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 most cases, opiate detox does include a buprenorphine taper to minimize the negative effects of withdrawal so that clients can begin actively working in group therapy while they are here.

Detoxing at Home

Home remedies for opiate detox, natural remedies for opiate detox, or detoxing from opioids at home, does not come highly recommended. There have been cases in which the process has been successful, or been aided from afar by professional medical personnel. But, there is no easy or painless method on how to detox from opiates at home. Relapse is typically associated with being more likely in patients who try to quit using opioids by themselves.

Methods of detoxing from opioids at home include:

  • Quitting Opiates Cold Turkey – this involves immediately and abruptly stopping the use of opiates. Cold turkey is the term used to represent the chills and gooseflesh that often comes in withdrawal from opiates. Quitting cold turkey can be painful, and difficult to accomplish. Symptoms of withdrawal most often make this method of detox inappropriate as users are rarely able to complete the detox on their own.
  • Controlled Opioid Taper – a controlled taper involves the gradual reduction of opioids over a period of time. Depending on the amount of opioids being used and the frequency of use the taper may take place over a few days, a few weeks, or a few months. A controlled opioid taper is a safer and more comfortable means of opiate detox but again, it’s difficult for an addicted individual to achieve on his or her own. The craving and desire to continue using are often too much for the user to maintain the lowered dose schedule.

Quitting opioids cold turkey at home, is a method in which an individual stops all use of opioids at once. Yet, since the use of opioid drugs should not be stopped suddenly, without support or supervision – as withdrawal symptoms are known to be more difficult in these circumstances – this method is not commonly employed by even the most stubborn individuals trying to remake their lives. Tapering off opiates is a safer, more common practice, for both those trying to achieve sobriety on their own, and medically assisted patients. There are outpatient opiate detox centers and programs available to the public. These centers aid in not only detox methods, but in finding long term support for recoveries

More commonly, the controlled tapering off of use is employed, even in medical detoxes, as it attempts to ease the person into withdrawal slowly, helping them manage their symptoms more readily, and hopefully with less severe effects. Either way, opiate detox at home is not recommended, as medical professionals should be involved in order to assist any and all individuals through the symptoms they experience, and monitor their overall health.

Alternative Treatments for Opiate Withdrawal

Several alternative treatments for opiate withdrawal also exist if residential opiate detox is not ideal for your needs. Outpatient opiate detox may be an option if you’re physical dependence is controlled and you’re able to commit to a safe opioid taper. Unfortunately, outpatient opiate detox rarely works for those who use heroin, fentanyl or stronger prescription opioids such as oxycodone. Discuss the potential for outpatient treatment with your healthcare provider to determine whether it’s appropriate for you or your loved one.

Finding a Detox Center

Finding an opiate detox center that can treat you with the love and respect you need to get well can be challenging. Florida especially is known for having poor treatment programs that do not do enough to advocate for patient wellness and comfort. At St. John’s Recovery Place we work hard to provide an opiate detox program that is different than anything you’ve experienced anywhere else. We advocate for YOU, and work diligently to provide you with a safe, clean, compassionate center where recovery CAN and WILL happen.

When you try to find an opiate detox center, consider the following:

  • Location: Choose a center that is set apart from the hustle and bustle of the city. You may find it ideal to step outside your hometown, even if it’s just a 30-minute drive, so that you can focus strongly on your recovery with less concern of what’s going on outside the treatment center walls. SJRP is located in Central Florida, across from a beautiful Lake that provides endless outings for clients interested in boating, fishing, swimming, and peace outdoors. Our location is ideal for recovery because you won’t face big city interruptions that could make focusing on your treatment hard to do.
  • Cost: Choose an opiate detox center that will deliver powerful, effective treatment at a price that you can afford. Most opiate detox centers accept insurance to help you pay for treatment. At St. John’s Recovery Place we accept most major insurance policies and will cover most of your opiate detox costs so that you pay little to nothing out of pocket. It’s important to choose a detox center that will deliver the appropriate level of treatment that you need without leaving you with a hefty bill to pay later in recovery.
  • Effectiveness: Choose an opiate detox program that touts effectiveness that you cannot afford to overlook. At St. John’s Recovery Place, although we are not a lockdown detox center, our AMA (leaving against medical advice) rate is below 1%. The majority of our clients stay with us through detox because we provide them with comfort medications that reduce symptoms of opiate withdrawal and minimize the potential for early abandonment of treatment. As a result, you or your loved one achieves lasting success in recovery, and are more likely to remain in our treatment program for the full duration approved by your insurance or our medical team.
  • Staff to Patient Ratio: Choose an opiate detox center that has a high staff to patient ratio meaning there are more staff than there are patients. You want to know that you or your loved one will have plenty of one-on-one time in treatment, that the nurses will not be too overwhelmed to provide quality care, and that the doctors are not too busy to listen to, and appropriate treat, your needs. At SJRP our staff to patient ratio is always high. And, on the flip side, our patient to staff ratio is always low. Thus, we maintain a significantly higher number of staff members on site than we do patients. You can rest assured that there is always a caring, loving staff member to help you — whether you need someone to talk to, you’re looking for someone to help you physically, or you’re not feeling well and need a visit to the doctor or nurse. We always have time for our clients.

Understanding Opioid Withdrawal and Detox

In the end, the greatest factor to remember when trying to understand opioid withdrawal and detox, is that everyone experiences it differently, but everyone also needs a good support system. Medical detox comes highly recommended, as opioid withdrawal symptoms can have painful, uncomfortable, and at times, long-drawn-out effects that are made a little easier when monitored by professionals. Opioid withdrawal is typically not life-threatening and short-lived in comparison to other types of drug withdrawals, but it can have life-threatening complications occur.

Using opioids or opiates, whether to alleviate pain or for recreational purposes, can lead to physical dependence and subsequent withdrawal.  If you or a loved one is struggling to quit using opioids, but you are looking to do so safely – or you just want to learn more about opiate detox – feel free to call St. John’s Recovery Place to speak with our admissions team at 833-397-3422.

References