Opiate Withdrawal & Detox

Opioid withdrawal, or opiate withdrawal, is the result of cutting back or stopping use of the drugs after heavy use. Withdrawal results in the surfacing of adverse symptoms, connected to taking the drugs themselves. These symptoms can be similar to other types of withdrawal, but each drug tends to have its own timeline and specifications as well, which is important to be aware of.

Opioid detox, or opiate detox, or detoxification, is the process in which the body cleanses itself of all toxins, including those of the drug itself. Detox and withdrawal can be long drawn out and painful. But, withdrawal and detox both are important steps to overcoming opioid addiction.

What Are Opioids or Opiates?

Opioids or opiates are a powerful type of drugs, designed to help treat pain – the term narcotic can be used to refer to either. Although very similar in their natures, opioids and opiates are both very different from each other. An opiate is a type of drug that naturally occurs in an opium poppy plant, and is used to produce other drugs like heroin, morphine or codeine.

An opioid is a broader term that refers to both opiates and any other substance that – naturally or synthetically – binds to the opioid receptors in the brain. These brain receptors are responsible for controlling reward, pain, and other addictive behaviors. But although all opiates are opioids it is important to remember that not all opioids are opiates, and that even when naturally occurring, all forms of this drug can be addictive and harmful to the human system.

What Causes Opioid Withdrawal?

Narcotics like opioids can cause physical dependence and addiction. Especially when used without medical supervision, these drugs can be harmful. Individuals trying to end their dependence on the drug, may try to quit using opioids altogether. This in turns causes opioid withdrawal or opiate withdrawal. As the slowing or ceasing of heavy opioid use, at any time after prolonged use, can incite the start of withdrawal symptoms. Opioid withdrawal syndrome itself can be life-threatening.

Opiate Withdrawal Symptoms

Opioid withdrawal symptoms, or opiate withdrawal symptoms, can have both early and late occurring signs. These symptoms can be very painful or uncomfortable to experience, but are typically not life-threatening themselves. Withdrawal symptoms can begin to surface as early as 6 to 30 hours after the last dose, depending upon which specific type of opioid or opiate used. Signs and symptoms of opioid withdrawal can include both physical and mental effects.

Short Term Opiate Withdrawal Symptoms

Of course, symptoms may occur at any time in any order. But, the typical withdrawal timeline includes both physical and mental effects that occur earlier on, and later on.

Here are some early signs and symptoms of opioid withdrawal:

  • Agitation
  • Anxiety
  • Restlessness
  • Irritability
  • Piloerection
  • Yawning
  • Sweating
  • Insomnia
  • Runny Nose
  • Opioid Cravings
  • Panic Attacks
  • Aggression
  • Loss of Appetite
  • Increased Tearing
  • Muscle Aches

Long Term Opiate Withdrawal Symptoms

The long term opiate withdrawal symptoms actually tend to be milder in their intensity, and not as frequently occurring for most individuals experiencing withdrawal. Even so, these signs and symptoms can still be very uncomfortable to work through and should be taken just as seriously as symptoms experienced in the first few days of the withdrawal process.

Long term withdrawal symptoms from opiates can also include (in the later stages):

  • Vomiting
  • Diarrhea
  • Abdominal Cramps or Stomach Problems
  • Nausea
  • Goosebumps
  • Dilated Pupils
  • Opioid Cravings
  • Fatigue
  • Depression

Physical Withdrawal Symptoms

The physical symptoms of opiate withdrawal can begin to surface as early as 6 hours after the last dosage. These symptoms can range from uncomfortable to painful in nature and can be broken down into two phases, in which the more intense, or severe, symptoms typically occur in the first phase. People may wonder, if there are multiple phases to withdrawal symptoms, how long do physical symptoms of opiate withdrawal last? Typically, physical symptoms of opiate withdrawal can last for nearly a week or longer, with symptoms normally peeking around 72 hours after the last dose.

Physical symptoms of opiate withdrawal can include (but are not limited to):

  • Vomiting
  • Diarrhea
  • Abdominal Cramps or Stomach Problems
  • Dilated Pupils
  • Goosebumps
  • Sweating
  • Muscle Aches or Cramping
  • Runny Nose
  • Yawning
  • Piloerection
  • Racing Heart
  • Fever
  • Tearing Up
  • Nausea
  • Fatigue

Psychological Withdrawal Symptoms

Although opioids are typically used to treat pain, they can also stimulate the emotional side of the brain, controlling such responses as pleasure and reward. As such – although most opioid withdrawal symptoms take physical effect – they can also have mental repercussions as well. Psychological withdrawal symptoms can begin to appear around the same time as physical symptoms, 6 to 30 hours after the last drug dose. And although most of these withdrawal symptoms are uncomfortable or painful, and typically non-life-threatening, there is always the potential for these symptoms to become deadly.

Psychological withdrawal symptoms can include (but are not limited to):

  • Depression
  • Agitation
  • Aggression
  • Irritability
  • Panic Attacks
  • Anxiety
  • Restlessness
  • Insomnia
  • Loss of Appetite

Symptoms of Post Acute Withdrawal Syndrome (PAWS)

Opioid Post-Acute Withdrawal Syndrome (PAWS), is typically a temporary condition that occurs when the brain is attempting to reset itself. Not all former users will experience PAWS, but there are no recognized specifications that create its onset. PAWS is the recurrence or worsening of acute withdrawal symptoms, the symptoms that occur most often in the beginning, more extreme discomfort phases of recovery. This syndrome can occur at any time, typically lasting for a few days at a time before disappearing again. Typically, PAWS can appear and reappear throughout the first year of recovery.

Opioid Post-Acute Withdrawal Symptoms or protracted withdrawal symptoms can include (but are not limited to):

  • Foggy thinking
  • Confusion
  • Memory problems
  • Urges and cravings
  • Irritability
  • Hostility
  • Sleep disturbances or vivid dreams
  • Insomnia
  • Fatigue
  • Issues with fine motor coordination
  • Stress sensitivity
  • Anxiety
  • Panic attacks
  • Depression
  • Lack of initiative
  • Impaired ability to focus
  • Mood swings

There is no known way to prevent protracted or PAWS symptoms, but plenty of ways available for people to manage their symptoms. It is important to be aware of PAWS, as its onset of unpredictable severe symptoms occurring can end in relapse.

Opioids Withdrawal Timeline

First, it is very important that anyone experiencing opioid withdrawal symptoms contact a medical professional immediately. Although symptoms themselves are not typically life-threatening, they can result in life endangering complications, and the medical treatment of withdrawal symptoms can help alleviate an individual’s pain, and potentially prevent relapse. So, how long do opiate withdrawal symptoms typically last then? The opioid withdrawal symptoms timeline can be broken into two phases.

Phase 1 or early opiate withdrawal symptoms (in chronological order occurring in days 1 – 3) begin with the onset of the last dose. The onset of symptoms – usually beginning 6 to 12 hours after the last dose of short-acting opiates or 30 hours after the last dose of long-acting opiates – will last for up to 3 days in phase 1. Symptoms usually peak around 72 hours after the last dose.

Typically phase 1 lasts for about 3 to 7 days. Phase 1 Symptoms can include (but are not limited to):

  • Headaches
  • Aggression
  • Loss of Appetite
  • Anxiety
  • Insomnia
  • Panic Attacks
  • Sweating
  • Muscle Pain
  • Stomach Issues
  • Irritation

Phase 2 Symptoms are typically occurring in days 3 – 5 and may include:

  • Shivers
  • Fatigue
  • Minor Muscle Aches
  • Stomach Issues

Cravings can occur at any point during the withdrawal process, but it is important to also note that each individual can experience withdrawal symptoms differently. For most individuals, symptoms do not occur farther than 5 to 7 days past their last dose. Most symptoms are quite mild following day three.

Factors Affecting Withdrawal Duration

Continued abuse of opioids leads to dependence. To break that dependence requires a great deal of dedication, support, and discomfort. But, like any other kind of chemical reaction within the body, dependence and the process of withdrawal and detox looks different for every person that experiences it, though some symptoms and their severity are more common than others.

Factors that can affect the opiate withdrawal duration of symptoms can include:

  • Length of time substance was abused
  • The particular type of substance abused
  • Amount of drug taken each time
  • The method of abuse (like smoking, snorting, injectiing, etc.)
  • Family history
  • Medical history
  • Mental health factors
  • Polysubstance abuse

Typically a person who uses a higher dose on a more frequent basis, will experience more intense withdrawal symptoms, for an extended amount of time. Other factors, like the phenomena occurrence of post-acute withdrawal syndrome (PAWS) – which occurs at random – may also need to be taken into consideration. Overall, withdrawal looks and behaves differently in each individual person.

Medical Detox

To support those experiencing opioid withdrawal, it is important to first contact a medical professional. Opioid withdrawal, and opiate detox, can cause great pain and discomfort, even dysphoria. And typically, patients who try to manage withdrawal on their own end up relapsing, thus continuing their use of opioids. Thus, a patient who is experiencing opioid withdrawal symptoms, or is working through opiate detox can  – and is encouraged – to seek out medically assisted, opioid withdrawal treatment, as vital signs should be closely monitored during this process.

Vital signs typically monitored during medical opioid detox include:

  • Blood pressure
  • Respiration
  • Body temperature
  • Heart rate

Medical detox from opiates encompasses both the physical and psychological treatment of opioid detox. Medically assisted opiate detox, makes use of pharmaceuticals and a good support system, to aid their patients through these difficult steps towards recovery.

Medications Used in Opioids Detox

The use of opioid withdrawal treatment medication is not unheard of. As a matter of fact, There are a variety of medications that can be used to aid in the alleviation and assistance in opioid detox, or withdrawal. Since severity is dependent on the specific type of drug used, initial testing will be performed to determine which line of action is best for each patient. Opioid withdrawal treatment protocols may vary as a result, but here are some of the more common medications and practises used.

Typical opioid detox medications used in treatment may include:

  • Methadone for opioid withdrawal: Methadone is often used for ongoing maintenance and to prevent opioid withdrawal when abrupt discontinuation of another opioid occurs. Methadone has several benefits, but it can be equally addictive and difficult to quit taking. Further, the detox from methadone is significantly longer and more difficult to achieve than drugs with a shorter half-life such as heroin or fentanyl. At SJRP we do not administer methadone as part of our detox program unless a methadone taper is prescribed by our clinical team in cases in which a client is already taking methadone when they enter treatment at our center.
  • Short term methadone use for opiate withdrawal: Short-term methadone use for opioid addiction can provide benefits and may be useful as a maintenance medication for some. At SJRP we do not advocate for methadone treatment simply because it does tend to have a more difficult withdrawal process and we aim to help you avoid long-term addiction.
  • Clonidine for opiate withdrawal: Clonidine is another medication that is sometimes prescribed for the comfort of the individual during opioid withdrawal. Clonidine can reduce blood pressure, calm anxiety, and minimize many of the effects of opioid withdrawal allowing the user to relax and rest. At SJRP, a clinical team decides whether clonidine treatment for opiate withdrawal is the necessary next step in recovery.
  • Buprenorphine treatment for opioid addiction: Buprenorphine is commonly used in the treatment of opioid dependence and to help reduce cravings and symptoms of opioid withdrawal. Several forms of buprenorphine are available including the brand name drug, Suboxone. Suboxone for detox from opiates can quickly minimize ongoing withdrawal symptoms but may not be prescribed immediately when treatment is entered. At SJRP the clinical team is responsible for determining whether clients are prescribed buprenorphine, but in m