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.