious. Still, most people can manage their withdrawal symptoms easily.
- Acute withdrawal: The symptoms of opioid withdrawal gradually get worse as the drug leaves the body and usually peak around 48–72 hours after the last dose, especially if the person was abusing prescription opioids. People will experience severe physical symptoms, which often lead to relapse as the person tries to self-medicate and get through withdrawal. This stage can last as long as two weeks.
- Post-acute withdrawal: During this stage, people generally experience milder opioid withdrawal symptoms, at least from a physical perspective. However, many people dealing with opioid use disorder often face strong emotional and mental hurdles and may still deal with drug cravings. It’s difficult to predict how long this opioid withdrawal stage will last, though people who don’t receive the right support may struggle with it for months.
Is Opioid Withdrawal Dangerous?
It’s a mistake to assume opioid analgesics only cause flu-like symptoms, as it takes away from the real dangers of withdrawal. People who’ve abused these drugs for a long time or who take high doses are at risk of developing opioid withdrawal syndrome, a life-threatening condition.
Two withdrawal symptoms that make this condition fatal are vomiting and diarrhea, which can lead to severe dehydration, high blood sodium levels, and even heart failure. Given that people can experience withdrawal symptoms for weeks in some cases, there is a real danger of loss of life.
There are also several documented cases of fatal opioid withdrawal syndrome, although they mostly occurred in incarcerated patients who did not have access to adequate medical care.
Still, the possibility of death is a strong motivator to seek professional help during withdrawal, as both dehydration and higher blood sodium levels can be effectively managed with proper medication.
How Is Opioid Withdrawal Managed?
People going through withdrawal will need close monitoring from a medical professional to differing degrees, depending on how severe their case is:
- Mild withdrawal: Symptoms are less severe, and the opioid withdrawal management plan will only include medicine and measures to address them. For example, patients can receive GI medication to treat their upset stomachs, fluids to counter dehydration and vitamin supplements.
- Severe withdrawal: In these cases, patients will also need additional medication (including an opioid) to help curb the unpleasant symptoms. Medical staff will often keep these cases under much closer supervision as the state of patients can rapidly change.
Opioid Withdrawal Medications
There are four possible drugs used in opioid withdrawal management:
- Methadone: A long-acting opioid agonist approved by the Food and Drug Administration to treat OUD because it can block the effects of opioids, reduce cravings, and ease some of the other withdrawal symptoms.
- Codeine phosphate: An opioid analgesic sometimes used to treat pain and ease withdrawal. Unfortunately, some patients don’t respond to codeine at all, so other opioids may be necessary.
- Clonidine: A type of medication that can lower blood pressure and relieve other withdrawal symptoms. Clonidine is commonly used before an opioid substitute is introduced and should not be mixed with any type of opiate.
- Buprenorphine: One of the most effective medications approved by the FDA for opioid addiction treatment. It’s a partial agonist that can diminish cravings and withdrawal symptoms and generally reduce physical dependence on the drugs.
Do Withdrawal Symptoms Indicate an Opioid Use Disorder?
Withdrawal only occurs if there is a physical dependence on the substance. But if you stop taking opioids abruptly and begin to notice withdrawal symptoms, you’re not necessarily dealing with an opioid use disorder.
Physical dependence usually precedes addiction, and the two main factors can contribute to it are:
- Dose: Taking high quantities of opioid medicine can lead to a substance use disorder and even increase your risk of overdosing. Over time, your body becomes used to the substance, and you’re required to increase your dose to get the same pleasant effects.
- Timeline: Taking opioids for over six months can also lead to addiction, even if you don’t exceed the recommended dosage. Currently, opioids are no longer recommended as a long-term way to treat pain.
What Happens After Withdrawal?
Opioid withdrawal doesn’t end once the drugs leave the system. Though physically, you may have severed the ties between you and the drugs, there are also emotional and mental factors to consider.
Even if you follow an opioid withdrawal management plan that includes medication, the post-acute phase can present with several symptoms of diminished well-being that could last for months. During this time, you can also experience cravings to different degrees, all of which increase the risk of relapsing.
This is why people are often encouraged to seek a drug abuse treatment program that tackles both physical dependence and emotional components, which can be done in either an outpatient or inpatient setting.
After successfully detoxing from opioids, you may need any of the following to help you cope and prevent relapsing:
- Cognitive behavioral therapy (such as talk therapy)
- Family therapy
- Support groups
- Holistic therapies such as meditation, yoga, physical activities, etc.
Such measures are crucial to avoid relapse and a potential overdose. After withdrawal and abstaining from opioids for a while, the body will have a lower tolerance to the drugs, which increases the chances of overdosing if you relapse.
How to Help Someone Going Through Opioid Withdrawal
If you or someone you know is addicted to opioid medicine, it’s crucial to approach withdrawal carefully. Here are some steps to consider:
1. Speak to a Doctor
The safest way to detox from opioids or any other drugs is under the supervision of health care providers. Even your family doctor may recommend an addiction specialist or a clinic that can provide access to the appropriate treatment for opioid use.
Consider reaching out to a specialist, regardless of whether you’ve experienced withdrawal symptoms or not, to help you start detoxing safely from these drugs.
2. Know the Early Symptoms of Withdrawal
Sometimes, a person battling drug use and addiction is not ready to seek help, so it often falls on those around them to adequately prepare.
First, you’ll need to become familiar with the signs of opioid withdrawal and ways to effectively manage symptoms. An addiction specialist can provide you with relevant resources and advice tailored to the unique circumstances of the person addicted.
3. Make a Plan
Ideally, you should gradually reduce your opioid dose instead of cutting cold turkey to give the body time to adjust to a smaller amount of drugs and potentially ease some of the withdrawal symptoms.
But addiction can make this almost impossible without outside help, so the next best thing would be to make a clear plan for withdrawal, which can include:
- A description of the timeline, as well as symptoms
- What over-the-counter medications to administer
- Methods to try and keep the person detoxing comfortable
- Major signs you should call a doctor
Though you might be familiar with withdrawal symptoms and their management, seeing someone you know go through this experience can be nerve-wracking. Writing everything down will help you provide adequate support to the person detoxing, even when you’re feeling anxious or scared.
4. Create a Safe Space
Experiencing withdrawal symptoms is an uncomfortable ordeal, and the person detoxing will need a lot of support.
It’s best to have some key supplies prepared, which can help both you and your loved ones get through it:
- Water: Withdrawal can lead to dehydration, so be sure to give your loved one plenty of water. Consider getting electrolyte water for better hydration.
- Medications: OTC medications can help curb some of the withdrawal symptoms. For example, ibuprofen can help with body aches, while loperamide can help manage diarrhea.
- Quiet, comfortable place: Ensure the person detoxing is comfortable. They may need a quiet room, soft blankets and pillows, and to have their bedding changed frequently because of increased sweating.
- Distractions: Movies, music, TV shows, or other distractions play a critical role in detoxing, as they can help keep the person’s mind off their discomfort.
Opioid withdrawal can cause severe pain and discomfort, and unfortunately, this makes it even harder to overcome an addiction. The severity of this condition is often strong enough to lead a person to relapse.
But with the right management plan, you can sever the physical link between you and the drugs and eventually reclaim your sobriety through long-term emotional and mental health support.