Opiate withdrawal refers to stopping or tapering down from a substance derived from the opium poppy plant (e.g. narcotic opioid alkaloids). Some major psychoactive opiates include substances like codeine, morphine, and thebaine. Many people consider semi-synthetic drugs like heroin, hydrocodone and oxycodone to be opiates, but they are not direct opiates, rather they are derived from opiates (e.g. opioids). People use these drugs for a variety of conditions, but most commonly they are used to provide pain relief.
These drugs are also used to achieve a recreational “high” by other individuals. The fact that these drugs make people feel less pain and stimulate the reward centers of the brain make them addicting. Most people also feel physically relaxed and no discomfort while they take this class of drugs. It is also believed that some people self-medicate with painkillers to block emotional pain associated with depression and anxiety. Others simply run out of opiates and/or cannot afford to get their prescriptions refilled. In any event, most people that take opiates will eventually want to (or be forced to) withdraw from them.
The withdrawal process can be very debilitating, but physical symptoms typically subside between 7 and 10 days of withdrawal. During the withdrawal process, the body tries to function without stimulation from the opiate drug that has been constantly supplied. When it doesn’t receive the same amount of the drug or none of the drug, it reacts powerfully with an array of physical and psychological symptoms as it attempts to restore normative homeostatic functioning.
Factors that influence opiate withdrawal
There are many different factors that are thought to play a role in determining the severity of opiate withdrawal. Since everyone is in a different situation, it is impossible to know exactly how long the psychological symptoms and/or post-acute withdrawal symptoms will last. Additionally the severity of the physical symptoms that are experienced may be significantly worse for one person than another.
1. Time Span
How long have you been using opiates? Someone that has been using opiates to function for years is going to have more difficulties coping without them than someone who used opiates for a month or two. There are people that have been using high doses of opiates daily for years as a means to continue functioning with chronic pain. Someone who has been functioning on opiates for years (or decades) is going to have a significantly more challenging time quitting than someone who took these for a month or two.
2. Drug / Dosage / Tolerance
The type of opiate that you were taking can play a big role in determining how addictive it is. For example, someone that is injecting heroin may not only become addicted to the drug, they may also become addicted to the ritual. Therefore certain drugs may be more addictive than others based on many factors.
The dosage of the drug that you have been taking as well as whether you have built up a tolerance is also going to influence your withdrawal. If you have developed a tolerance to a high dose of an opiate, you may want to consider tapering off of them so that the physical symptoms aren’t too unbearable.
Whether a person is psychologically addicted to taking an opiate can have a big influence on how well they deal with withdrawal symptoms. Someone who has used opiates as a crutch to help them make it through difficult aspects of life is going to have a much tougher time getting through the withdrawal process.
Additionally someone that has been taking opiates to deal with chronic pain may have an even tougher time coming off of them because their body’s endorphin supply and natural ability to fight pain has been depleted by painkiller usage. Someone who is seriously addicted will likely need to either: go to rehab and/or work with a psychiatrist (possibly for opiate replacement therapy).
4. Cold turkey vs. Tapering vs. Replacement therapy
There is really no “best” way to quit taking opiates. It is always recommended to taper down (i.e. wean yourself off the drug) over an extended period of time in order to minimize withdrawal symptoms. People that drop down to nothing after taking a high dose every single day for a long-term may experience powerful and potentially dangerous withdrawal symptoms. The tapering process can be relatively simple – just cut down your medication by about 25% every few days or every week until you are down to nothing.
However, if you discuss things with your doctor and it’s alright to quit “cold turkey,” just know that some people think cold turkey is the best way to go. By quitting cold turkey you face the pain head on and will have tough symptoms for about a week, but they will go away. Most people that are serious about kicking their habit quit, deal with the symptoms, an don’t look back.
A third option which many people take advantage of is that of replacement therapy. The idea behind replacement therapy is to go on something like Suboxone or Methadone (e.g. a less powerful opiate) to get off of the opiate that you were addicted to. The problem associated with replacement therapy is that many people become severely addicted to the drugs that they were prescribed for replacement. Realize that if you want to be “drug free,” sooner or later you will have to face the pain.
5. Individual Physiology
Why do some people have an easy time coming off of opiates while others can barely function? The answer has to do with individual physiology. Everyone has a different degree of social support, a different environment, and a unique nervous system. One person may have healthier habits and more mental toughness to cope with difficult withdrawal symptoms.
Other people may simply not be affected as severely as another person because they had a lower tolerance. Realize that your withdrawal process is going to be somewhat unique to you. The physical symptoms may be similar to that of other people, but your psychological healing will be a unique process – especially if you experience PAWS (Post-Acute Withdrawal Symptoms).
Opiate Withdrawal Symptoms: List Of Possibilities
Below are a list of the symptoms that you may experience when you stop taking opiates. These will vary in severity depending on how long you have been on them, the dose, and whether you withdrew cold turkey. You may experience a few of the symptoms, most of them, or all of them. Most of the severe physical symptoms last a little bit over a week before they clear up.
- Agitation: Withdrawing from opiates can make people very agitated. They no longer have their drug to stay calm and the physiology is chaotic because the person is trying to function without the drug.
- Anxiety: Some people report severe anxiety when they first stop using opiates. This has to do with the fact that most opiates help induce a feeling of calmness. When a person stops using them, it is common for them to feel anxious, nervous, and panic.
- Concentration problems: Due to the array of symptoms that you may experience, these can take away from a person’s ability to concentrate. You may experience clouded thinking and poor cognitive function until the withdrawal starts to clear up.
- Craving: Many people report strong cravings for the drug when they first quit. These cravings usually become easier to deal with as more time passes. Even when you make it through the difficult physical withdrawal symptoms, the psychological cravings may persist for a long period.
- Crying spells: Not only will your eyes probably water, but you may become so depressed that you cry. The withdrawal process is very intense especially in the first few days. If you breakdown and start crying, just realize that things will improve.
- Depression: Many people report pretty severe depression when they come off of opiates. This depression can last much longer than the actual physical withdrawal process. If you have been abusing opiates for a long term, it can take your body a long time to restore natural production of neurotransmitters and endorphins.
- Diarrhea: Since being on opiates tends to make people constipated, many people report the exact opposite when they come off of them. For this reason, it may be helpful to keep some Imodium on hand so that you can deal with the stomach aches and constant bowel movements.
- Dilated pupils: When people use opiates, their pupils tend to contract and become very small – almost like little pinpoints. When they stop using, their pupils retract and can look very dilated.
- Dizziness: Most people report that they feel dizzy when they first stop. This is a result of physical withdrawal that can feel uncomfortable, but it will eventually subside.
- Fatigue: You may feel extremely tired, lethargic, and fatigued throughout the day. In fact you may have a difficult time doing something as simple as getting out of bed. Work with your fatigue to get as much accomplished as possible, but recognize that your body needs some rest as it recovers.
- Goose bumps: You may notice that you have goose bumps all over your skin. This is a very common symptom that most people have when they come off of opiates.
- Headaches: It is common to experience pretty severe headaches when you stop taking opiates. These headaches may range from being constant and mild to severe, painful migraines. Do what you can to suck it up and realize that the pain will clear.
- Heart palpitations: Many people notice changes in their heart beat when they stop opiates. They may notice palpitations and/or an increased heart rate. Do your best not to freak out and realize that it is your body trying to cope without the drug. Normative functioning will be restored.
- High blood pressure: Opiates tend to lower blood pressure by depressing activity in the central nervous system. When you stop taking them, your blood pressure may shoot up for a temporary period of time as your body attempts to fix itself. Doctors may prescribe Clonidine to help target the blood pressure and anxiety symptoms upon withdrawal.
- Hot flashes: It is common to experience hot flashes when you stop taking an opiate. These are usually caused in hormonal fluctuations and our body trying to reset itself.
- Insomnia: Although some people report severe fatigue, tiredness, and sleepiness, insomnia can easily strike during withdrawal. If you feel as though you cannot fall asleep, focus on trying to relax and just get sleep when you can. Eventually your sleep cycle will be restored.
- Irritability: Most people will experience feelings of irritability and mood swings when they quit opiates. Any drug that has an influence on our mood can result in us experiencing the opposite when we withdraw from it.
- Itchiness: It may feel as though your skin is crawling with itchiness during the withdrawal. This shouldn’t last for an extended period of time.
- Memory problems: It may be pretty frustrating that your short term memory seems a little bit off during withdrawal. You may have difficulties with memory retrieval – this is due to the fact that you are experiencing an overwhelming amount of symptoms. Don’t freak out about your memory not working correctly, it will work normally again.
- Muscle aches: Opiates do a great job at treating muscle pain and other aches. If you are someone who was taking them for chronic pain management, you may notice that the pain comes back worse than before. Individuals that were taking opiates for alternative uses still report aches when they stop usage.
- Nausea: Many people report feeling extremely nauseated when they stop an opiate. This may lead to vomiting if it gets severe.
- Panic attacks: Some people experience anxiety to the point of causing panic attacks when they stop opiates. If you are experiencing panic attacks, do your best to focus on doing what you can do to calm down and relax. If deemed necessary, you could get medication to help you through this process.
- Paranoia: This isn’t necessarily a “common” symptom, but one that some individuals exhibit. Usually feelings of paranoia will last only a couple days following usage of the drug and then stop.
- Runny nose: This may feel worse than having a cold, but your nose is likely to run. Be prepared for a constant runny nose by having plenty of tissues around.
- Suicidal thoughts: My guess is that many people experience suicidal thoughts when they come off of opiates. This has to do with the fact that most opiates actually elevate and stabilize mood. When a person withdraws from them, they may feel suicidal. If you feel this way, make a promise to yourself that you will not harm yourself and/or talk to someone else about it. Some people end up acting on their present emotion because they don’t think that the painful feelings will ever go away – despite the fact that they will.
- Sweating: You may sweat profusely throughout the day and/or during sleep (i.e. night sweats). The sweating may feel uncomfortable, but just keep in mind that it’s from the withdrawal – it will eventually subside.
- Vomiting: Some people end up experiencing extreme nausea and actually vomit. With all the symptoms the person experiences, they may conclude that the withdrawal process feels “flu-like.” If you have an upset stomach, do your best to soothe it.
- Watery eyes: In addition to having a runny nose, your eyes may water. Just recognize that it is your body’s way of responding to sober functioning.
- Yawning: Many people report excessive yawning when they quit opiates. If you are constantly yawning, just recognize that this is part of the withdrawal process.
Rare symptoms: It should be noted that people also experience other, rarer symptoms as a result of opiate withdrawal. These include: cardiac arrhythmias, dehydration, seizures, strokes. If you are concerned that you might experience any of these symptoms, consult a medical professional.
Note: Most symptoms are pretty painful and can be extremely debilitating within the first three days of withdrawal. However, most people find that within a week they are feeling much better.
Opiate Withdrawal Timeline: How to Manage Symptoms
There is no set duration for the withdrawal process – especially regarding PAWS (Post-Acute Withdrawal Syndrome). For some individuals, the post-acute psychological withdrawal symptoms may linger for an extended period of time (e.g. months or years). For most hardcore addicts, it can take many months of being drug free to fully overcome the psychological aspects of the addiction.
A majority of people will have severe physical withdrawal symptoms that will be debilitating for up to 10 days. For shorter-acting opiates most physical withdrawal symptoms are overcome in as quick as 7 days (one week). For longer-acting opiates, the physical symptoms may be present for up to 10 days. Most people will notice that these symptoms become more manageable after a few days.
Many people withdraw, but then fall back into the trap of using opiates. The best way to help yourself stay off of these drugs is with professional help and personal will to overcome this battle. If you are experiencing severe anxiety, a doctor may prescribe you with clonidine to help ease these symptoms. If you are experiencing diarrhea, you may want to take some Imodium. Additionally if you were addicted to opiates for years and need some sort of additional support, you may want to consider Suboxone (Buprenorphine).
Suboxone has been proven to ease symptoms of withdrawal by working as a partial-opioid agonist. Other people have success using Methadone – work with your doctor to find a solution for yourself. In the meantime, allow your body to begin the healing process. Make sure you are engaging in as many healthy activities as possible during your recovery process.
Examples of things you can do for yourself include: physical exercise, eat healthy, socialize with family, see a therapist or support group, engage in online support group (forum) chat. Your physiology has to get used to functioning without the constant supply of an opiate and will be readjusting. The readjustment process can take a long time for many people, but it’s a battle.
Once you gain some positive momentum after being off of all opiates, you will start to see the light. Realize that the process of coming off of opiates is painful (psychologically and physically) and difficult. Most people have a lot of depression and struggles when they first quit, so try to take things one day at a time. Focus on what you can do right now (i.e. this exact moment) to ensure the fastest possible recovery.
Eventually sober days will turn into sober weeks, and sober weeks will turn into sober months. Bad days will start to turn into slightly better days, and eventually, you’ll have a good day. This single good day will be a sign that you are recovering and starting to regain your happiness and livelihood. If you keep doing your best and trying, you will make a full recovery in your withdrawal from opiates.
It should be noted that some people end up withdrawing, weathering the storm of symptoms and recover relatively quick within the first 10 days or so. For others, they have difficulties controlling their cravings to use the drug. Feel free to share your experience if you have withdrawn from an opiate successfully, are in the withdrawal process, or are planning on withdrawing.