Author: Ruben Bermea, LPC

People who use opioids for medicinal purposes or misuse them to experience their intoxicating effects may notice early opiate withdrawal symptoms when they attempt to stop taking these substances.^1,2 The physical and psychological symptoms that develop when attempting to quit using opioids can range from mild to severe.^1,2 Understanding opiate withdrawal stages can help you get the right support so you can detox from these substances safely with an appropriate aftercare plan.¹

In This Article:

• How Opiate Withdrawal Occurs
• Stages of Opiate Withdrawal Symptoms
• Transitioning to Treatment

How Opiate Withdrawal Occurs

Certain pain medications and illicit drugs come belong to the class of substances known as opioids or narcotics.³ These substances have a high potential for dependence, even when used as prescribed. The U.S. Food and Drug Administration (FDA) notes that quickly stopping or reducing use of opioid medication increases a person’s chance of developing withdrawal symptoms.⁴ The potential harm caused by quitting opioids “cold turkey” led the FDA to change its guidance for providers who prescribe opioid medications to their patients.⁴ Healthcare providers are advised to gradually reduce the dosage of opioids over time when ending their patients’ use of opioid medications.

Experiencing withdrawal symptoms is an indication that your body has developed a dependence on opioids. After becoming dependent on opioids, you may experience physical and psychological distress when you try to stop using these substances, especially if you have used opioids over an extended period of time.²

Everyone who uses opioid medications to treat a medical condition can expect to experience withdrawal symptoms to some degree, according to the American Psychiatric Association.² That’s why it’s important to follow your healthcare provider’s guidelines for gradually reducing and discontinuing opioid use. If you are no longer under the care of a doctor, treatment is available to help you safely withdraw from opioids.

Stages of Opiate Withdrawal Symptoms

The nature of opioid withdrawal symptoms will depend on factors including:³

• The type of drug(s) consumed
• The dose or amount of opioids consumed
• The method of consumption
• The duration of opioid use
• The frequency of opioid use
• Personal health and background factors

In light of these different influencing factors, health experts have established an approximate timeline of opiate withdrawal stages most individuals experience.^1,5

Early opiate withdrawal symptoms can develop within minutes, hours, or days of the last dose taken.² Withdrawal from short-acting opioid substances―such as codeine, oxycodone, and hydrocodone―can start between 6-12 hours, with the peak intensity of symptoms occurring between 1-3 days following your last opiate use. The symptoms of these short-acting substances can subside over 5-7 days.^5,6

For longer-acting opioid substances―such as oxycodone, transdermal fentanyl, methadone, and extended-release tramadol―withdrawal symptoms may start 2-4 days following last use and continue for 14-21 days.^2,5,6

Your unique demographics and personal healthcare needs can influence the timeline of opiate withdrawal symptoms that you experience.⁵ If you need more support understanding opiate withdrawal stages and recovery options, call 800-934-1582(Who Answers?) to speak with a treatment specialist.

Early Opiate Withdrawal Symptoms

Symptoms of early stage opiate withdrawal symptoms include both physical and psychological experiences, including:^1,2

• Yawning
• Excessive sweating
• Sleep disturbance associated with insomnia
• Tearfulness
• Aching muscles
• Agitation
• Anxious mood
• Runny nose
• Nausea
• Stomach cramps
• Pupils becoming extremely small
• Piloerection, also known as goosebumps
• Diarrhea

Protracted Withdrawal Syndrome

Protracted withdrawal syndrome describes the signs and symptoms of withdrawal that occur after early opiate withdrawal has passed.⁵ Protracted withdrawal syndrome is also known by several other terms, including post-acute withdrawal syndrome, late withdrawal, and extended withdrawal.⁵

Chronic opioid use can cause lasting changes that affect the cellular, molecular, and structural functioning of the brain. These changes can affect the way you think, behave, and feel. Your ability to take pleasure in other life activities and the perceived need for opioids to maintain functioning may be part of your experience during protracted withdrawal syndrome.⁵

Symptoms associated with opioid post-acute withdrawal include:⁵

• Irritable mood
• Fatigue or low energy
• Decreased executive control
• Depressed mood
• Poor concentration or inability to focus on tasks

Opioid post-acute withdrawal symptoms can occur even as you work toward long-term recovery.⁵ Chronic opioid withdrawal symptoms such as anxiety, insomnia, and depressive symptoms may continue for weeks to months following the last instance of use.² Receiving education, support, and timely intervention can help a person continue through the recovery process and reduce the risk of relapse.

Transitioning to Treatment

Getting help during the stages of opiate withdrawal can improve your health and wellbeing.⁷ When left untreated, opioid withdrawal can become complicated by other factors.

Complications that can impact the withdrawal process include:⁷

• Your medical history, including any health concerns directly related to opioid use
• Your mental health history, including any instances of suicidal ideation
• The stability and safety of your home environment
• Whether you have used or are using other substances in addition to opioids

The risk of opioid overdose presents one of the most serious and potentially life-threatening aspects of the addiction and withdrawal process.^8,9 When you stop taking an addictive substance, you can become more sensitive to its effects. This sensitivity can increase your risk of overdose if you relapse into using opioids.⁹

Withdrawal Management

Commonly referred to as “detox,” withdrawal management includes medical interventions that promote your safe recovery from the effects of opioid or opiate withdrawal. These services can take place in different settings or treatment centers depending on the nature and severity of the withdrawal process.⁷

Medical supervision during the withdrawal management process can ensure you receive proper monitoring and interventions, as needed, to protect your health.⁷ For people facing higher levels of medical risk or relapse, withdrawal management at an inpatient or residential facility may best serve their needs. For people at lesser risk, withdrawal management can take place through an intensive outpatient or partial hospitalization program.⁷

Getting matched with the right level of care takes time and an accurate assessment of withdrawal symptoms.⁷ Call 800-934-1582(Who Answers?) to find out where you can get an assessment from a qualified clinician.

Treatment Beyond Detox

Substance use treatment does not end at the withdrawal management stage of recovery.⁷ Many interventions continue after detox to support long-term recovery.

Interventions that treatment programs use to facilitate opioid addiction recovery include:⁷

• Mental health counseling
• Relapse prevention planning
• Group therapy
• Family therapy
• Recovery support groups
• Physical health and medical health management
• Medication management
• Holistic interventions
• Aftercare management
• Skills training
• Case management
• Sober living programs
• Case management and social services support

Just as withdrawal management can take place in different settings based on your needs, you can also achieve long-term recovery through a variety of program options.⁷ You may need to step up or step down to different levels of care based on how your symptoms change over time. Developing a system of support and maintaining a connection with treatment providers can help you recognize the signs of potential relapse in order to avoid it. Acting quickly to preserve your health and recovery efforts can mitigate or prevent the serious consequences of opioid addiction.

If you would like to learn more about your choices in treatment, call 800-934-1582(Who Answers?) today to speak with a treatment specialist.

References

1. Medline Plus. (2021, May 25). Opiate and opioid withdrawal. U.S. National Library of Medicine.
2. American Psychiatric Association. (2013). Substance-related and addictive disorders. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
3. 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.
4. Center for Drug Evaluation and Research. (2019, April 9). FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering. U.S. Food and Drug Administration.
5. Substance Abuse and Mental Health Services Administration. (2010). Protracted withdrawal. (2010). Substance Abuse Treatment Advisory: News for the Treatment Field, 9(1).
6. Smith, H.S. (2012). Rapid onset opioids in palliative medicine. Annals of Palliative Medicine, 1(1), 45-52.
7. Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating Addiction: A Guide for Professionals. The Guilford Press.
8. (2020, December 12). Opioid Overdose. U.S. National Library of Medicine.
9. Hoey, N.M. (2019). Overdose. Salem Press Encyclopedia of Health. Salem Press.