Opioids were previously classified as synthetic opiates but are now considered a class of drugs in itself that include opiates and narcotics. Opioids are typically prescribed as pain relievers but also include the illegal drug heroin and many byproducts of heroin. Common abused drugs in this class include:

  • Codeine
  • Fentanyl
  • Heroin
  • Hydrocodone (Vicodin)
  • Methadone
  • Morphine
  • Oxycodone (OxyContin/Percocet)

Opioids are prescribed to help treat many ailments such as a cough, diarrhea, and pain, and as pre-surgical or procedural sedation. However, even when taken as prescribed, weaning off of these drugs can be hard. Sudden decrease or abruptly stopping these drugs can cause opioid withdrawal. Opioid withdrawal can actually make the person feel as if they need another dose, creating opioid dependence and addiction unknowingly.

What is Opioid Withdrawal?

The brain produces natural opioids which reduce pain, prevent depression and anxiety, and can lower respiratory rates. These natural opioids attach to not only the brain but also the spinal cord and gastrointestinal tract. The body does not produce opioids in large amounts, and there is no threat of overdose.

Opioid medication and illegal drugs mimic the natural opioids in the body. However, when a person uses opiates, the drug enters the brain through the bloodstream. Then the opiate molecules adhere to and trigger the opioid receptors. This is a biochemical communication that facilitates with the analgesic properties of the drug and is related to the cause of releasing dopamine. Dopamine provides a pleasurable feeling urging the individual to continue the drug use. Additionally, dopamine destroys the noradrenaline (norepinephrine) neurotransmitter that adds energy and alertness. When the noradrenaline is destroyed, the person may begin to feel tired.

Over time, the brain develops a tolerance to the increased dopamine and lowers the noradrenaline levels. Gradually, the brain changes to functioning naturally when the drug is present and irregularly when it is not present, creating a physical dependency. A tolerance is formed when the brain realizes the average amount of dopamine levels are lower than when the opiate was used initially. Once someone has built a tolerance to opiates, he/she will consume higher amounts of the drug to have the same effects as before.

The above changes can develop in the body even when someone has been prescribed an opiate. With tolerance and physical dependency present, when a person tries to end use of opiates, he/she will have lower dopamine levels and higher noradrenaline levels. The neurotransmitter combination being out of balance is what causes the unwanted opiate withdrawal symptoms.

Since everyone is different and develops dependency and tolerance at different rates, it is hard to determine who will have severe drug withdrawal symptoms and how long they will last until it begins.

Is Opioid Withdrawal Dangerous?

Withdrawal from opiates is typically not dangerous or fatal. However, it can be uncomfortable, and the level of discomfort from the symptoms can differ depending on some key factors including:

  • Type of drug
  • Dosage
  • Frequency
  • Length of use
  • Physical and mental status

Those who have consumed opioids in higher doses, more often, and for extended periods of time have a higher chance of experiencing painful and challenging drug withdrawal symptoms.

The dangers of withdrawal occur when an addict is having intense cravings and experiencing depression. If an addict relapses on opioids, he/she is at a higher risk of fatal opioid overdose. This is especially true if the tolerance has decreased. Experiencing severe depression during withdrawal can place the individual at risk for self-harm or suicide.

Signs and Symptoms of Opioid Withdrawal

Signs and symptoms of opioid withdrawal can increase and change in time. Early symptoms of withdrawal to watch for include:

  • Anxiety
  • Chills
  • Cramping
  • Diarrhea
  • Dilated pupils
  • Goosebumps
  • High blood pressure
  • Increased heart rate
  • Muscle pain
  • Restlessness
  • Running
  • A runny nose
  • Being shaky
  • Sweating
  • Trouble sleeping
  • Vomiting
  • Watery eyes

Opioid withdrawal symptoms typically occur between 12 and 30 hours after quitting and can last between four and ten days. However, if someone is withdrawing from a longer-acting drug, such as methadone, it may take up to 21 days before the acute withdrawal process ends. Unfortunately, symptoms do not stop here. In some cases, a prolonged withdrawal period could occur after the body has processed the substance and acute withdrawal symptoms have ended. The continued withdrawal symptoms are known as post-acute withdrawal syndrome (PAWS), protracted withdrawal and chronic withdrawal. Post-acute withdrawal symptoms include:

  • Anxiety
  • Depression
  • Fatigue
  • Irritability
  • Reduced decision-making skills
  • Trouble sleeping

During withdrawal, it is advised to seek medical attention for the detox process. Detox is when the body naturally breaks down and removes the substance.

Opioid Detox

During treatment, the detox process has several strategies used to help control the withdrawal symptoms. During rehab, medical professionals including doctors, nurses, and clinicians help the detox and withdrawal process. Often, medications and other supportive involvements are used in combination to help decrease the painful symptoms. Those who are detoxing will benefit from a medically assisted detox facility to assess their physical and medical status as well as manage symptoms. When needed, they can be referred to a substance abuse treatment facility. Detox is offered as inpatient and outpatient services depending on the patients needs like:

  • The severity of opioid withdrawal symptoms
  • Level of support system and stressors
  • Current living situation
  • Transportation
  • Previous treatment or detox efforts

Depending on the addict’s level of use, treatment may be focused around slowly weaning the individual from the drug or using a medication such as buprenorphine or methadone to help treat the symptoms.

Attending behavioral therapy is essential during the care of detox and withdrawal. Appearing in many levels of inpatient, outpatient, residential environments, some treatment professionals may use:

  • Cognitive-behavioral Therapy (CBT). This is centered around changing destructive thoughts, behaviors, feelings and beliefs to prevent substance use in the future.
  • Contingency Management (CM). CM is built around behavioral values and operates to offer physical rewards for recovery-orientated, drug-free behaviors that offset the rewards of continued use.
  • Motivational Interviewing (MI). This form of treatment is operated with building deep motivation for change, recovery, and sobriety.
  • Family Therapy. Family therapy helps family members learn the issues associated with substance abuse and how to improve their relationships during sobriety.

Tips for Handling Cravings

Drug cravings are pretty common among those in recovery; however, the intensity or severity of the craving generally depends on the level of addiction or dependence. During treatment medical professionals teach techniques to overcome these cravings. The methods are split into three categories.

  • Behavioral – focuses on changing your behaviors to avoid relapse. Pushing the thought of your cravings to the back of your head, trying to distract yourself and choosing not to use are all examples of behavioral tactics.
  • Relaxation – relaxation skills including deep breathing exercises and guided imagery that can help reduce craving by lowering stress factors.
  • Cognitive – helps teach patients how to self-talk before, during or after a craving emerges. Having a positive attitude and positively speaking regarding the desires to use can lower the risk of relapse.

If you or a loved one struggles with opiate use, abuse or dependency, do not wait any longer. Take the steps towards treatment and living a happy, healthy and sober lifestyle. Call Serenity Acres today to begin your road to recovery.