When someone suddenly stops taking an opioid drug like heroin, codeine or fentanyl for example, the first symptoms of withdrawal can appear within hours. The experience is very rarely deadly, but it is highly uncomfortable and painful for most who endure it. In fact, many who try to cease opioid use on their own do not make it through the withdrawal phase.
Among those with opioid use disorder, withdrawal is the most challenging barrier to recovery. The unpleasant symptoms make sufferers believe the only way to stop the pain is to use drugs again. Understanding how to manage opioid withdrawal effectively is a crucial step in preparing for treatment and the long-term recovery process.
What is Opioid Withdrawal?
Withdrawal is a collection of mental and physical symptoms. They appear after someone stops or reduces their intake of an opioid drug. Opioids alter the way the brain reacts to pain, which is why they are so helpful as painkillers. When taken in excess, these drugs also interfere with the brain’s reward system. They can produce a euphoric or “high” feeling that alters brain chemistry.
When you consume an opioid in doses higher than for therapeutic effects, the drug floods the brain with serotonin and dopamine. Your brain’s reward system naturally produces these “happy hormones” in small amounts. These neurochemicals create motivation to perform functions necessary for survival. This happens by releasing dopamine and serotonin in response to basic actions like eating and socializing.
If you take opioids frequently, your brain gets used to swimming in synthetic neurochemicals and stops producing dopamine and serotonin. Opioids remove the natural motivation for many of life’s daily tasks. Meanwhile, your brain becomes dependent on these drugs for feelings of pleasure and reward.
Your brain also requires increasing levels of opioids to feel good. This leads to drug cravings when the substance begins to leave your system. At some point, you may keep taking them just to feel normal as withdrawal symptoms become unbearable.
This is how the addiction begins.
When someone stops using opioids, the brain has no way to compensate for the sudden disappearance of pleasure-inducing chemicals. The result is an array of withdrawal symptoms ranging from deeply unpleasant to potentially life-threatening, depending on various internal and external factors.
Learn How to Manage Opioid Withdrawal Effectively from Various Opioids
Any opioid can lead to withdrawal symptoms if you suddenly stop using it. The range of opioids available through both legitimate and illegal channels is vast, and each drug varies in strength.
Here are seven of the most common opioids that can cause a withdrawal period after cessation.
- Codeine
Codeine is a medication used to relieve mild or moderate pain. It is available in tablet form, though most derive it through cough syrups with codeine as the primary ingredient. Despite its chemical similarities to stronger drugs like morphine and oxycodone, codeine is subject to fewer regulations.
Its availability as medication also means some people who take it do not realize its addictive potential. Codeine can cause a person to feel unusually happy and calm, leading to drowsiness. It is sometimes referred to by other names like “lean” or “purple drank” by recreational users. Frequent use can result in serious health issues, including seizures and hallucinations.
Codeine withdrawal is usually somewhat less severe than other types of opioids. However, it can become more difficult the longer a person has misused it. Withdrawals generally begin 8-24 hours after last use, lasting an average of 4-10 days.
- Hydrocodone
Hydrocodone, a key ingredient in Vicodin, is a semi-synthetic opioid analgesic used to treat moderate to severe pain. Drug manufacturers commonly pair it with acetaminophen in painkillers like Lortab. Doctors prescribe medications containing hydrocodone when other treatment options have not worked to curb injury-related pain.
These medications usually come in tablet form. Most prescriptions dictate one dosage every 4 to 6 hours. This high frequency makes it easier to become addicted over time. It also means withdrawal symptoms set in very quickly after someone stops taking the medication.
In the longer term, the worst of Vicodin withdrawal symptoms usually dissipate within 10 days of stopping usage and beginning treatment.
- Morphine
Morphine is one of the oldest opiates and one of the only modern-day medications derived directly from the poppy plant. It is also a precursor to heroin and is highly dangerous. Physicians commonly use it to control patients’ pain before and after surgery, delivering it via an intravenous drip.
It is very easy to overdose when misusing liquid morphine due to its concentration. Although rare, morphine also comes in low-dose, extended-release tablets.
Morphine is highly regulated and difficult to obtain for most people. However, it carries a powerful withdrawal timeline very similar to heroin.
- Oxycodone
Like hydrocodone, oxycodone is semi-synthetic or human-made in labs with a combination of synthetic and natural components. Oxycodone’s best-known brand names are Percocet and the discontinued OxyContin.
When taking oxycodone outside of a doctor’s prescribed limits, the potential for addiction is extremely high. Even when someone takes this medication according to the recommendations of their physician, tolerance builds up quickly. This tolerance rate can transition into dependence within less than two weeks.
Oxycodone is one of the most common prescription medications people struggle with misuse. Withdrawal symptoms are comparable to those of other opioids. However, many find detoxing from oxycodone more difficult because they get used to taking the medication every 4 to 6 hours.
- Hydromorphone
This opiate is most widely available as a tablet to treat pain in those with severe chronic pain. Doctors only prescribe it to those who have already built up some tolerance from taking another opioid medication. Hydromorphone is available in tablets and liquid, though tablets are more common. The brand Dilaudid is an immediate-release formulation of hydromorphone and the leading product for drug misuse containing hydromorphone.
Hydromorphone is chemically similar to oxycodone and hydrocodone, but scientists have found it to be moderately more potent. Most physicians prefer to prescribe hydrocodone or oxycodone due to their relatively lower potencies. Still, some providers prescribe hydromorphone for patients who did not respond well to previous painkillers.
People who misuse hydromorphone usually do so because its injectable form is so concentrated and potent. That also makes injectable hydromorphone much more difficult to detox from than the tablet form. Withdrawal is often similar to heroin, depending on dosage and can take weeks.
- Heroin
Heroin is an illicit opiate derived from the poppy plant. This drug usually comes in a white powder or sticky black form known as “black tar” heroin. Heroin is significantly more potent than prescription opioids, as well as much cheaper. This combination leads to addiction more quickly than other opioids.
Many people view heroin as the archetypal form of addiction, and it does come with many unpleasant physical side effects. Withdrawal from heroin is one of the most difficult among all opiates and requires an unwavering commitment from the patient.
Most often, stopping heroin requires medical treatment. While withdrawal from most opioids does not border on life-threatening, those addicted to heroin greatly benefit from a medical detox. The potential danger from dehydration during withdrawal poses significant health risks.
- Fentanyl
Fentanyl is a fully synthetic opioid designed to treat severe pain. Like morphine, medical professionals use fentanyl in its medicinal capacity to manage acute pain after surgery. However, fentanyl is between 50 to 100 times more powerful than morphine and is the most dangerous opioid currently available. Prescribed fentanyl comes in the form of shots, transdermal patches or lozenges, but illicit fentanyl usually comes in powdered form.
The powdered form of fentanyl resembles cocaine and often ends up as a cutting agent to make street drugs more potent. Cocaine and heroin are common targets for the addition of fentanyl. The three substances look similar enough to combine without detection.
However, the people who consume drugs cut with fentanyl often do not realize what they are getting. They are significantly more likely to overdose on the more powerful product. Those who do not overdose are significantly more likely to become addicted.
Fentanyl is by far the most common synthetic opioid available on the black market. Fentanyl withdrawal is even more dangerous than heroin withdrawal, and people with a fentanyl dependency should not attempt to quit using it without medical supervision.
If you are wondering how to manage opioid withdrawal effectively on your own, there are no simple answers. Attempting to endure withdrawal without medical detox is often painful and long-lasting. Doctors recommend preparing a kit for withdrawal relief, although over-the-counter aid may not be enough. Start with vitamin supplements, sports drinks containing electrolytes and someone to call for help.
What to Expect During Opioid Withdrawal Recovery
Withdrawal symptoms are one of the top reasons people go back to using opioids. The severity of withdrawal effects depends on how long you have been misusing the drug and how potent it is.
The symptoms of opioid withdrawal come in two stages. The onset of common opioid withdrawal symptoms, which usually begin within 24 hours after cessation, includes:
- Aching muscles
- Feelings of restlessness and anxiety
- Teary eyes
- Runny nose
- Insomnia
- Excessive sweating
The second wave of symptoms sets in within a day or so of the first. These effects can make quitting cold turkey impossible, even for the most determined individuals. These symptoms include:
- Prolonged goosebumps
- Nausea and vomiting
- Diarrhea and abdominal cramps
- Rapid heartbeat
- Heightened blood pressure
People struggling with substance misuse will experience varying intensities of every symptom, and not all withdrawals look the same. Severe addictions cause withdrawals that are more stressful for the brain and body, and no one should go through it alone. Seeking the help of a medical professional ensures these symptoms do not damage the body or the chances of recovery.
Timeline of Opioid Withdrawal Symptoms
Knowing the approximate timeline and different stages of opioid withdrawal helps manage expectations for the start of recovery. Many people underestimate the discomfort they will experience, as well as the drug cravings withdrawal brings. To better envision the timeline, it helps to break down the four stages of opioid withdrawal.
Withdrawal Stage 1: 6 to 30 hours
Many people struggling with addiction experience some initial withdrawal symptoms without even realizing it. The runny nose, tiredness and aching muscles that set in the first day are easy to mistake for a cold. These symptoms mainly cause moderate discomfort at this stage.
Withdrawal Stage 2: 72 hours
Symptoms peak around three days after the last consumption of an opioid. At this point, the most dangerous symptoms set in, including rapid heartbeat and spiking blood pressure. This stage is when symptoms are at their most painful and cravings at their absolute strongest. Most people who try to quit opioids alone fail during stage two due to the severity of the symptoms.
With the most potent drugs like heroin and fentanyl, diarrhea and vomiting can lead to extreme dehydration. If a person has no medical supervision, they can succumb to electrolyte imbalance or other potentially fatal conditions.
Withdrawal Stage 3: One week
The most acute withdrawal phase usually passes by the end of the first week of abstinence. Some initial effects remain, such as tiredness, aches, sweating and anxiety. Some people continue to experience nausea, and irritability is quite common. Cravings continue to be a central challenge during this period.
Withdrawal Stage 4: One month and beyond
After the first few weeks of withdrawal, most physical symptoms will cease or decline significantly. However, many people experience post-acute withdrawal syndrome (PAWS) for months as their brains re-calibrate to function without opioids.
PAWS symptoms usually include anxiety, mood swings, tiredness and insomnia. These symptoms are highly manageable with help from a counselor or other clinical professional. The complete opioid withdrawal timeline is longer than many people imagine when considering PAWS.
Without support, many people have great difficulty going through PAWS. It poses a significant relapse risk.
Questions to Confirm Opioid Addiction
It is not always easy to determine if your opioid misuse has transitioned into addiction. If you are concerned about your drug use, ask yourself these questions to determine if you have an addiction:
- Am I spending time thinking about how to get more opioids?
- Am I considering, or have I gone through black market channels for opioids?
- Is my work or school performance suffering?
- Am I losing interest in friends, family and hobbies?
- Do I use opioids in inappropriate situations, such as during work or before driving?
If you answer yes to any of these questions and find yourself craving opioids, you are likely contending with addiction.
Let MedMark Treatment Centers Show You How to Manage Opioid Withdrawal Effectively
Opioid addiction and withdrawal are deeply challenging to combat, but quality treatment makes long-term recovery possible. MedMark offers the best in substance use treatment and counseling with the help of medication-assisted treatment. These are the two most effective tools to facilitate recovery, which is possible for everyone.
Our evidence-based, accredited programs provide the counseling and resources you need to succeed in treatment. If you are ready to take the next steps and find out more, locate an office near you and contact MedMark today.
withdrawal brings. To better envision the timeline, it helps to break down the four stages of opioid withdrawal.
Withdrawal Stage 1: 6 to 30 hours
Many people struggling with addiction experience some initial withdrawal symptoms without even realizing it. The runny nose, tiredness, and aching muscles that set in the first day after withdrawal are easy to mistake for a cold or flu. These symptoms mostly cause moderate discomfort at this stage.
Withdrawal Stage 2: 72 hours
Symptoms peak around three days after the last consumption of an opioid. At this point, the most dangerous symptoms set in, including rapid heartbeat and spiking blood pressure. This stage is when symptoms are at their most painful, and cravings at their absolute strongest. Most people who try to quit opioids alone fail during stage two due to the severity of the symptoms. With the most potent drugs like heroin and fentanyl, diarrhea and vomiting can lead to extreme dehydration if a person has no medical supervision.
Withdrawal Stage 3: One week
The most acute opioid withdrawal symptoms usually pass by the end of the first week of abstinence. Some of the initial effects remain, such as tiredness, aches, sweating and anxiety. Some people continue to experience nausea, and irritability is quite common. Cravings continue to be a central challenge during this period.
Withdrawal Stage 4: One month and beyond
After the first few weeks of withdrawal, most physical symptoms will cease or decline significantly. However, many people experience post-acute withdrawal syndrome (PAWS) for months as their brains re-calibrate to function without opiates. PAWS symptoms usually include anxiety, mood swings, tiredness, and insomnia. These symptoms are highly manageable with help from a counselor or other clinical professional.
The full opioid withdrawal timeline is longer than many people imagine when considering PAWS. A person in treatment needs a strong support system and ongoing therapy to maintain their recovery strides.
Questions to Confirm Opioid Addiction
It’s not always easy to determine if your opioid misuse has transitioned into addiction. If you’re concerned about your opiate use, ask yourself these questions to determine if you have an addiction:
- Am I spending time thinking about how to get more opioids?
- Am I considering or have I gone through black market channels for opioids?
- Is my work or school performance suffering?
- Am I losing interest in friends, family, and hobbies?
- Do I use opioids in inappropriate situations, such as during work or before driving?
If you answer yes to any of these questions and find yourself craving opioids, you’re likely contending with addiction.
Start Your Path to Recovery Today
Opiate addiction and withdrawal are deeply challenging to combat, but quality treatment makes long-term recovery possible. MedMark offers the best in substance abuse counseling and medication-assisted treatment — the two most effective tools to facilitate recovery. Our evidence-based, accredited programs provide the counseling and resources you need to succeed in treatment. If you’re ready to take the next steps and find out more, contact MedMark today.
