Opioid withdrawal is one of the most demanding aspects of recovery from opioid use disorder, affecting millions of U.S. adults each year.
This page examines the physiological and psychological aspects of opioid withdrawal, exploring symptom timelines, management strategies, and evidence-based treatment that can help people overcome this core phase of recovery from opioid addiction.
Understanding Opioid Withdrawal
Opioid withdrawal occurs when individuals who have developed dependence suddenly reduceor discontinue their use of opioid medications or substances. This condition affects people using prescription opioids like oxycodone and hydrocodone, and illicit opioids like heroin and fentanyl.
Physical dependence on these drugs can develop surprisingly quickly. While withdrawal most commonly affects individuals using opioids daily for at least 2 weeks, some people may experience symptoms after shorter periods of use, especially with high-potency substances or extended-release formulations.
The severity and duration of opioid withdrawal symptoms depend on the type of drug used, dosage amounts, frequency of use, duration of dependence, individual metabolism, and overall health status.
The Physiology of Withdrawal
Opioids bind to mu-opioid receptors in the brain, spinal cord, and gastrointestinal tract. These substances mimic the body’s natural opioid system, which regulates pain, mood, and various physiological functions. With repeated use, the brain reduces its production of natural opioids and becomes dependent on external sources.
When opioid use stops, the brain struggles to maintain normal function without these substances. Neurotransmitter systems become imbalanced, leading to the characteristic symptoms of withdrawal. The brain’s reward pathways, which have adapted to regular opioid stimulation, must readjust to function without artificial enhancement.
This process of neuroadaptation explains why withdrawal symptoms can be so intense and why fear of these symptoms often prevents people from seeking treatment. Fortunately, the brain possesses remarkable plasticity and can recover normal function with appropriate time and support.
Early Withdrawal Symptoms
The initial phase of opioid withdrawal usually begins within 6 to 12 hours for short-actingopioids like heroin or immediate-release prescription medications. For longer-acting substances like methadone or extended-release formulations, symptoms may not appear for 24 to 48 hours.
Early opioid withdrawal symptoms often resemble a severe case of the flu. Physical manifestations reflect the body’s attempt to readjust its temperature regulation and stress response systems and may include:
- Muscle aches
- Joint pain
- Excessive sweating
- Chills
- Goosebumps
- Fever
- Runny nose
- Tearing
- Yawning
Psychological symptoms include:
- Anxiety
- Agitation
- Restlessness
- Irritability
- Mood swings
- Difficulty concentrating
- Sleep disturbance
Autonomic nervous system changes manifest as:
- Dilated pupils
- Elevated heart rate and blood pressure
- Increased sensitivity to light and sound
Late-Stage Withdrawal Symptoms
As withdrawal progresses beyond the first 48 hours, symptoms may intensify and expand to include additional complications.
Gastrointestinal distress becomes prominent, featuring severe nausea and vomiting, abdominal cramping and pain, diarrhea that can lead to dehydration, and complete loss of appetite. These symptoms occur because opioids affect the digestive system’s function.
Neurological symptoms may include tremors or shaking, heightened pain sensitivity, coordination difficulties, and cognitive fog or confusion. The brain’s pain processing systems, which opioids have suppressed, become hyperactive during withdrawal.
Intense cravings for opioids typically peak during this phase. These cravings can be overpowering, and they are one of the main challenges to maintaining abstinence from this class of drugs. The psychological component of wanting to end discomfort by using opioids can be as challenging to overcome as the physical symptoms.
Mood disturbances often include severe depression, anxiety that may reach panic levels, feelings of hopelessness or despair, and emotional instability. These symptoms occur when the brain struggles to produce sufficient mood-regulating neurotransmitters.
Timeline and Duration
Withdrawal timelines vary widely based on the specific opioid involved:
- Short-acting opioids produce symptoms that peak within 2 to 3 days and begin to subside after 5 to 7 However, some people may encounter lingering effects for several weeks.
- Long-acting opioids involve symptoms that peak on days 4 to 6 and persist for 2 to 3 weeks or more.
Protracted withdrawal, also known as PAWS (post-acute withdrawal syndrome), may occur, featuring mild but persistent symptoms that may last months. These can include mood disturbances, sleep problems, and occasional cravings.
Potential Complications
While opioid withdrawal is rarely life-threatening, several complications can arise without proper medical supervision:
- Dehydration from vomiting and diarrhea can become severe, leading to electrolyte imbalances that affect heart rhythm and kidney Maintaining adequate fluid intake during withdrawal helps mitigate this.
- Aspiration can occur if vomiting leads to breathing stomach contents into the lungs, especially if a person is extremely drowsy from other It’s less common in uncomplicated withdrawal but can be serious and lead to aspiration pneumonia.
- Cardiovascular stress from elevated blood pressure and heart rate can be dangerous for individuals with underlying heart conditions. Medical monitoring helps identify and address these concerns.
- Psychological complications include severe depression or suicidal thoughts and require immediate professional intervention. The combination of physical discomfort and emotional distress can create mental health crises.
- Return to opioid use is the most common complication, often leading to overdose because tolerance has decreased during abstinence.
Medical Management Approaches
Professional medical management improves withdrawal outcomes and reduces the risk of complications.
MAT (medication-assisted treatment) is the cornerstone of opioid withdrawal management. Buprenorphine provides controlled opioid receptor activation, reducing cravings and withdrawal severity while allowing gradual tapering. Methadone offers similar benefits for cases of severe withdrawal. Clonidine or Lucemyra helps manage autonomic symptoms like sweating, anxiety, and elevated vital signs.
Symptomatic medications address specific withdrawal symptoms: anti-nausea medications for gastrointestinal distress, sleep aids for insomnia, pain relievers for muscle aches, and anti- diarrheal agents for digestive symptoms.
Psychosocial support includes counseling to address the psychological aspects of withdrawal, support groups for peer connection and encouragement, and family therapy to rebuild relationships and create supportive environments.
Inpatient treatment settings provide 24-hour monitoring and immediate intervention capability, while outpatient programs enable individuals to maintain their everyday commitments while getting effective treatment for opioid withdrawal.
Many people benefit from continued medication-assisted treatment, which can prevent relapse and support long-term recovery. Medication-assisted treatment comes in daily oral options such as methadone and buprenorphine as well as long-acting injectables including Sublocade, Brixadi, and Vivitrol.
Counseling, support groups, and lifestyle modifications help address underlying factors that contribute to opioid dependence. Recovery is possible with the proper treatment and support.
Conclusion
Recovery Centers of America intends to save a million lives affected by opioid use disorder and mental health conditions, one person at a time. Our evidence-based treatments are available in both inpatient and outpatient settings at facilities across the Northeast, Midwest, Southeast, and Mid-Atlantic regions. All our treatment programs promote enduring healing and lasting recovery from opioid addiction.
We offer a 24/7 admissions process, accept many major health insurance plans, and provide intervention, family support services, and transportation. We are proud to have been recognized as America’s Best Addiction Centers according to Newsweek’s rankings of excellence. For admissions and inquiries, call 1-844-5-RCA-NOW (844-572-229) today or contactus.
