Opioid Withdrawal Symptoms & Detox

Opioid withdrawal can be painful and symptoms can last several weeks. Knowing what to expect from withdrawal and the detox process can help you make an informed decision about receiving treatment.

More About Opioid Abuse

How Long Do Opioids Stay in the System?

Opioids don’t stay in the system for very long; the half-life is about 3.5 to 9 hours for hydrocodone-based drugs and 1.5 – 6 hours for drugs like morphine and heroin. The half-life is the amount of time it takes for the drugs to reduce by 50 percent in the bloodstream. A urine screening can detect the presence of opioids for up to 72 hours after the last use, and blood tests will yield a positive result for up to 24 hours.

Depending on the length and extent of opioid use, symptoms of withdrawal begin to set in between six and 48 hours after the last dose. They can continue for up to a week after ceasing opioid use. The severity and length may vary with different types of opioid-based drugs, but the symptoms are similar regardless of whether withdrawal is from heroin or hydrocodone. Intensive opioid addiction treatment is designed to manage the pain of opioid detox while the brain and body become accustomed to functioning without drugs.

Opioid Withdrawal Symptoms

Opioid addiction treatment begins with detox to manage opioid withdrawal symptoms, which can become intense. At first, mild symptoms like head and body aches, low-grade anxiety, and restlessness occur. These build with each passing hour after the final dose of opioids is taken, and are accelerated and joined by profuse sweating, chills, goosebumps, vomiting, diarrhea, and drug cravings. The longer an addict goes without using again, the more these symptoms will intensify.

Then, the panic sets in. 

The brain is no longer able to function properly without the stimulus from opioids. Mood swings begin, and there may be bouts of depression and fatigue. It may seem easier to just sleep until these feelings pass, but severe or long-time users may experience sleep disturbances and hallucinations. The withdrawal period is extended for those trying to quit taking potent forms of opioids like fentanyl and medications that are formulated for extended release. Without medication and supervision during this critical phase, many will start using again just to alleviate the pain and discomfort of withdrawal.

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Opioid Withdrawal Timeline

The opioid withdrawal timeline varies by the individual, the type of drug dependency, and the length or severity of use. Symptoms begin as the last dosage wears off, and they peak in intensity by about 72 hours after quitting. Most of the physical complaints will taper off and cease by the end of the first week, but the emotional by-products of withdrawal like depression and anxiety may persist for months, even with opioid treatment.

The breakdown of what the body and mind experience during withdrawal will follow this general timeline:

Medications Used for Opioid Detox

Opioid treatment programs begin with medically supervised withdrawal to alleviate the initial pain that occurs when the brain and body are deprived of drugs. This is thought to restore function faster and allow a smooth transition to active opioid treatment. A range of medications may be tried during this period, and medical maintenance continued for some time after substance abusers leave the treatment facility.

Mild or short-term use can be stepped-down slowly until the patient is weaned off of the medication. Doctors may try anti-anxiety medications and non-narcotic pain relievers to make the patient more comfortable during the first critical week. Severe addictions will require medically assisted treatment (MAT) during this transition and beyond.

MAT is a proven strategy for managing withdrawal symptoms, which can become debilitating. Patients in programs that employ medical assistance are less likely to relapse after treatment and do better during the therapeutic phase. It reduces the likelihood of death by overdose, transmission rates for infectious diseases like HIV and hepatitis, and criminal activity over those who attempt to quit without medical supervision.

Medications used during withdrawal may include methadone and buprenorphine. Once the drugs are completely out of the system, naltrexone and suboxone are introduced to manage symptoms and prevent relapse. These medications reduce the craving for opioids or block the pleasurable effects of use, and they can cause unpleasant side-effects that are similar to withdrawal symptoms if relapse occurs. Methadone and suboxone are also used in medical maintenance programs after release from a rehab facility.

What to Expect From Opioid Addiction Treatment

At the height of the recent opioid crisis, which peaked in 2015, the Secretary of Health and Human Services (HHS) created a protocol that was designed to deal with opioid treatment in a more comprehensive manner. The recommendations covered five critical points that are considered paramount to successful opioid detox and relapse prevention.

  1. Increase access to recovery and treatment programs.
  2. Promote development and use of overdose-reversing drugs like Narcan
  3. Facilitate deeper understanding of the nature and patterns of addiction
  4. Support research into the relationship between pain and addiction, including increased funding
  5. Encourage researchers and doctors to devise more effective, drug-free pain management practices

Treatment facilities usually provide 30 – 90 days of intensive inpatient treatment that includes opioid withdrawal, private and group therapy sessions, holistic healing practices and treatment for underlying medical problems, and concurrent treatment for those with dual diagnoses of substance use and mental health disorders. Therapy provides individual insight into the underlying causes of addiction, helps identify triggers, and provides tools for coping without resorting to drug use. Aftercare provides continued support after release from a treatment facility.