How Does Opioid Withdrawal Look And What To Expect

Opioids, also referred to as opiates or narcotics, are a classification of drugs used for the management of pain. They are also used recreationally for their incidental, psychoactive side-effects such as euphoria.

There are an abundant number of opioids, both organic, derivative opioids and inorganic, opioid analogues. Their repeated use leads to dependence: the body requires the external introduction of opiates to function. Stopping the use of the drug, in turn, leads to opioid withdrawal.

What are opioids?

Opioids are a class of drug with pain-relieving effects. They can be natural or synthetic. Opioids can be broken into two main categories: prescription and illicit.

Prescription opioids: Opioids that are prescribed by doctors to help manage pain, such as fentanyl, morphine, codeine, and others.

Illicit opioids: Opioids that are illegally manufactured and distributed, such as heroin and opium.

What are common opioid withdrawal symptoms?

The physical symptoms of opioid withdrawals can last anywhere from several days to several weeks, depending on the individual. The psychological ‘need’, however, can last much longer.

Opioid withdrawal is generally marked by a variety of physical symptoms, including:

• Dysphoria
• Fatigue
• Irritability
• Insomnia
• Headache
• Sweating
• Bowel irregularity
• Restless leg syndrome

Going “cold turkey”, or immediately stopping the use of opioids, can have lethal withdrawal symptoms.

Protracted vomiting can cause aspiration (fluid in the lungs) and pneumonia. Depletion of fluids can also result in electrolyte imbalance which can cause cardiac irregularity, leading to stroke or a heart attack.

Opioid withdrawal symptoms include…

• Racing heart
• Sweating and/or chills
• Nausea and vomiting
• Diarrhea
• Insomnia
• Anxiety, restlessness, or agitation
• Muscle aches
• Dilated pupils
• High blood pressure

The duration of withdrawal symptoms varies depending on the type, dosage, and use history of the specific drug. The onset of symptoms can be within 8 hours of the final dose and can last a week or more.

What is opioid withdrawal syndrome?

‘Opioid withdrawal syndrome’ is a term that refers to the combination of symptoms that happen during withdrawal. They can range from mild to serious, potentially life-threatening conditions.

How long does withdrawal last?

The severity of withdrawal is predicated on the type of narcotic used, its dose, and duration of use. Heroin withdrawal, for example, begins 8 to 12 arrows after the last use of the drug and is signaled by anxiety and craving. Withdrawal will reach its peak 36 to 72 hours after the final dose, and will gradually subside over a 5 day period.

This timeline will, of course, vary according to which narcotic the body withdrawals. Fentanyl, for example, has a rapid mechanism of action which corresponds with a rapid, acute withdrawal period.

What are common symptoms of opioid abuse?

Although prescription opioids are safe when used as prescribed, they are highly addictive. It doesn’t take long to build up a tolerance for them. When you can no longer function normally without opioids or your daily life starts to revolve around your next dose, that’s when a doctor may diagnose you with an opioid use disorder.

Symptoms of opioid abuse include:

• Changes in behavior, including work, hobbies, and exercise routines
• An inability to control opioid use
• Cravings for opioids
• Drowsiness and/or changes in sleep habits
• Weight loss
• Decreased libido
• Changes in behavior or relationships with family or friends
• ‘Doctor shopping’ (visiting multiple doctors for a diagnosis)
• Prescription pill bottles from multiple doctors, or with other peoples’ names on them

Fortunately, regardless of how long or how severe your addiction is, you can overcome an addiction with professional medical attention.

What is opioid-induced neurotoxicity?

Opioid-induced neurotoxicity is a side effect of opioid use disorder that typically develops after prolonged use of this class of drug. Opioid-induced neurotoxicity typically affects older individuals and those who have been using opioids for a long time. This condition also occurs in patients who have kidney issues since the body cannot process waste produced by the drug, resulting in a buildup of waste that can damage the brain.

Opioid-induced neurotoxicity is not the same thing as overdose and is characterized by symptoms such as:

• Confusion
• Difficulty thinking clearly
• Difficulty concentrating
• Cognitive impairment

How to know if you’re addicted

Prescription opioids are highly addictive. If you’re taking prescription opioids and are concerned you may be addicted, here are some questions to help you recognize opioid addiction.

• Have you noticed withdrawal symptoms when you stop using opioids?
• Are you taking increasingly higher doses of opioids to achieve the same effect?
• Have you experienced any negative consequences alongside opioid use, whether in your personal or professional life?
• Do you have difficulty reducing the amount of opioids you use?
• Have you changed your schedule to accommodate your opioid use?
• Are you becoming preoccupied with either using or obtaining opioids?

If you’ve answered yes to three or more of these questions, you may want to speak to your doctor for their advice as to your next steps.

What are opioid withdrawal treatment options?

There are a variety of treatment options available for opioid withdrawal syndrome. Although home remedies such as detox kits and drinks are easy to find on the internet, home remedies are NOT recommended for opioid detox due to the potentially dangerous side effects that can come with withdrawal symptoms.

What medications are used for opioid withdrawal?

Many of the medications available for easing the withdrawal process involve acting on the same receptors to which opiates bind.

Note that the efficacy of these medications in treating opioid withdrawal is variable and should only be pursued via professional oversight. Methadone is one such medication: it is an opiate receptor agonist, like all opium derivatives. However, it does not induce the same effects as more potent opiate-agonists such as heroin or fentanyl. It is also longer acting, allowing the body to “taper” and cycle off its reliance on the opioid. Other drugs work in a similar fashion, including Kratom, Naltrexone, and Buprenorphine.

There are also a variety of anticonvulsant medications available to help ease the symptoms of opioid withdrawal. These include Gabapentin (Neurontin) and Topiramate. Medications which ease anxiety and seizures are also used to treat symptoms. These medications include benzodiapem in the form of Lorazepam, Diazepam, and Ativan. Other medications used for the treatment of symptoms include anti-depression medication such as Trazodone.

What are other treatment options?

Opioid addiction treatment typically takes one of three forms: inpatient, outpatient, or in-home rehab services.

Inpatient: Patients travel to and stay at a facility for the duration of their program, which may last several weeks or months. Patients receive professional medical attention and attend group therapy, counseling, and coaching.

Outpatient: Patients travel to a rehab facility for half day or full day programs and return home every night. These programs may be useful for mild addiction or as part of an ongoing treatment program, as they do not offer as comprehensive medical care as inpatient facilities.

In-Home Rehab: In-home services combine the quality of care of inpatient facilities with at-home convenience. Appointments take place in the privacy and comfort of the patient’s home, and patients have dedicated care and individualized therapy and support sessions.

Medically managed detox for opioids

Medically managed detox is the safest and most effective way to overcome opioid withdrawal symptoms and recover from an addiction. There are three methods that medically managed detox can take.

Can you overdose from opioids and how to handle it?

Prescription opioids are intended to help manage pain, but there is a fine line between effective treatment and an overdose from opioids. Let’s talk about how to identify an overdose as well as your treatment options.

Symptoms of opioid overdose

Opioid overdose happens when you take more of a prescription or illicit opioid than your body can process at one time. Although both prescription and illicit opioids can lead to an overdose, illicit opioids are particularly culpable in doing so, as the contents and strength of the drug are unknown.

• Symptoms of opioid overdose include:
• Unconsciousness/unresponsiveness
• Vomiting
• Gurgling noises
• Pinpoint pupils
• Slow or stopped breathing
• Slow or stopped heartbeat
• Pale skin that may feel clammy to the touch
• A blue or purplish color to fingernails and/or lips

Opioid overdose is a medical emergency, so if you think someone has overdosed on prescription of illicit opioids, call 911 immediately.

What is respiratory depression?

Respiratory depression (also known as hypoventilation) happens when your breathing slows to the point where your body can no longer effectively remove carbon dioxide from your blood.

Respiratory depression is common in opioid overdose since this type of drug affects the part of your brain that regulates your breathing. This means that an overdose can slow your breathing and potentially result in damage to your brain. If your breathing stops, it can result in death.

Preventing opioid overdose

Preventing opioid overdose is the best way to avoid potential damage to your brain, coma, or death. Fortunately, there are many ways to prevent an overdose from happening.

• Take prescription opioids as prescribed
• Don’t take them longer than your doctor recommends
• Don’t take them more often than prescribed
• Don’t take them recreationally (to get high)
• If your pain gets worse, contact your doctor instead of using more opioids
• Avoid mixing prescription opioids with alcohol, sleeping pills, and other drugs
• Dispose of any leftover prescription opioids
• Inform your family about the signs of opioid overdose
• Talk to your doctor about alternative pain management options
• Avoid using illicit opioids, which vary in strength and composition and can be dangerous

Treatments for opioid overdose

Although home kits for opioid overdose have recently become available, they are not a replacement for professional medical attention. An overdose is a medical emergency, so if you think someone has overdosed on opioids, call 911 right away.