Two days had passed since his last use. That’s when James showed up at the county health department seeking help for his opioid withdrawal. His hair was damp with perspiration. In a matter of seconds, he’d go from hot chills to cold flashes. His legs ached. He had uncontrollable diarrhea, and he hadn’t slept the night before.
Every year, thousands of people like James who are addicted to opioids show up at hospital emergency rooms, doctor’s offices, local health clinics, and rehab centers across the U.S. In some cases, the state of withdrawal is so agonizing that it can be unbearable.
Yes, opioid withdrawal is unpleasant. Usually, if they are fortunate, people suffering through opioid withdrawal are given medicines that will help with vomiting or diarrhea and urged to seek additional treatment. Some do. Many more don’t. But, if you choose, you can get back on your feet again.
Opioids, a class of drugs naturally found in the opium poppy plant, have been around for thousands of years. By using the same chemical structure found in these plants, scientists can also create opioids in a laboratory. Because they contain chemicals that can relax the body, these prescription drugs are relied on to treat moderate-to-severe pain. Hence, the advent of painkillers.
But, opioids are not only used for medical purposes. Because the relaxed feeling or “high” can an attractive commodity for pleasure, opioids have been identified among the world’s most-abused drugs. The problem with opioids is that they are highly addictive. Their dangers – from overdose to death – have been highly chronicled.
In fact, the heightened awareness and the growing pool of people and their families who have been harmed by the addictive nature of the drug has led many to believe the United States is in the throes of an opioid epidemic.
Consider that as a nation, Americans consume almost 80 percent of the world’s opioid supply, which amounts to the highest rate of use per capita anywhere. Surveys also claim that more than 2 million Americans – aged 12 and older – suffer from opioid use disorder or a physical dependence on the drug. In other words, they are addicts.
According to the U.S. Centers for Disease Control and Prevention, opioid overdoses account for some 50,000 deaths in the United States, annually. That’s about 130 deaths each day. No wonder, thanks to these alarming statistics, doctors have cut down on the number of opioids they prescribe.
Some opioids are more prevalent than others. Common opioids in order of increasing strength along with their generic names include:
- Hydrocodone (Vicodin, Hycodan)
- Morphine (MS Contin, Kadian)
- Oxycodone (Oxycontin, Percocet)
- Hydromorphone (Dilaudid)
- Fentanyl (Duragesic)
Besides heroin, an illegal drug synthesized from morphine, some of these opioids serve a worthwhile purpose. Methadone is another synthetic opioid that is administered to heroin addicts to relieve their withdrawal symptoms. As painkillers, hydrocodone and oxycodone are the nation’s most prescribed opioids.
Fentanyl was originally manufactured as an anesthetic for surgery and is often prescribed to alleviate pain related to terminal illnesses including cancer. But, because it is up to 100 times more powerful than morphine, even a small dose of fentanyl can be deadly. Authorities claim fentanyl has been a driving force behind a rash of overdoses in recent years.
Opioid withdrawal is the most common contributor to high rates of relapse. The brutal side effects from withdrawal can send far too many addicts in search of some form of relief or quick-fix. Complications from opioid withdrawal should not be underestimated. If left untreated, withdrawal from opioids can advance from flu-like illness to heart failure and, in rare cases of inadequate hydration and electrolyte imbalance, even death.
The good news is that people who are addicted to opioids can move beyond their chemical dependency toward a healthier and more productive lifestyle. It won’t be easy. But, with appropriate medical care, even opioid withdrawal can be managed, and lives can be changed.
What is Opioid Withdrawal?
Opioids disrupt pain signals by attaching to receptors in the brain and spinal cord. By working to release the hormone dopamine, opioids activate reward areas of the brain with a euphoric feeling or “high.” Once the body can no longer satisfy a conditioned threshold for opioids, withdrawal will begin; usually about six to 12 hours after the last intake. The consequences of withdrawal are often both physical and emotional.
Acute withdrawal from opioids reaches its peak in about three to five days and can continue for up to four weeks Physical symptoms are most commonly associated with this early withdrawal period. Post-withdrawal symptoms or emotional reactions, are usually less severe, but may last for as long as two years.
What Are Opioid Withdrawal Symptoms?
All opioid symptoms are similar, but may vary in severity depending on the drug, its dosage, and duration of dependence. Common symptoms of opioid withdrawal include:
- Runny nose, teary eyes and sneezing
- Low energy, yawning
- Cold chills, sweating and goosebumps
- Muscle aches, pains, cramps and tremors
- Anxiety, restlessness and irritability
- Disturbed sleep
What are the Stages of the Opioid Withdrawal Timeline?
Opioid withdrawal can be, at the very least, extremely excruciating. However, knowing what to expect can alleviate some of the fears of withdrawal and serve as a source of encouragement for addicts to continue with treatment.
Although abstinence is noble and considered the first step in recovery, stopping “cold turkey” is not recommended. A sudden stoppage in opioid use without the guidance of a medical professional can promote severe side effects. Understanding and recognizing these side effects and the timeline for their emergence can serve as a leg up on recovery.
Any timeline for withdrawal can depend on the individual, type of opioid consumed, dosage, means of ingestion, and length of dependency. Most signs of withdrawal will intensify across the first 30 hours, and extend beyond physical to emotional expressions of discomfort. These experiences can be classified into three stages of withdrawal.
In the first six to 12 hours, a set of uncomfortable physical and psychological symptoms will begin to surface. Symptoms will emerge sooner for short-acting opioids, such as heroin, and after longer periods for prescription drugs
Post-acute withdrawal including mood swings, anxiety, disturbed sleep, lack of focus and low enthusiasm levels will peak after the first 72 hours but can extend up to two days
Some of the more intense psychological symptoms that begin to surface can provoke relapse. At this point, even though physical symptoms may have dissipated, anxiety, restlessness and disturbed sleep will become that much more troublesome for many.
Treatment for Opioid Withdrawal
Withdrawal from opioids is notoriously excruciating and difficult to endure. The physical side effects of withdrawal can be enough to provoke relapse and a return to addictive behavior.
That’s why medications that can offer comfort are so critical in the withdrawal stages. Loxfexidine, the first medication approved by the U.S. Food and Drug Administration (FDA) that was targeted to specifically treat withdrawal symptoms, has helped doctors provide some level of relief. Unlike methadone, the drug is not to be confused as another form of opioid, but rather a medication to be used when the need to detoxify is immediate.
Detoxing from opioids without medication is for the brave at heart. But even the most courageous have embraced methadone and buprenorphine — known medically as medication-assisted treatment, or MAT — to treat their withdrawal symptoms. As opioids themselves but without the “high,” these medications can address complications, reduce cravings and compromise withdrawal symptoms. When administered under controlled conditions, MAT, in combination with counseling and therapy, can increase the chances for sustained and meaningful sobriety.
Why Should I Detox?
If you are sick and tired of being sick and tired, you no longer need to feel the way you do. The time has come to think about detox. A professionally monitored detoxification in a residential treatment facility will provide an avenue for you to withdrawal safely and effectively and increase the chances of a long and sustained recovery as well.
That’s because inpatient detox provides a setting for doctors to prescribe medications to assist you through the pain and suffering associated with withdrawal. In the meantime, other medical professional can monitor your vital signs – blood pressure and heart rate among others – in a quiet and comfortable environment where you can focus your attention on getting sober.
What is the Next Treatment Step?
Your dependency on opioids has been slowly killing you. So, don’t expect a miracle overnight. Recovery will take time, but it is not impossible. Making the decision to stop abusing opioids can prove to be the smartest choice you will ever make. However, getting clean can be as difficult as you allow it to be. The choice is yours.
Detoxification is only the first step on a path toward continued sobriety. Your journey toward recovery will not end with Detox. Sustained sobriety will often require a stay at a residential treatment center. Here you will be provided with the tools—such as group therapy, one-on-one counseling, educational lectures and workshops and customized treatment plans to match your individual needs – to build a successful recovery program and prevent against relapse.