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.
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.
Heroin is the fastest acting opioid; therefore, it also has the shortest half-life, 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 hours, the American Pain Society publishes. The 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.
Opiate withdrawal symptoms may range from mild to severe, depending on how dependent the individual is on an opioid drug. Dependency can be 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.
These usually start within 6-12 hours for short-acting opiates, and they start within 30 hours for longer-acting ones:
These peak within 72 hours and usually last a week or so:
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.
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. 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.
Naloxone and naltrexone are opioid antagonists that bind to opioid receptor sites along the central nervous system and “block” other opioids from filling them. This means that even if someone tries to take a drug like heroin while on an antagonist, the drug will not produce the desired effects and instead may cause a precipitated withdrawal syndrome to start. Precipitated withdrawal is the sudden and rapid onset of withdrawal symptoms, which can be intense and can serve to keep someone on an antagonist from attempting to abuse an opioid agonist at the same time.
Naloxone is added to buprenorphine as an inactive relapse-prevention agent in drugs like Suboxone and Zubsolv unless the drugs are altered and then abused via injection. Naltrexone products like Vivitrol are used more commonly to help prevent relapse after detox is completed and opioid drugs are fully removed from the brain and body. The intention of detox is to stabilize an individual dependent on opioids both emotionally and physically, and detox may use both pharmacological and psychological therapy methods to accomplish this.
Since addiction is a chronic and relapsing disease, with both physical and emotional side effects and symptoms, treatment needs to be comprehensive. Medical detox is relatively short and can provide the stepping stones for a more stable recovery. Relapse is common for individuals struggling with addiction as it may seem like a return to drug abuse may offer relief. After a period of not using drugs, tolerance to certain levels of drugs may be reduced, however, and relapse after detox can be especially dangerous as it may increase the risk for a fatal overdose.
Drug overdose is the leading cause of injury death in America. The American Society of Addiction Medicine (ASAM) estimates that 100 Americans die of a drug overdose every day, and 46 people in the United States die daily due to prescription opioid overdose. The New York Times reports that opioids are responsible for more deaths than any other medication or drug. Medical detox may help smooth out withdrawal, reducing side effects, preventing serious complications, and reducing drug cravings. This can provide a good start toward recovery and help to maintain sobriety long-term.
Detox followed with counseling, education, family and individual therapy, and support groups can help an individual stop using drugs and maintain sobriety.