Opioid Withdrawal & Detox
In This Article
Why is Detoxing From Opioids Dangerous?
Detoxing from opioids is dangerous because it can cause withdrawal symptoms. Opioids bind with receptors in different areas of the body to block pain signals. Those that bind with opioid receptors in the brain release dopamine.
Dopamine is a well-known neurotransmitter that boosts feelings of pleasure. 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 physical and psychological symptoms accompany it.
Commonly Prescribed Opioids
Prescription opioids can treat moderate-to-severe pain caused by injury or illness. The most common prescription opioids are:
Some opioids, like heroin, are produced illegally and sold in the streets. Others, like carfentanil, are prescribed for animals but are used for recreation.
Can I Quit Opioids Cold Turkey?
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, 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.
How to Taper Off Opioids Safely
Tapering off opioids means reducing your dose over time. You should taper at a rate that allows you to function normally without experiencing any withdrawal symptoms.
The best way to taper off opioids is gradually decreasing your dose while staying under the care of a doctor who monitors your progress.
Those taking opioids for two weeks or less may be able to stop without experiencing withdrawal symptoms. If you've taken opioids for longer, it's recommended to taper the drug by about 10% per week or month.
During an opioid taper, your doctor may do the following:
- Monitor your blood pressure, heart rate, breathing, and mental status
- Provide support during the tapering process
- Test your urine and blood to examine opioid levels in your body
- Introduce you to other pain therapies
- Prescribe medication to relieve pain or withdrawal symptoms
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 a willingness to recover. If you choose to do it at home, you need a strong support system like family members and friends.
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.
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.
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.
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.
Naltrexone is a full opioid antagonist with 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 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.
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
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 significantly decreases.
Here are the signs and symptoms of opioid withdrawal:
- Muscle ache
- Distress or agitation
- Difficulty sleeping (insomnia)
- Stomach cramps
- Cold flashes
- Uncontrollable leg movements
- Intense opioid cravings
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.
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
- Genetic profile
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 the first week: Withdrawal disappears, except in people with severe problems like 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 Vs. Long-Acting Opioids
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.
Opioid withdrawal is an unpleasant process that lasts anywhere from a few hours up to several days. It’s important to understand what happens during this period so you know what to expect. You can manage withdrawal symptoms through proper planning and medication.
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- “The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder - 2020 Focused Update.” American Society of Addiction Medicine.