The opioid crisis in the U.S. is growing more blatantly apparent each passing day. According to the CDC, in 2016, on average, more than 100 people a day died of an opioid overdose, and there’s no sign of things slowing down, with new reports showing a 30 percent increase in opioid overdoses across the country from 2016 to 2017.
Currently, in the United States, there are more than 1,000 people sent to emergency rooms daily for treatment due to the misuse of opioid prescriptions. Of these 1,000 people per day, 46 of them do not survive.
The term opioid used to apply to any synthetic drugs created to work the same way as naturally-derived “opiates” like morphine or codeine, which were themselves made from opium. Today, however, the term opioid is used to refer to the entire family of opiate drugs, both natural and synthetic, and are categorized as any substances that act on the opioid receptors in the brain.
Opioids are typically utilized as pain relievers or anesthesia, and some weaker ones such as methadone are actually used in medical maintenance therapy to help wean people off of stronger, more dangerous opioids. However, even opioids used in addiction therapy have the potential to be highly addictive both physically and mentally and produce an intense and uncomfortable withdrawal experience for those using them for an elongated period of time.
Opioids themselves are a class of drug with a range of substances, both legal and illicit, that fall within the classification. This is in part why the opioid epidemic has been able to grow to such massive proportions.
And with the United States prescribing three times as many opioids as the rest of the world at about 71 prescriptions per 100 people, things are unlikely to improve unless drastic changes are made. The best way to avoid becoming another tragic statistic is to seek treatment as soon as possible and begin the process of detoxification and recovery.
How Opioids Affect the Brain
The body produces its own endogenous opioids, such as endorphins, and uses them as neurotransmitters that bind and activate opioid receptors. Upon binding, signals are sent to the brain of the “opioid effect,” meaning that pain is blocked. The opioid receptors are responsible for acting as natural painkillers and regulating stress levels. Opioids bind to and activate these receptors by mimicking the molecular composition of naturally occurring neurotransmitters, or brain chemicals.
Since the body itself cannot create enough neurotransmitters to block pain the way that opioids can, it can overwhelm the system. This results in abnormal messages being sent throughout the body, blocking the brain from receiving pain signals, depressing breathing, and also releasing feelings of relaxation and euphoria by increasing the levels of dopamine in the brain.
Dopamine is a different neurotransmitter that primarily regulates pleasure, emotion, cognition, and, perhaps most importantly, our motivation and reward system. By flooding the brain with more dopamine than it can naturally make, opioids create the learned behavior of regular use to activate the “pleasure center” of the brain in addition to its pain-blocking effects, thus beginning the cyclical nature of opioid addiction.
The short-term effects of opioid use include:
- Pain relief
- Depressed breathing
- Possible unconsciousness
Someone regularly abusing opioids for long periods of time can expect the following effects:
- Brain damage due to respiratory depression
- Abdominal bloating
- Bowel perforation
- Liver damage
And if they are using opioids via injection, which is the primary means of heroin use, they are also likely to experience:
- Infection of the heart valves and lining
- Lung complications and increased risk of pneumonia
- Collapsed veins
- An increased risk of HIV and hepatitis B and C
- Open sores
In order to try and halt these negative effects as well as attempt to prevent the onset of permanent damage, it is vital that anyone suffering from a dependency on opioids detox as soon as possible to flush the drugs from their system, ideally in the controlled and supervised environment of a professional medical detox center.
What You Can Expect From Opioid Withdrawal
Over time, the brain begins to deplete its naturally produced dopamine in order to balance out the vast amount of artificial dopamine provided by the opioids, which leads to both the brain and body becoming dependent on the opioids. It also builds up a tolerance, so you need more and more to achieve the same effects.
This is why when someone who has regularly been abusing opioids suddenly stops, their body “crashes” and struggles to cope with the sudden loss of dopamine, which is what causes opioid withdrawal symptoms as the brain attempts to regulate its dopamine production to normal levels once more.
While there are variations in the opioid withdrawal symptoms someone can expect to experience based on the specific opioid they’ve been abusing, the common symptoms of opioid withdrawal that can be expected during an opioid detox include:
- Mood swings
- Muscle pain
- Excessive sweating
- Runny nose
- Abdominal cramping
- Difficulty concentrating
- Rapid or irregular heart rate
These symptoms are typical of opioid withdrawal across the board, even in the cases of extremely potent opioids such as fentanyl or carfentanil. However, if someone has been abusing significantly large amounts opioids over a long period of time, especially heroin or Tramadol, they may experience an acute and atypical opioid withdrawal, which has its own set of more intense and dangerously unpredictable symptoms, including:
- Dangerously high blood pressure
- Uncontrollable muscle spasms
- Panic attacks
- Impaired breathing
- Extreme paranoia
- Severe depression
Opioid Withdrawal Timeline
When discussing the opioid withdrawal timeline, it is important to keep in mind that there are many factors at work, unique to each person undergoing opioid withdrawal, that determine exactly how long their opioid withdrawal will last. While there is a common opioid withdrawal timeline associated with detoxing after regular abuse, it will vary based on:
- How long an individual was abusing opioids
- How much of it they had been taking
- How they were taking it (as a tablet, crushed into powder and snorted, smoked, via injection, or one of the many ways that fentanyl can be absorbed into the body, including by transdermal patch)
- If they were abusing opioids in conjunction with alcohol or other drugs
- If they have a history of previous addictions
- The overall state of their current health
- If they have any mental health issues or other co-occurring disorders
- Whether or not they are detoxing on a tapering schedule or using medical maintenance therapy
The length of an opioid withdrawal timeline is also dependent on what opioid someone has been abusing. For example, heroin enters the brain very quickly and therefore has a short half-life, meaning that heroin withdrawal symptoms might start as soon as six hours after the last use.
On the other hand, methadone is a much longer-acting opioid and can take anywhere from 15 hours to several days after the last use for someone to start experiencing symptoms of withdrawal, making for a significantly longer detox period.
Keeping the distinctions between opioids and how long they stay in the body in mind, the general opioid withdrawal timeline can be broken down as follows:
3 TO 12 HOURS
Withdrawal symptoms from morphine, fentanyl, and Dilaudid can begin appearing in as little as three hours after the last use, while other opioids such as Tramadol, heroin, and carfentanil usually start at roughly six hours. The majority of opioids will begin manifesting early withdrawal symptoms, generally mild and flu-like, within 12 hours.
As previously mentioned, medical maintenance opioids such as methadone and Suboxone withdrawal symptoms will take much longer to appear, usually more than 24 hours.
ONE TO THREE DAYS
Between the next 24 hours to several days, the more moderate and severe symptoms will appear as well and eventually reach their peak strength and be at their worst. This is the period when those undergoing opioid detox are most vulnerable to relapse.
7 TO 10 DAYS
Over the course of roughly a week, but sometimes longer, most of the physical symptoms of opioid withdrawal should have stopped, or at least become much weaker and easier to manage. Some of the psychological symptoms will have also faded but others, like anxiety or depression, will most likely persist.
However, it is during this period when the symptoms of opioid withdrawal will be at their peak strength for methadone and Suboxone
Once past 10 days to two weeks, the body will have finished its opioid detox, although symptoms of depression and anxiety, as well as drug cravings, can still continue for as long as several months after someone has stopped using opioids.
For Suboxone and methadone, it can take up to several weeks for symptoms to weaken and diminish, with the withdrawal timeline lasting roughly a month. Like the other opioids, some psychological symptoms are likely to linger for months afterward.
While some symptoms of lingering depression are to be expected, there is also the chance of experiencing what is known as Post-acute withdrawal syndrome, or PAWS, a secondary withdrawal period that can randomly appear after the initial one. Some signs and symptoms of PAWS include:
- Difficulty concentrating
- Unstable moods
- Suicidal thoughts
- Extreme sensitivity to pain
- An increased lack of coordination and impaired movement
What Are the Opioid Withdrawal Treatment Steps?
Unlike the process of detoxing from other substances, such as benzodiazepines, opioid withdrawal is rarely ever life-threatening. However, because many of the symptoms, especially the ones associated with acute withdrawal like seizures and hallucinations, can be so intense and often unpredictable, detoxing at a professional medical detox center is the recommended first step of opioid withdrawal treatment.
Being treated for opioid withdrawal at a detox facility as opposed to on your own or at home guarantees your safety with 24-hour medical supervision, while also avoiding the risk of relapsing midway through the opioid withdrawal process.
“Detoxing at a professional facility also means that you can be put on a tapering schedule by a doctor experienced in detox treatment, slowly diminishing usage without the risk of triggering a seizure or worse. ”
Many detox centers will also use medical maintenance therapy as part of their tapering process, weaning people off of opioids through the use of other drugs that have similar effects but are much weaker, in order to reduce drug cravings.
The medications generally used in this kind of therapy include:
Methadone: which lessens cravings while blocking the euphoric effects of heroin.
Buprenorphine: which is what’s known as a “partial opioid” that works like methadone but has less potential for addiction.
Suboxone: the brand name of a combination of buprenorphine and naloxone, a drug that completely cuts off the effects of opioids like heroin and is too strong on its own to be used to taper down usage.
However, as we’ve mentioned, these drugs, though weaker, are still opioids and still present the danger of misuse and addiction, and their administration requires strict monitoring. Also, if someone is detoxing from opioids like methadone or Suboxone, they are more than likely not going to receive those substances as a form of maintenance therapy and instead may be given:
Naltrexone: is a drug that works differently from the ones mentioned above. It is not addictive, and it carries no opioid qualities. Instead, naltrexone totally negates the high that opioid use creates and is also available in the form of an extended-release injection called Vivitrol.
Clonidine: a medication that is primarily used to help with high blood pressure but has been shown in several studies to help ease opioid cravings.
Once past the withdrawal phase and a successful detox, the next step in opioid treatment should be checking into an addiction recovery treatment program, as this is the best way to learn how to successfully manage addictive behaviors and maintain long-term sobriety.
Opioid detox makes it possible for someone to focus on their recovery without the discomfort of withdrawal or the distraction of still having opioids in their system, but detox alone is not recovery, and it’s not enough to lower the chances of a relapse.
Generally, once in a rehabilitation treatment program, an individual will work with their therapist or counselor in order to create a customized treatment plan that will be best suited to their needs and may involve support groups, educational workshops, and other different types of individual therapies.