Opiate and Opioid Withdrawal

What is opioid withdrawal?

Opioid withdrawal refers to symptoms that happen if you suddenly stop using opioids or opiates. These are powerful painkillers that are addictive. Opioid withdrawal, sometimes called opioid withdrawal syndrome, can affect people who use opiates like heroin or morphine, or lab-made opioids like oxycodone and hydrocodone.

People can become physically dependent and at risk for withdrawal even after short-term use to manage pain. But in general, withdrawal happens more often in people using opioids daily for longer than two weeks, especially more than 90 days.

Opioid withdrawal isn’t life-threatening, but it can make you feel very sick. Studies show fear of withdrawal symptoms is a major reason why people keep using opioids. If you have opioid use disorder, receiving treatment for withdrawal symptoms may be the first step toward recovery.

What are the symptoms of opioid withdrawal?

The symptoms of opioid withdrawal vary from person to person and depend on factors like the type of opioid or opiate that you take and how long you take it. Some early symptoms make people feel like they have a bad cold or the flu. Specific symptoms are:

• Aches and pain.
• Anxiety.
• Chills and fever.
• Diarrhea.
• Dilated pupils.
• Elevated heart rate and blood pressure.
• Heavy sweating.
• Insomnia.
• Intense desire or craving for opioids or opiates.
• Nausea and vomiting.
• Tearing up or crying.

How long do withdrawal symptoms last?

That depends on the opioid. For example, withdrawal symptoms for fast-acting opioids like heroin or oxycodone may last four to five days. But withdrawal symptoms for a slow-acting opioid like methadone can last for a week or longer.

What causes opioid withdrawal?

Over time, opioids cause changes in your brain. They reduce pain and you may find taking opioids alters your mood. Your body can become used to the way the drugs make you feel. When you suddenly cut back on or stop using opioids, these brain changes react to the absence of opioids in ways that create withdrawal symptoms.

What are the complications of opioid withdrawal?

The most serious complication is having an accidental opioid overdose if you stop taking an opioid and then return to using it. Sometimes, withdrawal symptoms are so severe that people return to opioid use to make symptoms stop.

How is opioid withdrawal diagnosed?

Healthcare providers will do physical examinations. They may do blood tests to check for drugs in your system. They’ll ask:

• If you have a diagnosis of opioid use disorder.
• The kind of opioid that you were taking.
• When you stopped taking it.
• The symptoms you’re experiencing.
• When your symptoms started.
• Whether you’ve gone through withdrawal before.

What are treatments for opioid withdrawal?

Healthcare providers may prescribe medication for specific physical symptoms like diarrhea or muscle spasms.

They’ll also talk to you about your opioid use and recommend ways you can stop using opioids and avoid withdrawal. For example, if you’re taking prescription opioids to manage pain after surgery or injury, your provider will work with you to gradually reduce how much you’re taking.

If you have or think you may have opioid use disorder, your provider will ask if you want treatment like cognitive behavioral therapy.

Some common opioid withdrawal symptoms and medications that treat them include:

• Opioid cravings: Buprenorphine (Subutex®). Providers typically prescribe this medication in pill form, but you may also receive this medication by injection. Your provider may prescribe medication that combines buprenorphine and the opioid blocker naloxone (Suboxone® or Zubsolv®). They may also prescribe methadone (Dolophine® or Methadose®).
• Stomach cramps and diarrhea: Clonidine (Catapres®), which also helps with high blood pressure that happens during withdrawal. Your provider may recommend over-the-counter medications for diarrhea.
• Insomnia: Trazodone (Desyrel®), doxepin (Silenor®) or mirtazapine (Remeron®).
• Nausea and vomiting: Ondansetron (Zofran ODT®), prochlorperazine (Compazine®) or metoclopramide (Reglan®).
• Muscle spasms: Baclofen (Ozobax®).
• Aching muscles and pain: Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.

Can I prevent opioid withdrawal?

You may not be able to prevent opioid withdrawal, but you can take steps to avoid severe symptoms. If you use opioids for any reason and are worried about withdrawal, ask your healthcare provider for help. They can prescribe medication to manage symptoms. And getting help for your symptoms may keep you from developing opioid use disorder, or help you to begin to recover.

What can I expect if I have opioid withdrawal?

In general, you can expect to take medication that eases your craving for opioids. Your provider will explain how long you’ll need to take medication.

How do I take care of myself?

The most important thing is to take withdrawal medication exactly as prescribed. Withdrawal symptoms can come back if you miss a dose, increasing the chance that you’ll start using opioids to avoid the symptoms. It can take time for your symptoms to go away completely. Here are some ideas to help you work through withdrawal symptoms:

• Consider counseling: If you’re withdrawing from opioid use, it means you were dependent on the drug or have opioid use disorder. Working with an addiction counselor may help you continue your recovery.
• Get rest: You may receive medication for insomnia, but self-care habits like avoiding caffeine and alcohol before bedtime may help.
• Take plenty of fluids: Like insomnia, you may receive medication to help with withdrawal symptoms like diarrhea and vomiting. But you can still develop dehydration that can make you feel dizzy or cause headaches.
• Take a walk: Or go for a run, a swim or a bike ride. Exercise releases endorphins, hormones that your brain releases when you’re in pain, stressed out or feeling down. An endorphin boost may help with pain and stress and improve your mood.

When should I see my healthcare provider?

If you’re receiving treatment for opioid withdrawal, you should meet with your provider if your withdrawal symptoms get worse and you’re thinking about using opioids to make the symptoms go away.

What questions should I ask my healthcare provider?

Opioid withdrawal symptoms can take you by surprise. You may want to ask your provider questions like:

• I followed the prescription instructions. Why do I have withdrawal symptoms?
• Will I need medication to treat my symptoms?
• Do withdrawal symptoms mean I have opioid use disorder?
• I have opioid use disorder. How can I avoid returning to opioid use?