There's no talking about substance use disorders without discussing withdrawal. As anyone who has dealt with addiction can attest, cutting out the thing you depend on is no easy feat. With opioids, which are often first taken out of necessity, withdrawal can be even more complicated to navigate.
You don't have to be dependent on opioids to experience withdrawal symptoms, but opioid use disorder is often the cause. The condition itself is the "result of a complex interplay between genetic, behavioral, environmental, and situational factors," Asif Ilyas, MD, MBA, president of the Rothman Orthopaedic Institute Foundation for Opioid Research & Education in Philadelphia tells Health.
In many cases, people first gain access to opioids to manage pain after surgery or an injury, Dr. Ilyas says, but it doesn't take long for opioids to become addictive. According to the Mayo Clinic, after only five days of use, the odds of you still being on opioids one year later goes up.
Dr. Ilyas recommends that medical professionals help combat this by providing risk assessments and preoperative education to patients.
Opioid use disorder may also occur in part due to psychiatric reasons like anxiety and depression, a genetic predisposition to substance abuse, a family history of abuse, chronic pain, or a person's personality traits, says Ashley McGee, RN, the vice president of nursing at Mountainside treatment center, based in Connecticut.
"Overall, the addiction is a chemical imbalance in the brain that causes the person to desire the substance in excess," McGee tells Health.
When to consider opioid withdrawal
Taking opioids can lead people to isolate themselves, enter dangerous situations, and go into debt, among other problems, according to McGee and Dr. Ilyas. It's critical to be aware of points that indicate you need to try removing opioids from your life.
Signs a person should consider stopping opioid use and seek treatment include:
- Frequently desiring or needing the substance
- Increasing the opioid's dosage to maintain the same effect
- Being unable to function on a day-to-day basis without the substance
- Mentally and physically craving the substance
- Losing interest in activities
- Displaying erratic behavior
- Not taking care of oneself
- Experiencing financial hardship
- Spending much more time alone
What are the symptoms of opioid withdrawal?
According to the American Psychiatric Association, one of the symptoms of opioid use disorder is experiencing a feeling of withdrawal if you stop taking opioids. Even if you haven't reached the level of having a disorder yet, those feelings can still be present.
"Withdrawal is by definition the presentation of physical and mental discomfort after discontinuing the use of a mood-altering substance," Sarah Fletcher, LPC, LAC, chief clinical officer at Sandstone Care in Denver, tells Health. She reports that the physical and mental symptoms of opioid withdrawal will start 24 to 72 hours after last use and include:
- Upset stomach
- Leg cramps
- Consistent sneezing
- Loss of interest
- Lack of appetite
- Inability to focus
How long do opioid withdrawal symptoms last?
According to Fletcher, symptoms such as dizziness, stomach aches, hopelessness, and lack of appetite can appear within 24 to 72 hours of last opioid use. However, the amount of time symptoms last will vary, and a medical professional should monitor them.
How opioid withdrawal works
While it can be tempting to try cutting off opioid use cold turkey, according to McGee, this can exacerbate withdrawal symptoms and lead to life-threatening situations, such as taking too much to satisfy cravings.
Something all the experts agree on: withdrawal is extremely difficult to do alone. "Your body will go through a physical and emotional withdrawal process that is intense. Having a specialist or team to guide you through the process can help you reach recovery," Angela L. Robinson, LPCMH, NCC, the clinical director at NorthNode Group Counseling in Dover, Delaware, tells Health. You can do supervised withdrawal via an outpatient or inpatient process.
Fletcher says people interested in participating in an outpatient program can reach out to a psychiatrist or local medication-assisted treatment (MAT) program to ask about completing a taper—a gradual reduction in opioids to reduce withdrawal symptoms, per Mayo Clinic. This will allow people to complete a supervised medication regimen without entering inpatient care. Providers will offer a treatment plan (usually involving medication), a schedule, and connect you with a therapist, adds Robinson.
Medicines to reduce opioid withdrawal symptoms
Medical professionals often use methadone and buprenorphine to help limit cravings and withdrawal symptoms. Methadone does this by activating opioid receptors and restricting the drug's effects, says the National Institute on Drug Abuse (NIDA). It is available at Substance Abuse and Mental Health Services Administration (SAMHSA)-certified treatment programs. Buprenorphine works similarly to methadone but doesn't activate opioid receptors as strongly, says NIDA. It is available as a prescription.
According to Dr. Ilyas, a taper is unnecessary only if a person has taken opioids for less than a few weeks. However, it's still advisable to get help if you experience withdrawal symptoms or cravings when trying to stop after a short time.
Inpatient or outpatient care for opioid withdrawal
Inpatient programs are also available to people with opioid use disorder, according to NIDA. In this case, care is available at all times, and medical professionals are constantly managing patients' symptoms.
The choice between inpatient and outpatient care may depend on severity of symptoms, financial state, and time commitment. In theory, outpatient care may seem like the less-regulated option, but a 2020 study in JAMA Network Open found it to be more effective. The study compared 37,090 individuals who were either receiving outpatient treatment with medication for opioid use disorder (MOUD) or inpatient care (which doesn't always offer MOUD). Researchers found that outpatient treatment had lower one-year overdose and hospitalization rates.
A combination of denial and a prevailing stigma can lead people to delay seeking help with opioid withdrawal. It's critical to keep in mind that it is extremely easy for anyone to become dependent on opioids, and there is no shame in it, reports NIDA. "Care is waiting, and making the decision to discontinue substance use can be incredibly scary and overwhelming," says Fletcher. "Always remember that there are resources that can help support this process.
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