Opiate Withdrawal Timelines, Symptoms and Treatment
What Are Opiate Withdrawal Symptoms?
Opiate drugs, including prescription painkillers and heroin, can produce withdrawal symptoms just hours after the last dose, and the symptoms can last for a week or more.
Unassisted withdrawal may not be life-threatening, but it can lead to relapse. Medications and therapy, accessed in medical detox, may make relapse less likely.
- Muscle cramping
- Opiate cravings
The National Institute on Drug Abuse (NIDA) publishes that between 26.4 million and 36 million people around the globe abuse opiate drugs, which includes prescription pain relievers and the illegal drug heroin.
Opiates change the way the brain responds to pain stimuli and can also produce a “high” feeling by disrupting the reward and pleasure centers in the brain.
The central nervous system, which includes the brain, cardiovascular and respiratory systems, has opioid receptors that receive opiate drugs, and these drugs bring a variety of physical and emotional effects. Heart rate, respiration, blood pressure, and body temperature are lowered while pleasant feelings are increased.
Repeated use or abuse of an opioid drug can actually change the way an individual’s brain chemistry works and lead to physical and psychological dependence. The body may not feel “normal” anymore without the drug’s interaction, and withdrawal symptoms may start in between doses or when an individual stops taking the opiate.
Each opiate drug has a unique half-life, which is the length of time it takes for a drug to reduce its potency by half. As a result, withdrawal symptoms may start at different times, depending on the drug and method in which it is taken.
Heroin is the fastest acting opioid; therefore, it also has the shortest half-life and activity, according to the Drug Enforcement Administration (DEA). Its half-life may only be a matter of minutes to a few hours. Short-acting prescription opioid drugs, such as immediate-release oxycodone (OxyContin) and hydrocodone (Vicodin), have half-lives around 4-6, the American Pain Society publishes. U.S. Food and Drug Administration (FDA) reports that the half-life of methadone may be much longer, closer to an average of 30 hours.
Injecting, snorting, and smoking drugs may have a more immediate effect; however, they may also stop working sooner than drugs that are swallowed and digested through the stomach and digestive system. The start of withdrawal is highly dependent on the type and method of opioid drug abused.
Signs of Opiate Withdrawal
Opiate withdrawal symptoms may range from mild to severe, depending on how dependent the individual is on an opioid drug. Dependency can be directly tied to the length of time taking a particular drug, dosage amount, which drug was taken, how the drug was taken, underlying medical conditions, the co-occurring presence of a mental health issue, and certain biological and environmental factors, such as family history of addiction, previous trauma, or highly stressful and unsupportive surroundings. Withdrawal from an opioid drug may roughly adhere to the following timeline, although it can vary from person to person.
Early Withdrawal Symptoms
These usually start within 6-12 hours for short-acting opiates, and they start within 30 hours for longer-acting ones:
- Tearing up
- Muscle aches
- Trouble falling and staying asleep
- Excessive yawning
- Nose running
- Racing heart
Late Withdrawal Symptoms
These peak within 72 hours and usually last a week or so:
- Nausea and vomiting
- Stomach cramps
- Drug cravings
Some of the psychological withdrawal symptoms and cravings for opioid drugs may continue longer than a week in some cases. Therapy and psychological support provided by a mental health professional as a part of a complete substance abuse treatment program can decrease the symptoms and side effects of withdrawal.
Mental health professionals can also evaluate and stabilize individuals during medical detox. While there is no specific timeline for detox, as each individual will likely experience withdrawal from opiates differently, medical detox usually lasts 5-7 days.
Opioid drugs should not be stopped suddenly, without physical and emotional support and supervision, as the side effects of withdrawal may be powerful and even have dangerous complications.
Medications, such as anticonvulsants, antidepressants, and other symptom-specific pharmaceuticals, may be useful during medical detox to control the more difficult withdrawal symptoms.
Medical professionals may help an individual wean off opioid drugs by slowly lowering, or tapering, the dosage during medical detox. This keeps the opioid receptors filled and prevents the onset of severe withdrawal symptoms. Drug cravings and withdrawal as a whole may be managed by replacing a short-acting opioid like heroin with a longer-acting one such as methadone. Buprenorphine is a partial opioid agonist often used during opioid detox and dependency treatment as well, as it remains active in the body for longer than most opioids and requires a lower dosage amount. Partial agonists also do not usually create the same “high” as full agonists do, therefore making them less likely to be abused. Buprenorphine even stops being effective after a certain point, further acting as an abuse deterrent.
Medical Detox as Part of a Whole Treatment Plan
Detox followed with counseling, education, family and individual therapy, and support groups can help an individual stop using drugs and maintain sobriety.
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