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Opioid Withdrawal: Symptoms, Causes & Treatment

People using opioids, whether in their legal or illegal forms, face numerous health risks. Besides the common side effects of opioid consumption itself, there is a distinct group of dangers associated with the cessation of opioid use. In such cases, one has to be ready to act in order to prevent consequences that might have lasting negative effects on individual and collective well-being.1

What Are Opioids?

Opioids present a group of drugs from the opium poppy family. Their main feature is an ability to bind to opioid receptors in one’s brain, thus producing sedating and pleasing psychological effects.2 There are two types of opioids. The first of them involves legally prescribed drugs such as oxycodone, oxymorphone, codeine, morphine, or tramadol. These opioid drugs are known as effective analgesics that help patients suffering from a whole host of diseases go through the associated pain more easily. Another opioid type is comprised of illegal drugs, with well-known heroin as the most notorious example.3 4

Due to their specific features, opioids are prone to cause dependence in people who consume them regularly. At this stage, people might feel a compulsion to use the drug even though they are aware of the negative consequences it produces in their lives. This is the main reason why legal opioids are usually prescribed with a lot of warnings and caution, while the use of illegal opioids is so tightly controlled. Despite these efforts, estimates show that there were more than 10 million opioid misusers in the U.S. in 2018. Out of these, around 800 000 people developed a heroin dependence.5 6

What Is Opioid Withdrawal?

Becoming dependent on an opioid drug possesses numerous negative implications in addition to the dependence itself. One of these has to do with the process of opioid withdrawal. At one point in time, opioid consumers might decide to either reduce the amount of the drug they take or cut the drug off completely. Regardless of the legal status of the drug, this process is usually initiated with good intentions but is commonly accompanied by grave difficulties. Extremely unpleasant symptoms that take place during the phases of opioid withdrawal might even lead to significant health deterioration.7

What Are The Opioid Withdrawal Symptoms?

There is a wide range of symptoms that might be related to the opioid withdrawal process. Even though most of these symptoms are generic and can be associated with multiple diseases, the context of their emergence indicates that they present a consequence of changes in opioid consumption patterns. The most common opioid withdrawal symptoms are7 8:

  • Chills
  • Sweating
  • Diarrhea
  • Nausea and vomiting
  • Increased body temperature
  • Muscle and bone pain
  • Racing heart
  • High blood pressure
  • Anxiety

Most of these symptoms, particularly chills and sweating, may be less severe and last for a shorter duration. There are, however, symptoms that may take a longer time to subdue and may present the opioid user with more difficulties in everyday functioning. These include9:

  • Opioid cravings
  • Fatigue and dysphoria
  • Focus difficulties
  • Lesser pain sensibility
  • Diminished cognitive abilities

It may be very hard for opioid consumers to endure these symptoms. Due to their duration and intensity, these symptoms may compel opioid consumers to revert to drug use. However, if one succeeds in resisting the compulsion for long enough, they may reasonably hope for a successful recovery.10 In addition to their painfulness, these symptoms could even be life-threatening.

How Do Opioids Affect the Brain?

Of the body parts, opioids primarily affect the brain. Their influence goes through opioid receptors to which opioids bind, thus altering the signals received from the body. Notably, opioid use dulls the pain perception and increases the production of dopamine. The latter is responsible for the euphoric effect commonly present after the drug consumption. Such an outcome sends a reward signal to the brain, making the person more likely to consume the opioid again. When this process is repeated several times, it creates an addictive habit that is hard to escape from.11 12 13

Once the initial euphoric effects subside, other effects on the brain start to take place. These effects primarily concern the prefrontal cortex, which is a part of the brain responsible for rational thinking and problem-solving. The impact opioids have on the prefrontal cortex is manifested by a person’s lower cognitive abilities, particularly in the area of decision-making.11

How Long Does Opioid Withdrawal Last?

The duration of someone’s opioid withdrawal depends on a number of factors. The most important factors include the type of opioid consumed, for how long the opioid was consumed before, and patient-related idiosyncratic factors, mostly having to do with one’s overall health. The opioid withdrawal process usually starts within 36 hours and lasts for 5 to 14 days, depending on the opioid type.10

How Does an Opioid Withdrawal Timeline Look Like?

The type of drug taken is probably the biggest predictor of one’s opioid withdrawal timeline. Heroin withdrawal symptoms, for example, commonly take the least to show (up to 12 hours). They also take the least to resolve. While they peak in the range between days 2 and 4, they are usually gone after 4 to 7 days.10

The situation is a little bit different in the case of short-acting opioid medications. For these medications (which include drugs such as hydromorphone, oxymorphone, hydrocodone, oxycodone, immediate-release morphine, codeine, and fentanyl), it is common for symptoms to start within 24 hours, completely develop in up to 72 hours, and resolve within 7 to 10 days.14

Finally, there are long-acting opioid medications. Examples of these are levorphanol, methadone, and certain formulations of short-acting opioid medications. Taking the longest to start (up to 36 hours, 72-96 hours in a fully developed form), the symptoms associated with the withdrawal of these medications usually take around 14 days to resolve. In some cases, it may take even longer for these symptoms to disappear.14

Opioid Withdrawal Treatment and Medications

In the case of experiencing opioid withdrawal symptoms, especially in their severe form, addiction sufferers are best advised to seek treatment. What type of treatment a person should attend will mostly depend on the nature of their opioid dependence. People with mild symptoms might get away with a shorter detox program while people with a deep underlying condition and a lot of co-occurring disorders might be advised to enroll in long-term treatment and take part in aftercare activities once the treatment is over. Regardless of the treatment someone ends up attending, they will most likely have to stick to a mix of medication regimens and therapy sessions.14 15

What Types of Opioid Withdrawal Treatments Exist Out There?

The first-line type of treatment, which is also the most common, involves up to around 7-days-long medical detoxification on an inpatient basis. On the first day of treatment, commonly known as intake, the patient will be thoroughly assessed. The medical professionals at the rehab facility will introduce the detox program attendee to the setting, making the transition into a hospital as easy as possible.14

The crux of the detox treatment against opioid withdrawal symptoms involves a carefully designed medication regimen. The drugs that are most commonly prescribed are buprenorphine and methadone, as well as suboxone, which is a mix of buprenorphine and naloxone. The main purpose of these drugs is to decrease the intensity of opioid withdrawal symptoms and keep opioid cravings under control. By performing such a function, these drugs may prevent relapse and overdose in patients.16

In addition to these, there are many auxiliary drugs aimed at lessening the withdrawal-accompanying symptoms. Examples of such drugs include clonidine (commonly used for anxiety) and loperamide, which is known for its effectiveness against diarrhea.10

Despite the high effectiveness of medical detoxification treatment, it is frequently the case that patients need a more comprehensive and long-term treatment in order to reach lasting recovery. This is why rehab facilities organize a whole host of rehab treatments with different features. In addition to the use of medication, most of these treatments are accompanied by regular therapy and counseling sessions. The treatments also differ concerning their setting: while some of them involve a significant portion of treatment on an outpatient basis, others are entirely conducted in the hospital.14 15

It is important to note that the majority of opioid withdrawal rehab facilities require payment in order to receive admission into their programs. Prospective rehab attendees are thus encouraged to examine their payment options and see whether their insurance providers cover their treatments of choice. Anyone interested can even search our online tool to see which insurance providers cover certain opioid withdrawal rehab programs.17 18

Are There Any Co-Occurring Disorders That May Arise During the Opioid Withdrawal?

Opioid withdrawal carries a separate risk of contributing to various co-occurring disorders. Particular risk exists for the development of mental health issues. Different national surveys discovered that around half of people suffering from substance abuse also develop an accompanying mental illness.19

Most frequent are anxiety disorders, ranging from generalized anxiety disorder to post-traumatic stress disorder. Among people suffering from substance abuse, there is also a high prevalence of depression, bipolar disorder, borderline personality disorder, attention-deficit hyperactivity disorder (ADHD), and antisocial personality disorder, as well as other mental illnesses.19

Potential comorbidities are not confined to the area of mental health. A higher risk for the development of numerous physical diseases is established among opioid addiction sufferers as well. These ailments involve heart disease, chronic pain, and cancer. It also involves infectious diseases, among which particularly prevalent is HIV/AIDS.19

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