Author: Ruben Bermea, LPC

If you have been using an opioid medication, you will likely experience some degree of withdrawal symptoms when you stop taking it. The U.S. Drug Enforcement Agency (DEA) recognizes narcotics, also known as opioids, as a class of substances that can cause dependence.¹ Dependence can lead to narcotic withdrawal symptoms when you attempt to significantly reduce or stop your opioid use, even when instructed to do so by your doctor.² If your symptoms are medically significant, withdrawal management services can help you safely stop using opioids and transition to another pain management treatment plan.³

In This Article:

• What Causes Narcotic Withdrawal?
• What Are Narcotic Withdrawal Symptoms?
• How Does Detox Manage Narcotic Withdrawal Symptoms?
• Is There a Risk of Overdose After Narcotic Withdrawal?
• What Are Treatment Options Following Detox?

What Causes Narcotic Withdrawal?

Narcotic, or opioid, substances are a class of drugs that can have intoxicating, euphoric, and pain-relieving effects.^1,2 These substances can come in the form of legally manufactured prescription medications, illicitly produced drugs, or counterfeit substances sold as medications.¹

The effects of prescription and illegal narcotics can change the way your brain responds to feelings of pleasure and your experience of pain.^1,4 As a result, you can become both physically and psychologically dependent on these substances.³ This means that you may need to continue taking narcotic substances to feel okay or to function normally.

The type of narcotic, legal or illegal, and how you use that substance can influence your likelihood of developing dependence.³ People who misuse prescription medications or illicit narcotics are at the highest risk of developing an addiction, also known as a substance use disorder, in addition to symptoms of dependence.

Those who use medications as prescribed tend to take opioids in smaller doses for shorter periods of time to alleviate acute, intense pain. When used in this way, opioid use is less likely to develop into a substance use disorder. However, you may still experience withdrawal symptoms, especially if you suddenly stop or significantly reduce the dosage you are using.² For this reason, your doctor will most likely recommend that you gradually reduce the dose or frequency of your opioid medication before you stop using it.

Withdrawal symptoms may also develop when a person uses opioid antagonists or opioid partial ag­onists, which are medications used to treat narcotic addiction.² Specific opioid antagonist medications that can trigger withdrawal include:^2,5

• Naltrexone
• Naloxone
• Buprenorphine

What Are Narcotic Withdrawal Symptoms?

Narcotic withdrawal symptoms can impact your mind and body. Withdrawal symptoms include:^2,5

• Aching in muscles, legs, or back
• Increased sensitivity to pain
• Anxious mood
• Restlessness
• Increased sweating
• Yawning
• Sweating
• Poor sleep
• Teary eyes
• Vomiting or nausea
• Goosebumps
• Diarrhea
• Pupil dilation

While narcotic withdrawal symptoms alone may not become life-threatening, other factors can contribute to a greater likelihood of harmful or life-threatening consequences.⁶

Experiences or problems that can complicate the narcotics withdrawal process include:^2,3

• Medical complications
• Mental health symptoms, such as suicidal ideation
• Impaired judgment
• Going into withdrawal in unstable or unsafe living conditions

Each of these concerns can contribute to the problems you experience while undergoing narcotic withdrawal.³ Getting medical support to manage withdrawal symptoms can ensure that you, or anyone else facing these challenges, can begin to recover safely. For more information on the withdrawal management recovery options available to you, call 800-934-1582(Who Answers?) to speak with a treatment specialist.

Withdrawal Timeline

The timeline for narcotic withdrawal symptoms can vary depending on several factors. When attempting to stop using short-acting opioid substances you can develop withdrawal symptoms between 6-12 hours after the last dose. Short-acting opioids include heroin, codeine, oxycodone, and hydrocodone.^7,8 Symptoms from short-acting narcotics normally peak for 1-3 days and gradually subside between 5-7 days after the last use.^7,8

Withdrawal from longer-acting opioids can occur within 2-4 days after you last used narcotic substances. Long-acting opioids include methadone, transdermal fentanyl, and extended-release tramadol. ^7,8 Narcotic withdrawal symptoms from these and other long-acting opioids can persist for more than 14 days, even lasting months following the last dose taken.^2,7,8

Beyond the initial withdrawal period, you might experience extended withdrawal symptoms that may include heightened sensitivity to pain, craving or strong urge to use narcotics, dysphoric (i.e., depressed) mood, and sleeping problems.⁷ These symptoms can last for months following the last episode of opioid use, which is why it’s critical to receive long-term recovery treatment and support.⁶

How Does Detox Manage Narcotic Withdrawal Symptoms?

When people say they will “go to detox,” they might think that detox refers to a specific place. In reality, detox refers to a sequence of withdrawal management services that a person can receive. These services can help you recover from the effects of narcotics withdrawal safely.³

Qualified substance use treatment professionals can offer withdrawal management services in a variety of settings.³

Inpatient hospitalization is one of the highest levels of care, offering medical management and monitoring services to treat narcotic withdrawal symptoms. Medical management can include routine medical procedures, stabilization efforts, prescribing of medications, and life-saving interventions to ensure a safe withdrawal process.

While some people may need hospitalization to manage their symptoms of narcotic withdrawal, many people can have their withdrawal process managed at lower levels of care.³ Clinical specialists at residential treatment centers can prescribe medications, monitor you during withdrawal, and, if needed, refer you to other treatment specialists if your symptoms require greater care. A benefit of residential treatment centers is that they provide substance use recovery services beyond detox.³

Intensive outpatient recovery programs and regular outpatient addiction treatment providers also can provide narcotics withdrawal management services.^3,4

Is There a Risk of Overdose After Narcotic Withdrawal?

During the withdrawal process, you may feel strong urges to use narcotics to stop experiencing the uncomfortable effects of withdrawal. This is when opioid overdose poses a serious risk.^2,9 Relapsing into substance use following a period of withdrawal, brief or otherwise, can contribute to your likelihood of experiencing an opioid overdose.⁴

If you use opioids for an extended period of time, you can develop a higher tolerance to that substance.² However, when you begin the narcotic withdrawal process, your tolerance to the effects of opioids decreases.⁵ This process can raise your sensitivity to opioids and, as a consequence, increase your risk of overdosing on smaller amounts of narcotics if you relapse during or soon after narcotic withdrawal.

The effects of an overdose can cause breathing challenges, decreased heart rate, and be life-threatening when left untreated.¹⁰ The loss of oxygen to the brain and body can lead to further problems associated with opioid overdose, including coma and brain damage.

Treat any sign of overdose as an emergency and seek medical support right away. Naloxone is a life-saving emergency medication that can restore breathing to a person experiencing an opioid overdose.¹⁰ Naloxone is available in a nasal spray form under the brand names of Kloxxado and Narcan in many states without a prescription.^11,12

Consult your local pharmacy to see if naloxone is available to you or contact your doctor for a prescription, if required. Anyone who obtains naloxone needs to be educated on how to use it properly. Whether or not naloxone is administered, it is also crucial to call 911 for emergency assistance if an overdose occurs. This is because other life-saving medical care may still be required after using naloxone.¹¹

What Are Treatment Options Following Detox?

Withdrawal management and detoxification services are only the beginning of the treatment process. The process of recovery can incorporate medication, counseling, medical support, and connection with a program that can help you find new, healthy ways of coping with stressors.^3,4

Substance use recovery programs offer various treatment options for people facing the challenges associated with narcotic withdrawal and opioid use disorder. An assessment by a qualified provider can help you explore your personal preferences and individual needs in recovery from opioid use.

To find medical supervision for safely withdrawing from opioid use and to learn about treatment options for a substance us disorder, call 800-934-1582(Who Answers?) today to talk with a specialist about your choices in recovery.

References

1. Drug Enforcement Administration Community Outreach and Prevention Support Section (2020). Drugs of abuse: A DEA resource guide/2020 edition. U.S. Department of Justice Drug Enforcement Administration.
2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
3. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating addiction: a guide for professionals. The Guilford Press.
4. National Institute of Drug Abuse (2021). Prescription Opioids DrugFacts.
5. MedlinePlus (2020, May 10). Opiate and opioid withdrawal. U. S. National Library of Medicine.
6. Blanco, C., & Volkow, N. D. (2019, March 13). Management of opioid use disorder in the USA: present status and future directions. The Lancet, 393, 1760–1772.
7. Substance Abuse and Mental Health Services Administration. (2010). Protracted withdrawal. (2010). Substance Abuse Treatment Advisory: News for the Treatment Field, 9(1).
8. Smith, H.S. (2012). Rapid onset opioids in palliative medicine. Annals of Palliative Medicine, 1(1), 45-52.
9. MedlinePlus (2020, August 18). Opioid addiction. S. National Library of Medicine.
10. MedlinePlus (2020, December 12). Opioid overdose. U. S. National Library of Medicine.
11. National Institute on Drug Abuse. (2021). Naloxone DrugFacts.
12. Lutz, J. (2021, May 14). Naloxone Nasal Spray: FDA Approves Higher Dose for Opioid Overdose. Practical Pain Management.