Opioid Withdrawal: Symptoms To Look Out For And Withdrawal Timeline

Last Updated: June 9, 2020

Reviewed by Michael Espelin APRN

In recent years there has been an increase in the cases of opioid withdrawal in various parts of the world, especially the United States. The improper technique of opioid withdrawal often leads to severe health issues. Withdrawal symptoms of opioids can be extreme and require the attention of a qualified medical professional.
Sudden withdrawal from opioids always presents with a large number of side effects which progressively deteriorates into both physical and mental incapacitation. Clinics report that opioid withdrawal is increasingly on the rise, as more people are attempting to get off the drug, quite often the wrong way. There are many ways on how to get off of opioids, and in all cases, it requires the assistance of health care professionals.
How long do opioids stay in the system, and what is the timeline for withdrawal? Often time withdrawal symptoms can be just as extreme as opioids side effects. Let’s look at how to detox from opioids and how to get off the drug.

Reasons Of Getting Off Opioids

Understanding how to get off opioids requires a comprehensive study on how the drug works. How do opioids work? The drug alters the activities of the CNS, causing increased tolerance and dependency.
If this drug is so addictive, then why do people take opioids? The prevalence of addiction to this drug is mainly among students and adults who may have indulged in the substance as a recreational drug.
The prevalent use of the drug and resultant opioid epidemic statistics shows a high level of dependency in millions of people from various regions of the United States and beyond. Reports showed an exponential growth in a neonatal opioid withdrawal syndrome. Due to the high rate of opioids overdose and dependency, many people are seeking the best options on how to get rid of their addiction.

Some may suggest various programs and medications inclusive of pain relievers, Aromatherapy, exercises, and many others, however, when experiencing signs of opioid withdrawal on abstinence, the first line of action should be to adopt the opioid taper method.

Tapering Off Opioids

Tapering or weaning off opioids is a technique used to mitigate dependency to the drug by progressively reducing the amounts of substance a person takes on a particular tapering schedule.

opioid tapering pill holder

Affected individuals often wonder how to wean off opioids, especially since the drug is highly potent and very addictive. The best method is creating a long tapering schedule to wean the individual off the medication properly. The longer the tapering period, the more effective the results would turn out. For many individuals, 2 to 6 months is the ideal amount of time required for weaning. This may be accompanied by less painful opioid withdrawal symptoms than going cold-turkey. This stage may be challenging to deal with for many individuals who may prefer to go back to their addictions, but tapering schedules can be combined simultaneously with the right medication, diet, and supplements, physical and mental activities. Hydration is essential to avoid headaches and muscular pains.

Opioid Withdrawal Symptoms

The opioid withdrawal comes with various complications owing to the fact that the body has adjusted to high levels of this medication in the system. Schedule II opioids such as hydrocodone, methadone, and oxycodone present with severe withdrawal symptoms. Despite that other opioids were classified as Schedule III it is not easier to withdraw from them. A person may begin to experience opioid withdrawal symptoms just a few hours after the last indulgence.
Symptoms of opioid withdrawal may be experienced at different periods depending on the mechanism of action of the drug. Some opiates are short-acting and start within 6-12 hours while the longer-acting opiates start within 30 hours and longer. Signs are differentiated into early and late withdrawal symptoms.

woman suffering from abdominal pain

Symptoms of withdrawal from opioid for which the nurse should assess include:

Early Symptoms Of Opioid Withdrawal

The initial symptoms include:

  • Frequent muscular aches and pains as well as stomach cramps
  • Palpitations and lacrimation with levels of insensitivity to light
  • Inability to sleep
  • Anxiety, agitation, mood swings, and hypertension
  • Frequent yawning
  • Feverish conditions and running nose

Late Symptoms Of Opioid Withdrawal

Late withdrawal symptoms may include the following conditions:

  • High craving for the drug
  • Vomiting and nausea
  • Recurrent diarrhea
  • Depression and moodiness
  • Cramping of the stomach
  • Goosebumps

The symptoms and side effects of opioid withdrawal can last for weeks, depending on the severity of the addiction. The opiates vs opioids withdrawal symptom is similar, and uncomfortable but unlikely lead to death.

Opioid Withdrawal Timeline

The opioid withdrawal timeline is a schedule of physical symptoms that can last through a particular period depending on the severity of addiction to the substance. How long does it take to detox from opioids? How long does opioid withdrawal last? Withdrawal period varies from one patient to the other; however, the good part is that the timeline acts as a guide for those who are going through the withdrawal process, that there is an end to these phases and endurance is what counts.

Writing Opioids withdrawal timeline

The withdrawal timeline can be categorized into three phases:

Phase One

The first stage begins immediately when the amount of substance that was usually taken is reduced or stopped completely. This stage occurs within the range of 12 to 36 hours after the last fix. Symptoms of this stage can last from 3 to 5 days, hitting its peak about 70 hours into withdrawal. The first phase may present with symptoms such as:

  • Agitation, irritation, mood swings
  • Vomiting and nausea
  • Stomach cramps
  • Inability to sleep

Phase Two

Many users battle with the second phase and often end up reverting to using the substance, especially long-term users. The chemical known as endorphins are produced in the brain, and they are responsible for regulating a person’s mood and behavior. These medications completely deplete the number of endorphins in the brain, so during the second phase, the brain begins to re-manufacture endorphins. The downside to this process is that it comes with the most distressing feeling of depression. This phase can last for about two weeks or more. The dominant characteristics of this phase are:

  • Dilated pupils
  • Muscular cramps
  • Depression
  • Fever
  • Goosebumps
  • Insomnia

Phase Three

Milder symptoms are expected during the third phase of the timeline. The duration of this stage largely hinges on the physical and mental condition of the individual and may last for two months or more depending on levels of dependency. This particular phase comes with symptoms that are more psychological than physical; they include:

  • Irritability and restlessness
  • Inability to sleep
  • Depression
  • Anxiety

Withdrawal And Detox Medications

There are various processes of opioid detox, and the duration varies from one person to the other. Some rehab facilities may suggest forms of medical therapy such as rapid detoxification for inpatients or office-based treatment for outpatients. Rapid opioid detoxification is known to be based on the use of anesthesia and other medication to mitigate the withdrawal symptoms experienced by the patient. This process of sedation may seem like a great option to evade symptoms felt during prolonged tapering processes. However, this method is unorthodox and may present with complications as there is no evidence to support its efficacy.
Opioid withdrawal medications may be obtained by prescription or over the counter. Some drugs that are recommended for treatment for opioid addiction are:

Buprenorphine

The drug Buprenorphine was approved as an opioid withdrawal treatment medication in 2002 by the FDA. The medicine functions as a partial opioid agonist by binding to receptors to create similar neurological effects as drugs such as morphine, hydrocodone, heroin, oxycodone, and others. Buprenorphine prevents cravings as well as relapse. Buprenorphine is also one of the most preferred opioid withdrawal treatments.

Clonidine

Clonidine for withdrawal of opioids is one of the most common prescription medications sold as brand name Catapres. The central alpha agonist alters the functions of the sympathetic nervous system. Clonidine for opioid withdrawal is an antihypertensive therapy and mitigates mental conditions such as anxiety and panic disorders as well as post-traumatic stress disorder (PTSD). The drug contributes as an opioid withdrawal medication in the following ways:

  • Prevents goosebumps and anxiety
  • Helps with palpitations
  • Mitigates insomnia

Methadone

When it comes to opioid detox, methadone is one of the most credible medications that can guarantee complete removal of withdrawal symptoms. The medication functions by binding to receptors located in the brain and mimic the effects of the drug by creating euphoric effects but with no withdrawal pain. As one of the best opioid withdrawal treatments methadone effects are:

  • Sedation
  • Constriction of pupils
  • Relief from pain
  • Euphoric effect
  • depression

Individuals who require an easy, painless withdrawal often opt for methadone.

 Doctor Injecting Male Patient with Methadone

Benzodiazepines

This popular psychoactive medication is known for its ability to alter the functions of neurotransmitters in the brain, similar to the effects of marijuana and opioids. The GABA receptor enhancer relieves symptoms of opiates through these properties:

  • Anxiolytic capabilities
  • Used as sedative
  • Effective as a muscle relaxant
  • Efficient as an anticonvulsant

Benzos come in brand names such as Xanax, Klonopin, Valium, Ativan, and others.

Baclofen

The opiate withdrawal syndrome can be countered with this muscle relaxant, which plays major roles in the alleviation of muscular spasms and pains. Baclofen is used as an off-label medication for opiate withdrawal because its composition mimics GABA neurotransmitters, also due to its ability to control these withdrawal symptoms:

  • Cerebral palsy
  • Injury of the spine
  • Multiple sclerosis

Seeking Help From Medical Professionals

The opioid withdrawal scale continues to tip as more and more people are seeking professional help for their addiction through inpatient and outpatient programs. It is necessary to seek the counsel of a medical professional as self-medication is dangerous, and so is quitting cold turkey.


Page Sources

  1. the U.S. Department of Health and Human Services, Opioid Crisis Statistics, https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html

Published on: September 17th, 2019

Updated on: June 9th, 2020

About Author

Peter J. Grinspoon, MD

Dr. Peter Grinspoon is an experienced physician with long-term clinical practice experience. As a former analgesic addict, Dr. Grinspoon knows precisely how important it is to provide patients with effective treatment and support. Medical writing for him is the way to communicate with people and inform them about their health.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.

Comments

Leave a comment