Opioid Addiction Withdrawal: Timeline, Risks & Treatment

Understanding Opioid Addiction & Withdrawal 

How Addictive Are Opioids? 

Opioids are considered highly addictive. 

After taking opioids for 5 days, there is an increased risk of long-term dependence and opioid addiction. The risk of opioid addiction is higher for those with a history of substance use disorder, existing mental health conditions, or higher stress levels. Opioids include morphine, OxyContin, codeine, methadone, and hydromorphone.

What Is Opioid Withdrawal Syndrome?

Opioid withdrawal syndrome includes both physical and psychological symptoms that occur when reducing or stopping the use of opioids. 

Opioid withdrawal syndrome is mainly caused by the physical dependence that occurs when the brain and body have adapted to the presence of the opioid and have formed a tolerance to the existing dose. The longer opioids are taken and the higher the dose, the more they can affect the severity and number of opioid addiction withdrawal symptoms.

How Does Opioid Dependence Develop With Prescription Opioids?

Opioid dependence relating to prescription opioids develops due to how opioids interact with the brain’s reward system. 

Opioids bind to receptors in the brain, spinal cord, and body, and flood the brain with dopamine, which both reduces pain and creates a sense of pleasure. Even short-term, prescribed use may cause the brain to start associating this pleasure with the opioid itself, which can lead to dependence due to the body’s growing tolerance and potentially to opioid use disorder. 

Effects of Opioid Withdrawal 

What Happens to Your Body When You Stop Taking Opioids?

When you stop taking opioids, your body and brain go through opioid withdrawal, which includes physical and psychological symptoms.

Withdrawal symptoms occur as the body experiences a chemical imbalance, due to the reduction of endorphins (“feel-good” chemicals) that opioids create. In the time it takes for your body to recover, it experiences withdrawal symptoms caused by its inability to produce its own endorphins naturally.

How Do Opioids Affect the Brain and Nervous System?

Opioids bind to opioid receptors in the brain’s nerve cells to reduce pain signals in the brain and create feelings of euphoria. 

The National Institute on Drug Abuse states that opioids work by binding to receptors in the spinal cord and other organs in the body, while simultaneously reducing the amount of pain signals. Euphoria occurs when opioids trigger the release of dopamine, a neurotransmitter in the brain (and a hormone in the body) that is known to regulate pleasure and reward. 

Why Does the Body Develop Opioid Dependence?

The body becomes dependent on opioids when regular use causes opioid receptors in the brain to become less responsive. 

Over time, higher or more frequent doses become necessary for the body to achieve the same “high,” since it produces fewer natural endorphins on its own. This leads to a greater bodily tolerance of opioids, which makes the body dependent on them not only to provide feelings of pleasure, but also to maintain a “normal” equilibrium, according to Science & Practice Perspectives.

What Factors Influence the Severity of Opioid Withdrawal?

The type of opioid, dosage, duration of use, individual biological and psychological factors, and whether withdrawal occurs suddenly or over a prolonged period of time are all factors that affect how severe opioid withdrawal is.

Short-acting opioids, such as oxycodone, can lead to more intense withdrawal symptoms that take place more quickly, whereas long-acting opioids, such as methadone, lead to more prolonged symptoms. A higher dosage and longer-term use of opioids can also increase the severity and duration of withdrawal, due to the higher amount of physical dependence on the opioid.

Factors such as liver and kidney function, metabolic rate, and age also play into how quickly opioids leave the body’s system. Mental health issues like anxiety, depression, or stress may also increase the intensity during withdrawal, along with the time it takes for healing to occur, as does immediately stopping all opioid use instead of gradually tapering the dosage.

Symptoms of Opioid Withdrawal

What Are the Symptoms of Opioid Withdrawal?

According to the World Health Organization, opioid withdrawal syndrome symptoms can include physical indicators:

• Muscle aches
• Sweating
• Nausea
• Diarrhea
• Cravings
• Tremors
• Lacrimation (tearing)

Psychological symptoms of opioid withdrawal can include the following:

• Restlessness
• Irritabilitby
• Anxiety
• Depression
• Mood Swings
• Hopelessness or despair

Why Do Muscle Aches, Cravings, and Anxiety Occur During Withdrawal?

Symptoms, including muscle aches, cravings, and anxiety, occur when the brain and body try to adjust after reducing or stopping an opioid substance. 

Once the body is physically dependent on the opioid, especially after long-term use, the nervous system grows hyperactive, which can lead to symptoms like muscle cramps. For those experiencing opioid addiction, the brain adapts to the major release of dopamine, which slowly builds a tolerance in the brain and body; more of the opioid is needed to achieve a “normal” feeling. SAMHSA notes that, during withdrawal, the brain’s ability to receive pleasure from everyday activities is decreased, leading to anhedonia, a reduced ability to experience pleasure. 

Opioids suppress noradrenaline, a neurotransmitter related to stress and alertness. During withdrawal, the suppression ceases, which causes the body to release an excess of noradrenaline, which often leads to feelings of heightened anxietyand/or panic.

How Do Opioid Withdrawal Symptoms Affect Mental Health?

The symptoms experienced during opiate withdrawal include anxiety, irritability, depression, insomnia, and general mental distress. 

The changes in chemistry in the brain can exacerbate these symptoms, which can lead to chronic pain, ongoing depression, mental exhaustion, and possible suicidal ideation. 

How Long Do Opioid Withdrawal Symptoms Typically Last?

Opioid withdrawal symptoms typically continue for 4 to 10 days. 

Withdrawal symptoms for long-acting opioids, such as methadone, usually last for approximately 10-20 days, according to Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.

Timeline & Stages of Opioid Withdrawal

What Is the Timeline for Opioid Withdrawal Symptoms?

Opioid withdrawal symptoms typically begin 8 to 24 hours after the last use of the opioid. They can last for approximately 4 to 10 days. 

The following provides a closer look at the timeline:

• Short-Acting Opioids (ex. Oxycodone): Symptoms appear 6 to 12 hours after the last dose, peak during days 2 and 4, and typically last for 5 to 10 days total.
• Long-Acting (Methadone): Symptoms appear within 24 to 72 hours after the last dose, peak during day 3, and continue for up to 3 weeks.

What Are the Stages of Withdrawal Symptoms? 

The stages of opioid withdrawal syndrome include the early phase, peak phase, and late or final phase, as follows:

• Early Phase (between 6 and 24 hours): Symptoms include anxiety, restlessness, sweating, yawning, a runny nose, and teary eyes.
• Peak Phase (between 24 and 72 hours): Symptoms include abdominal cramps, muscle aches, nausea, vomiting, diarrhea,  and a rapid heart rate.
• Late or Final Phase (between days 4 and 10+): Symptoms begin to subside, while anxiety and/or insomnia may last longer.

Why Are Withdrawals Worse at Night?

Fluctuations in the circadian rhythm, causing lower cortisol and endorphin levels, make withdrawal symptoms more apparent. 

The Psychofarmacology Bulletin also notes that the lack of external activity found during the daytime plays a part inexposing withdrawal symptoms more directly.

Risks & Complications During Withdrawal

When Can Opioid Withdrawal Become Dangerous or Life-Threatening?

Opioid withdrawal becomes dangerous or life-threatening by leading to severe dehydration, cardiovascular stress, or other medical issues for those with pre-existing illnesses, such as heart disease or HIV. 

Increased vomiting or diarrhea during withdrawal can cause extreme dehydration or an electrolyte imbalance, such as hypernatremia (high levels of sodium). Major withdrawal symptoms can increase blood pressure, heart rate, or respiratory rate, especially for those with congestive heart failure. 

How Does Withdrawal Increase the Risk of Opioid Overdose?

Physical tolerance of an opioid is reduced during withdrawal. 

If relapse occurs, there is a greater chance that the body will not tolerate the same dosage that was previously taken before withdrawal, which can lead to potential overdose or fatality.

Why Is Medical Supervision Important During Detoxification?

Medical supervision prioritizes safety and helps manage withdrawal symptoms to prevent relapse during opioid detoxification. 

According to Drug Misuse: Opioid Detoxification, medical professionals can monitor vital signs, offer medication to help with discomfort caused by withdrawal symptoms, and address any psychological withdrawal symptoms being experienced.

Exclusive Hawaii Rehab™ focuses on evidence-based and natural methods to address core root issues when experiencing opioid substance use disorder, so clients feel safe and supported during the recovery process.

Medications Used for Opioid Withdrawal Management

What Drugs Are Used to Treat Opioid Withdrawal?

Common medications used for opioid-withdrawal management include buprenorphine (Suboxone), methadone, and lofexidine (Lucemyra). According to MedLine Plus, these opioid withdrawal medications may be used to treat chronic pain or other withdrawal symptoms. Medications used in opioid withdrawal can include the following:

• Buprenorphine (Suboxone, Subutex)
• Methadone
• lofexidine (Lucemyra)
• Naltrexone (Vivitrol)
• Clonidine
• Lofexidine (Lucemyra)
• Loperamide (Imodium)
• Ondansetron (Zofran) or Promethazine
• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Hydroxyzine (Vistaril) or Trazodone
• Dicyclomine (Bentyl)

How Do Medications Like Buprenorphine, Methadone, and Suboxone Work?

Buprenorphine, methadone, and suboxone ease withdrawal symptoms without providing the high created by opioids by interacting with opioid receptors in the brain. 

These types of medications help regulate brain chemistry and reduce the overall risk of overdose. These medications remain safe for long-term use and can contribute to a safer, more comfortable recovery process.

What Role Do Clonidine and Other Medications Play in Withdrawal Management?

Clonidine and other medications used in withdrawal can lower blood pressure and heart rate, while also helping to ease opiate withdrawal symptoms such as muscle aches, sweating, anxiety, and agitation. 

According to the American Journal of Drug and Alcohol Abuse, these medications inhibit the release of norepinephrine to reduce over-stimulation in the sympathetic nervous system.

Will I Need Medication for Withdrawal Symptoms? 

FDA-approved medication is often recommended for opioid withdrawal to relieve symptoms and reduce cravings. 

Medications can also help prevent overdose and/or relapse, while contributing to a safe and effective healing process.

Seeking Professional Rehab for Opioid Addiction

When Should Someone Seek Medical Help for Opioid Withdrawal?

The inability to control opioid use is the most common sign that someone should seek medical help for opioid withdrawal. 

Other signs include having severe cravings, stealing medication from friends or family, engaging in secret behaviors such as stashing medication, obsessive thoughts about acquiring opioids, ongoing depression, or the loss of interest and/or withdrawal in work, family, friends, and previously enjoyed activities.

What Happens During Opioid Detox?

Those undergoing opioid detox can experience withdrawal symptoms that include muscle aches and pains, vomiting, and diarrhea, as the opioid substances are removed from the body. 

These symptoms can peak within 36 to 72 hours and last between 4 and 10 days for shorter-acting opioids, according to Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.

How Do Professionals Help Manage Withdrawal Safely?

Healthcare professionals offer medical supervision and prescribe medications to manage withdrawal symptoms. 

They also provide support to individuals, their families, and loved ones during the recovery process. Professionals continue to provide ongoing care, along with resources and information, from the early withdrawal stages into long-term recovery and healing.

What Evidence-Based Treatment Options Support Opioid Addiction Recovery?

A combination of medication and support is at the heart of evidence-based opioid addiction treatment options. 

The clinical team at Exclusive Hawaii Rehab™ offers clients a MAT transition off all substances within five to 10 days to reduce the risk of medication misuse for those experiencing OUD (opioid-use disorder), along with holistic approaches that include naturopathic medicine and nutritional coaching. 

The Role of Mental Health and Dual Diagnosis Care

How Are Mental Health Conditions Addressed During Opioid Detox?

Mental health conditions are addressed during opioid detox through medication-assisted treatment (MAT). 

These medications are used to ease physical symptoms, which aids in lessening psychological stress and anxiety. In addition to MAT therapy, Exclusive Hawaii Rehab™ offers holistic & therapeutic approaches, including cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), trauma therapy, and art/music therapy. These approaches assist in identifying trauma-based distress and mental health issues while supporting emotional health.

Why Is Dual Diagnosis Treatment Important for Long-Term Recovery?

Dual diagnosis treatment simultaneously addresses co-occurring substance use and mental health disorders to address the root causes of addiction (and prevent relapse). 

Exclusive Hawaii Rehab offers dual diagnosis treatment as part of an integrated, personalized approach that treats the whole person, rather than just the symptoms. The dual diagnosis approach typically includes individualized therapy, such as cognitive-behavioral therapy, medication management, and support focused on long-term recovery.

How Do Clinicians Support Emotional and Psychological Stabilization?

Clinicians use individualized care & self-exploration programs during opioid withdrawal to address and resolve the core root of the addiction, including understanding underlying psychological patterns. 

Exclusive Hawaii Rehab™ also supports emotional and psychological stabilization through therapies such as Transcranial Magnetic Stimulation (TMS) and Ketamine therapy. Clinicians also help clients learn to build resilience, self-regulate, improve coping skills, and manage emotions using cognitive-behavioral approaches, as well as holistic therapies such as yoga, massage therapy, acupuncture, art/music therapy, and nutritional care.

Continuing Recovery After Detox

What Happens After Opioid Detox Is Complete?

Once opioid detox is complete, the focus is on long-term rehabilitation, which can include behavioral therapy and additional counseling to prevent a possible relapse. 

Physical symptoms usually fade within a week to 10 days, while anxiety, insomnia, or cravings, referred to as Post-Acute Withdrawal Syndrome (PAWS), can require ongoing care. Exclusive Hawaii Rehab™ post-detox care includes 15 to 30 hours of virtual aftercare and personalized, one-on-one, non-12-step treatment to support clients in achieving long-term recovery and healing.

How Does Follow-Up Care and Support Improve Long-Term Recovery?

Follow-up care and support assist in reducing the risk of relapse for clients after the opioid withdrawal process. 

Therapy, peer support, and medication management (MOUD) create and maintain structure and offer a sense of community, while addressing both physical and mental health needs for clients in long-term recovery. 

Exclusive Hawaii Rehab™ clinicians are focused on helping clients set achievable goals for aftercare by creating tailored aftercare plans with clients before healing is complete. Aftercare plans include relapse prevention strategies that allow clients to feel confident in their ability to maintain sobriety post-rehab.

Why Is Ongoing Support Important After Detox?

Ongoing support after opioid detox is a key factor in preventing relapses or fatal overdoses. 

Exclusive Hawaii Rehab™ provides ongoing support after recovery to assist clients in dealing with any physical and psychological cravings, while preparing them to cope with stressors. The support they continue to have helps them apply the skills they learned during their healing and focus on their ongoing health and well-being.

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