In order to stop using opioids, individuals must first allow their body to detoxify or “detox” from the drug. Opioid detox is the process that reduces the shock to the brain and body as they react to the sudden absence of the drug that they were accustomed to. This sudden shock of rebounding from drug use is why opioid withdrawal symptoms occur. Medical detox works to safely cleanse the body and make patients as comfortable as possible.
Is there a difference between opiates and opioids? The term “opiates” refers to naturally occurring compounds from the opium poppy (such as codeine, morphine and heroin), whereas “opioids” refers to all drugs that act on opioid receptors in the brain, which includes opiates, semi-synthetic derivatives of opiates (such as hydrocodone, oxycodone and hydromorphone), and fully synthetic opioids (such as fentanyl, methadone and sufentanil).
What Causes Opioid Withdrawal?
As the brain is repeatedly exposed to psychoactive opioids, it experiences changes in its chemistry, which it normally tries to keep constant. These brain chemicals, or “neurotransmitters,” are responsible for how the brain functions. They control everything from how people think and feel to how they move and behave. In efforts to normalize these huge opioid-induced neurotransmitter fluctuations, the brain makes major changes to its chemical processes.
Opioid withdrawal occurs because with the sudden cessation of exposure to opioids the brain is disrupted by a significant change in its chemistry and is shocked into trying to normalize itself once again. Until this occurs, its function becomes disrupted and symptoms result.
Opioids also cause massive releases of the brain’s feel-good neurotransmitters, which form its reward system. The brain tries to compensate for these huge surges in the reward neurotransmitters by down-regulating the reward system. As a result, during opiate withdrawal, the brain’s reward system is functioning at very low levels, causing individuals to feel low, lethargic and listless.
Opioid Withdrawal Symptoms
The “acute” phase of withdrawal is the initial period after discontinuing or drastically reducing an opioid, when the body and brain react to the sudden change, resulting in uncomfortable adverse opioid withdrawal symptoms.
The signs and symptoms of opioid withdrawal may differ between people depending on individual factors, but they are generally very similar for all people. They may be physical or psychological in nature.
Physical Withdrawal Symptoms
Physical symptoms usually begin soon after stopping the opioid use, depending on the individual and the type of opioid they used. During the acute withdrawal phase, typical physical symptoms of opiate withdrawal include:
- Diaphoresis (intense sweating)
- Muscle aches
- Runny nose
- Shaking, hot and cold chills, goosebumps
- Loss of appetite
- Dilated pupils
- Fatigue, lethargy
- High blood pressure, rapid heart rate, heart palpitations
How long do physical symptoms of opiate withdrawal last? The worst physical symptoms usually last four to ten days in most people. Protracted symptoms, if they occur, may last much longer.
Psychological Withdrawal Symptoms
During the acute phase, the physical symptoms are usually the most noticeable, but some psychological symptoms can be present, including:
As the acute withdrawal period winds down, longer-term symptoms may emerge. These are primarily psychological and may include:
- Relapse dreams
- Anhedonia (inability to experience pleasure)
- The “pink cloud” syndrome (excessively happy feelings, ignoring the reality of life)
- Feelings of guilt, remorse, self-loathing, low self-esteem or anger
These psychological symptoms are an especially potent cause of relapse and are indications of why proper rehab treatment is necessary for a lasting recovery.
Symptoms of Post-Acute Withdrawal Syndrome (PAWS)
Post-acute withdrawal syndrome (PAWS) refers to a lingering collection of symptoms that may persist following acute withdrawal, often lasting for a year or more. Many of the symptoms of PAWS are simply acute withdrawal symptoms that last longer than the usual duration, especially:
- Sleep disturbances
- Depressive symptoms
- High blood pressure and heart rate
- Low energy, fatigue, apathy
While PAWS is predominantly associated with alcohol use disorder (AUD), it can occur following withdrawal from other drug use as well. However, it is more common that opioid post-acute withdrawal symptoms do not fit with the typical PAWS presentation, and are instead simply known as protracted withdrawal symptoms.
Protracted Withdrawal Symptoms
Protracted withdrawal symptoms are simply acute withdrawal symptoms that persist beyond the anticipated time frame for withdrawal and detox — about 4–10 days for opiates.
Protracted withdrawal symptoms tend to differ somewhat for different substances of abuse. Opioids are known to cause any of a variety of protracted symptoms:
- Anhedonia (inability to feel pleasure)
- Emotional blunting
- Difficulty concentrating
Protracted withdrawal symptoms can last from weeks to months after the last opioid use.
Opioids Withdrawal Symptoms Timeline
It is difficult to predict how long opiate withdrawal symptoms last for a particular individual, but withdrawal symptoms usually taper off and end after 4–10 days.
Acute withdrawal symptoms usually start a few hours to a few days after the last use, depending on the half-life of the opioid that was used. For example, fentanyl has a very short half-life, so withdrawal symptoms begin within hours. Methadone, however, has a long half-life, so it may take days before withdrawal effects become apparent.
Protracted withdrawal symptoms may last weeks to months.
Factors Affecting Withdrawal Duration
Opiate withdrawal and duration of symptoms usually follow a general timeline, but there are some factors that affect withdrawal that are specific to individuals. These factors may include the individual’s:
- General health
- Liver and kidney health
- Genetic and biological makeup
- Concurrent use of other drugs
- Co-occurring mental health disorder (if any)
- Use of medically assisted detox
Opioid Detox for Treatment of Withdrawal
Withdrawal symptoms can be uncomfortable and even dangerous, but proper opioid detox can help patients safely transition away from substance use.
Medical detox from opiates involves the use of medical supervision with or without medications to withdraw safely and as comfortably as possible from opioid and/or other substance use. An inpatient medically assisted opiate detox program may be critical to some individual’s ability to stop their drug use because many fear the withdrawal process and will avoid it unless they have help. Even for those who are willing to attempt to endure opioid withdrawal without help, the cravings and drive to end the sickness by using again can be overwhelming.
Medications Used in Opioids Detox
There are currently three opioid withdrawal treatment medications approved by the FDA:
- Methadone: opioid replacement
- Buprenorphine: opioid replacement
- Extended-release naltrexone: blocks opioid effects
With opioid replacement therapy, a long-acting opioid medication — either methadone or buprenorphine — is used to taper off of opioid use in a slow and medically controlled manner until the recipient is opioid-free. The opioid withdrawal treatment protocol prevents the sudden shock to the brain and reduces withdrawal symptoms to a minimum.
Extended-release naltrexone is a non-opioid medication, but it reduces cravings by blocking opioid receptors in the brain. If the recipient relapses and uses opioids, the naltrexone will block the physical effects of the drug. Unfortunately, the recipient must already be detoxed from opioids prior to starting this medication.
There are other opiate detox medications used during opioid detox in order to help with specific symptoms. These include sedatives, antidiarrheals and the medication clonidine, which helps reduce some withdrawal symptoms.
Methadone is a fully synthetic opioid that is used for pain management in people who are dying of cancer, and for opioid replacement therapy in addiction treatment. Methadone treatment for opioid addiction is meant for short-term use in helping people to taper off of regular opioid use in order to avert significant withdrawal symptoms. Short-term methadone use for opiate withdrawal may be an attractive option for those who find fear of withdrawal to be a barrier to recovery. Clonidine is an older type of blood pressure medication that has some efficacy at reducing withdrawal symptoms. Opioid withdrawal treatment with clonidine can cause low blood pressure and rebound high blood pressure and rapid heart rate when it is discontinued. Clonidine for opiate withdrawal is usually used in conjunction with opioid replacement therapy. The drug may be taken by mouth, injection and there is a clonidine patch for opiate withdrawal. Of the two FDA-approved opioids used for opioid withdrawal treatment protocols, buprenorphine generally has a more favorable side effect profile. Buprenorphine treatment for opioid addiction often involves using the buprenorphine product Suboxone. Besides buprenorphine, Suboxone for detox from opiates also contains naloxone, which blocks the high from an opioid. People might hear about a seemingly attractive option of rapid opiate detox with Suboxone, but this has proven to be an unsafe practice and may lead to worse outcomes compared to standard medical detox practices.
Opioid Detox Medications
Methadone is a fully synthetic opioid that is used for pain management in people who are dying of cancer, and for opioid replacement therapy in addiction treatment. Methadone treatment for opioid addiction is meant for short-term use in helping people to taper off of regular opioid use in order to avert significant withdrawal symptoms. Short-term methadone use for opiate withdrawal may be an attractive option for those who find fear of withdrawal to be a barrier to recovery.
Clonidine is an older type of blood pressure medication that has some efficacy at reducing withdrawal symptoms. Opioid withdrawal treatment with clonidine can cause low blood pressure and rebound high blood pressure and rapid heart rate when it is discontinued.
Clonidine for opiate withdrawal is usually used in conjunction with opioid replacement therapy. The drug may be taken by mouth, injection and there is a clonidine patch for opiate withdrawal.
Of the two FDA-approved opioids used for opioid withdrawal treatment protocols, buprenorphine generally has a more favorable side effect profile. Buprenorphine treatment for opioid addiction often involves using the buprenorphine product Suboxone. Besides buprenorphine, Suboxone for detox from opiates also contains naloxone, which blocks the high from an opioid.
People might hear about a seemingly attractive option of rapid opiate detox with Suboxone, but this has proven to be an unsafe practice and may lead to worse outcomes compared to standard medical detox practices.
Alternative Treatments for Opiate Withdrawal
There are many home remedies for opiate detox, but people who are addicted to opioids should be careful when considering such treatments. Discussing any chemical use in advance — natural or otherwise — for treating withdrawal with a healthcare professional who is knowledgeable about opioid detox is a good idea.
A natural remedy for opiate detox that appears to have some merit is the naturally occurring hallucinogen ibogaine. However, this drug is illegal in the U.S. due to its considerable potential for harmful side effects.
Outpatient opiate detox involves detoxing at home with advice and help from a physician or under the guidance of an outpatient detox center. The major disadvantages to this approach are the increased danger in case of significant withdrawal effects and the lack of availability of professional help at all hours in case of difficulty or serious complications.
Additionally, outpatient detox lacks the significant advantage of inpatient detox, which removes individuals from the surrounding temptations and access to relapse that they may have at home. The cravings during detox may be intense and many people may not succeed in completing their detox successfully when doing so on an outpatient basis.
Detoxing at Home
When making the decision to attempt opiate detox at home, individuals should do so in conjunction with their physician or a detox center, and should be forthcoming about the extent of their opioid usage, as well as any other drug use. They should be sure to get appropriate medical advice on how to detox from opiates at home.
Addiction to opioids is a serious and life-threatening substance use disorder, and people who wish to end the drug use should be sure to give themselves the best shot at success. Detoxing from opioids at home may not provide the best recipe for success. Some home detox methods include:
- Quitting Cold Turkey
Quitting opiates “cold-turkey” results in a rapid onset of withdrawal symptoms, which are usually severe. The risk of relapse during such a stark withdrawal is high as the craving to use substances in order to stop withdrawal symptoms can be overwhelming. When people try self-tapering or quitting opiates cold turkey at home they often experience setbacks.
Quitting cold turkey is not recommended, as it is the most difficult way to stop opioid use. Rather, medically supervised detox and withdrawal using medications, counseling support, and symptom management make the experience more comfortable, safer and more likely to result in successful recovery.
- Controlled Taper
It is common for people who struggle with addiction to overestimate their ability to control their drug use, and this may include a belief in their ability to self-taper off their opioids. People with opioid addiction who wish to avoid withdrawal symptoms by doing an opioid taper should discuss opioid replacement therapy with an addiction professional as part of an overall plan for treatment and recovery.
Finding a Detox Center
Undergoing medically assisted detox at an accredited facility is the safest and most effective way to rid the body of opioids and other substances, and to smoothly transition into treatment and recovery. Some factors to consider when selecting a detox program to attend include:
- Staff-to-patient ratio
When people detox from opioids at The Recovery Village Palm Beach at Baptist Health, a team of healthcare and addiction professionals can help them to feel as comfortable as possible during this difficult process. This renowned center helps clients taper off their drug use so withdrawal symptoms are not as severe as quitting cold turkey. If you wish to discuss opioid addiction for yourself or a loved one, please feel free to contact us for a confidential discussion with one of our intake counselors.
Our Drug Detox Center
The Recovery Village Palm Beach at Baptist Health
4905 Lantana Rd
Lake Worth, FL 33463
Key Points: Understanding Opioid Withdrawal and Detox
There are some key points to remember about opioid withdrawal and detox:
- The first part of recovery from opioid addiction involves detoxing the body from the drug, during which withdrawal symptoms occur.
- These withdrawal symptoms are extremely uncomfortable if they are not treated in most cases, but can be greatly reduced with medically-assisted detox.
- Detox is not treatment for addiction, but an inpatient medical detox allows for a smooth transition into a treatment program.
Bergland, Christopher. “The neurochemicals of happiness.” November 29, 2012. Accessed July 14, 2019.
Chalana, Harsh; Kundal, Tanu; Gupta, Varun; et al. “Predictors of relapse after inpatient opioid detoxification during 1-year follow-up.” Journal of Addiction, April 7, 2016 Accessed July 14, 2019.
Dugosh, Karen; Abraham, Amanda; Seymour, Brittany; et al. “A systematic review on the use of psychosocial interventions in conjunction with medications for the treatment of opioid addiction.” Journal of Addiction Medicine, March-April 2016. Accessed July 14, 2019.
Kleber, Herbert. “Pharmacologic treatments for opioid dependence: Detoxification and maintenance options.” Dialogues in Clinical Neuroscience, December 2007. Accessed July 14, 2019.
Kosten, Thomas; O’Connor, Patrick. “Management of drug and alcohol withdrawal.” New England Journal of Medicine, May 1, 2003. Accessed July 14, 2019.
Prunty, Leesa; Prunty, Jeremy. “Acute opioid withdrawal: Identification and treatment strategies.” U.S. Pharmacist, November 17, 2016. Accessed July 14, 2019.
Substance Abuse and Mental Health Services Administration (SAMHSA). “Protracted withdrawal.” July 2010. Accessed July 14, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.