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Updated on September 27, 2022

Opioid Withdrawal & Detox

What is Opioid Withdrawal?

Opioid withdrawal happens when a person who uses opioids stops or reduces their intake.

It is the body's reaction to the sudden decrease in opioid levels after being used to its presence.

Examples of opioids that cause withdrawal are:

  • Codeine
  • Heroin
  • Hydrocodone
  • Methadone
  • Morphine
  • Oxycodone

Withdrawal occurs as a consequence of opioid use disorder. If you misuse opioids and suddenly stop taking them, you may experience withdrawal symptoms.

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Opioid Withdrawal Treatment

Opioid withdrawal causes a range of physical and mental effects. These symptoms are uncomfortable and last for several days to a week. The discomfort of withdrawal, along with cravings, increases your risk for relapse.

Treatment options such as opioid detox and medication-assisted treatment (MAT) help manage opioid withdrawal. They can ease your symptoms so you can focus on your recovery. Once you treat your opioid addiction, you can avoid opioid withdrawal in the future.

Taking opioids can alleviate withdrawal symptoms. But you also become stuck in a cycle of dependence and drug addiction. The best way to prevent relapse is to reduce your discomfort.

Opioids and Opioid Use Disorder

Opioids are a class of drugs found in poppy plants. They can be derived naturally or produced synthetically in laboratories.

Depending on their chemical composition, opioids are classified into:

  • Opiates: natural opioids from opium poppy (e.g., morphine and codeine)
  • Manmade or semi-synthetic opioids: made in labs using natural opiates (e.g., heroin and oxycodone)
  • Fully synthetic opioids: made in laboratories using synthetic chemicals (e.g., fentanyl)

Opioids treat moderate to severe pain. They are often used for chronic pain relief, such as people with cancer pain. Doctors are also prescribing opioids for the treatment of coughs and diarrhea.

The most common prescription opioids are:

  • Morphine
  • Codeine
  • Methadone
  • Oxycodone
  • Hydrocodone
  • Fentanyl
  • Hydromorphone
  • Buprenorphine

Some opioids like heroin are produced illegally and sold in the streets. Others like carfentanil are prescribed for animals but are used for recreation.

How Opioid Addiction Occurs

Obtaining and using opioids for illicit reasons is a form of substance abuse. So is taking prescription opioids beyond their intended use.

You can also develop an opiate dependence if you accidentally misuse the drug. This can lead to prescription opioid addiction.

Here are some examples of unintentional opioid dependence:

  • Increasing your dose to relieve pain without your doctor's knowledge
  • Extending the length of opioid treatment and not telling your doctor
  • Drinking opioids with alcohol because you do not know the risks

The chronic misuse of opioids can lead to opioid use disorders. Unless you get substance abuse treatment, it can lead to opioid dependence and possibly even addiction.

What is Opioid Use Disorder?

Opioid use disorder (OUD) is the desire to obtain and take opioids despite its consequences. If your opioid use causes significant impairment and distress, you have an opioid problem.1

It can affect your physical and mental health, as well as your job and relationships. Opioid abuse and addiction are both types of opioid use disorder.

In 2018, about 10.3 million Americans aged 12 and older reported opioid misuse. Over 2 million or 0.7% of the U.S. population were diagnosed with an opioid use disorder.

According to the Diagnostic and Statistical Manual-V (DSM-5), here are the signs of opioid use disorder:2

  • Taking opioids in increasing amounts or for a longer time
  • Inability to reduce or stop the use of opioids
  • Problems with family and loved ones about your opioid habit
  • Difficulty keeping up with responsibilities at work, school, or home
  • Spending more time using and obtaining opioids or recovering from their effects
  • Continued opioid use despite its physical and psychological effects

Regular use of opioids can cause physical dependence and tolerance. A person with opioid use disorder may also show signs of withdrawal if they stop taking.2

Talk to a mental health professional if you have any of these symptoms. A proper diagnosis is essential in the treatment of opioid use disorders.

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How Do Opioid Drugs Affect the Brain?

Opioids mimic endorphins, which are natural painkillers produced by the body. However, they produce more powerful effects and are prescribed for chronic and severe pain.

Opioids bind with receptors in different areas of the body to block pain signals. These include your brain, spinal cord, and gastrointestinal tract. Those that bind with opioid receptors in the brain release dopamine.

Dopamine is a well-known neurotransmitter that boosts feelings of pleasure. This feel-good hormone acts as a reward for certain behaviors. It helps you remember which activities produce this feeling, so you will keep on repeating them.

Opioids trigger large amounts of dopamine — enough to produce a euphoric high. Your brain remembers this "high" and gets hooked to it.

Eventually, you will start to seek out opioids and continue taking them in increasing amounts. As your brain gets used to the flood of dopamine, you become physically dependent on the drug. This is known as opioid dependence.

When you stop taking opioids or reduce your dose, your body reacts to the sudden decrease in opioids. This is known as opioid withdrawal and is accompanied by physical and psychological symptoms.

Opioid Withdrawal Symptoms

After several hours of your last dose, symptoms of acute opioid withdrawal will start to appear. These symptoms worsen within 72 hours when the amount of opioids in your body are significantly decreased.

Here are the signs and symptoms of opioid withdrawal:

  • Muscle ache
  • Anxiety
  • Distress or agitation
  • Difficulty sleeping (insomnia)
  • Sweating
  • Diarrhea
  • Nausea
  • Stomach cramps
  • Cold flashes
  • Goosebumps
  • Uncontrollable leg movements
  • Intense cravings for opioids

Withdrawal is not life-threatening, but it can be extremely uncomfortable. The more severe your dependence or opioid addiction, the worse your symptoms will be.

The intensity of your withdrawal also depends on the type of opioid used. Short-acting opioids like heroin wear off quickly and lead to stronger cravings.

Studies show that intense cravings increase your risk for relapse. People who experience more severe cravings are also less likely to seek treatment for their opioid disorder.3 This makes it difficult to quit opioids or begin treatment.

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How Long Does Opioid Withdrawal Last?

Opioid withdrawal can last anywhere from a few hours to several days. How long these symptoms last varies across opioid users.

The timeline of withdrawal depends on factors such as:

  • Frequency of opioid use
  • Amount of opioids you take
  • Severity of your opioid dependence or addiction
  • Your health while taking opioids
  • Type of opioid used (e.g., long-acting or short-acting)
  • How you take the drug (e.g., snorting and injection)
  • If you combine opioids with other drugs

Factors such as metabolism, genetic profile, weight, and lifestyle may also affect the length of your withdrawal symptoms.

Opioid Withdrawal Timeline

The half-life of a drug also determines when your withdrawal symptoms will appear and for how long.

Below is a general timeline of opioid withdrawal:

  • 48 hours: Withdrawal symptoms start to appear.
  • 3 to 5 days: Withdrawal symptoms peak.
  • First week: Symptoms begin to taper off. But you may still have digestive problems, poor appetite, and dehydration.
  • After first week: Withdrawal disappears, except in people with severe problems such as heroin addiction. In these cases, you may continue to experience insomnia, irritability, intense cravings, depression, and anxiety for six months or more.

Short-acting opioids provide fast pain relief, but their effects do not last long. Some examples include opioid analgesics such as heroin and oxycodone. If you stop taking them after prolonged use, withdrawal symptoms appear within 12 hours and peak at 24 to 48 hours. These symptoms will subside in 3 to 5 days.

Long-acting opioids such as morphine and short-acting oxycodone (Oxycontin) build up in the body before they take effect. It can take time for your body to get rid of them. Withdrawal symptoms do not show up until after 30 hours of your last dose. And it can take up to 10 days before these symptoms subside.

Management of Opioid Withdrawal Symptoms

Opioid withdrawal management eases your symptoms.

There are two ways you can manage opioid withdrawal:

  1. Opioid detoxification
  2. Medication-assisted treatment

These treatments reduce your risk for relapse and enable you to transition to rehab. Whichever option you choose, you are taking the first step to recovery from opioid use disorder.

Treating Opioid Withdrawal with Detoxification

Drug detoxification or drug detox is a medically-supervised treatment. During medical detox, opioid-dependent patients receive medications that reduce withdrawal symptoms.

Opioid detoxification can help you get past withdrawal safely and comfortably as your body gets rid of the opioids. Medical professionals will oversee the process in an in-patient setting to ensure your safety.

Treating Opioid Withdrawal with Medication-Assisted Treatment

Medication-assisted treatment (MAT) offers a well rounded approach towards the management of opioid withdrawal. It combines detox with behavioral therapy and patient counseling. Treatments are also personalized to your individual needs.

Doctors prescribe medications to treat opioid withdrawal symptoms. Counseling and therapy help you address unhealthy behaviors and psychological triggers that cause you to misuse opioids repeatedly. It's clinically proven to reduce the need for in-patient detox.

If you undergo medication-assisted treatment, it can help you:5

  • Sustain long-term recovery
  • Decrease your opioid use for illicit purposes
  • Reduce involvement in criminal activities
  • Improve your chances to get and maintain a job
  • Lower your risk for opioid-related deaths (e.g, overdose)

Keep in mind: Many health care providers recommend combining detox with additional treatments. Some of which include therapy and support groups. However, there is no one way to treat opioid withdrawal.

Medical Detox vs. Medication-Assisted Treatment

Drug detox treats opioid withdrawal medically using prescription medications. Medication-assisted treatment uses the same meds for detox. But there's the addition of cognitive behavioral therapy and counseling.

Both help manage your withdrawal symptoms in different ways:

Detoxification treats withdrawal symptoms within an in-patient setting.

To ensure your safety during detox, it involves the supervision of healthcare providers. This makes it ideal for opioid users with severe dependence or addiction.

Medication-assisted treatment treats withdrawal and prevents relapse by addressing psychological triggers. You can get MAT as an in-patient or out-patient service.

The treatment works best on opioid users who show willingness to recover. If you choose to do it at home, you need a strong support system such as family members and friends.

Opioid detox and medication-assisted treatment are only the first steps towards recovery. They can manage your opioid withdrawal symptoms. However, they cannot treat opioid use disorders such as drug dependence and addiction.

Keep in mind: Opioid withdrawal treatment does not have a one-size-fits all approach. Your doctor can help determine which treatment is best for your condition.

Detox Medications for Opioid Withdrawal

The National Institute on Drug Abuse (NIDA) recommends the following medications for the management of opioid withdrawal. Doctors may prescribe them to reduce your discomfort and pain while undergoing withdrawal.

These medications can be used during medical detox or medication-assisted treatment.

1. Buprenorphine (Subutex)

Buprenorphine is a synthetic opioid that can treat opiate withdrawal symptoms. It's a partial opioid antagonist that attaches to opioid receptors — just like other opioids. However, buprenorphine does not release dopamine or block pain signals. What it does is block the effects of addictive opioids.

When used as a detox medication, buprenorphine activates opioid receptors to reduce cravings and withdrawal symptoms. It can also speed up your recovery from withdrawal. Studies further show that buprenorphine can help you transition into relapse prevention treatment using naltrexone.6

2. Methadone

Methadone is a synthetic opioid and a partial opioid antagonist like buprenorphine. It produces similar effects and activates opioid receptors to compete with addictive opioids. In turn, this reduces any cravings and withdrawals caused by other opioids.

Research also shows that methadone is just as effective as buprenorphine.4

Do medications like methadone and buprenorphine replace one addiction with another?

No. Commonly misused opioids usually have strong and short-term effects that lead to a crash. This causes you to crave opioids and to keep taking them.

Methadone and buprenorphine are not addictive because they produce gradual effects on the brain.

Patients who take methadone and buprenorphine do not experience the same euphoric high as other opioids. These detox meds also block the effects of addictive opioids, causing users to slowly lose interest in them.

3. Naloxone (Narcan)

Like many detox meds, Naloxone is an opioid antagonist. It is often used as an emergency medication for opioid overdose because it quickly reverses the effects of opioids.

Naloxone is also prescribed to patients who are at risk for opioid intoxication. Evidence suggests that it helps with the rapid decline of opioid withdrawal symptoms.7

4. Naltrexone

Naltrexone is a full opioid antagonist that produces stronger effects than other detox drugs. It works differently from methadone and buprenorphine, which compete with addictive opioids to reduce their impact.

Instead, naltrexone binds with opioid receptors. It completely blocks the effects of opioids such as heroin, codeine, and morphine to suppress your opioid cravings.8

Moreover, it can help opioid users avoid relapse. If you misuse opioids after getting treated for opioid use disorder, naltrexone prevents you from getting high.8 Naltrexone is often used for relapse prevention.

Naltrexone Precautions

Improper intake of naltrexone can lead to precipitate withdrawal. If you take opioids or have taken any in the past 7 to 10 days, naltrexone treatment may cause withdrawal symptoms.8

Before you take naltrexone, we recommend talking to your doctor. They can assess you for withdrawal signs and delay treatment until your symptoms subside.

When transitioning from methadone or buprenorphine therapy, you must also wait 7 to 10 days before being treated with naltrexone.8

What is the difference between naltrexone and naloxone?

Naloxone and naltrexone are both opioid antagonists. They bind with opioid receptors to block other opioids from affecting your body.

Despite their similarities, there are key differences:

  • Naloxone is a short-acting drug. It is sold as a nasal spray or in injection form. It is usually given as an immediate medical intervention for opioid overdose. For people who are at increased risk of overdose-related deaths, it can be a life-saver.
  • Naltrexone is long-acting drug. It is only available in injection form. You can use naltrexone to reduce cravings and prevent relapse while taking other treatments for your opioid substance use disorder.

5. Clonidine

Clonidine is an antihypertensive drug that treats high blood pressure. Research shows that it reduces symptoms of opiate withdrawal.9

You can also take clonidine after undergoing maintenance therapy with methadone. It can shorten your withdrawal time to a few weeks when it normally takes 3 to 6 months.9

How Long is a Detox Treatment Program?

Opioid detox generally lasts for a week. How long detox takes depends on factors such as:

  • Your age, sex, and medical history
  • The type of opioid used
  • If you take opioids with other illicit drugs and alcohol
  • How much opioids you take on a regular
  • How long you've been taking opioids
  • How long your withdrawal symptoms last
  • If you have co-occurring mental health disorders

Opioid Withdrawal and Co-Occurring Mental Disorders

Withdrawal can be worse for people with mental health problems, such as:10

  • Depression
  • Anxiety Disorders
  • Personality Disorders
  • Schizophrenia

People who have problems with their mental health and opioid use have co-occurring disorders. Symptoms associated with these mental disorders may "rebound" and appear during withdrawal.

Co-occurring disorders put you at risk for relapse. You might take opioids to cope with your mental health. You should find a facility that provides treatments for your mental health and opioid disorder. Unless they are treated simultaneously, you will have a high risk for relapse.

Getting Help For Opioid Withdrawal

Suddenly stopping or “going cold turkey” on opioids causes withdrawal symptoms. Since they can be highly uncomfortable, you will more likely relapse.

If you have symptoms of opioid withdrawal, you should talk to healthcare providers about your treatment options. They can help manage your withdrawal symptoms and safely transition you to opioid rehab.

Opioid withdrawal is rarely life-threatening. But if you show signs of opioid overdose and intoxication, visit the emergency department for immediate medical help.

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Resources

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  1. "Opioid Use Disorder." PubMed.
  2. "Assessing and Addressing Opioid Use Disorder (OUD)." Centers for Disease Control and Prevention.
  3. "Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice." Frontiers in Psychiatry.
  4. "Medication-Assisted Treatment (MAT)." Substance Abuse and Mental Health Services Administration.
  5. "Buprenorphine for Opioid Detoxification." Lippincott Williams and Wilkins Journals.
  6. "Opioid Agonists and Partial Agonists (Maintenance Medications)." National Institute on Drug Abuse.
  7. "Opioid detoxification using naloxone." Wiley Online Library.
  8. "What Is Naltrexone?" University of Arkansas for Medical Sciences Psychiatric Research Institute.
  9. "The use of clonidine in detoxification from opiates." PubMed.
  10. "Mental Health and Substance Use Disorders." Mental Health.
  11. Medication and Counseling Treatment.” Substance Abuse and Mental Health Services Administration.
  12. Naloxone.” Substance Abuse and Mental Health Services Administration.
  13. Heroin Drug Facts.” National Institute on Drug Abuse.
  14. Fentanyl Drug Facts.” National Institute on Drug Abuse.
  15. More FAQs about Opioids.” National Institute on Drug Abuse.
  16. Effective Treatments for Opioid Addiction.” National Institute on Drug Abuse.
  17. Opiate and Opioid Withdrawal: MedlinePlus Medical Encyclopedia.” Medline Plus.
  18. Opioid Use Disorder.” American Psychiatric Association.
  19. "2018 National Survey on Drug Use and Health." Substance Abuse and Mental Health Services Administration.
  20. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder - 2020 Focused Update.” American Society of Addiction Medicine.

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