Opioid Withdrawal: Symptoms, Management, & Help
The opioid class of substances includes several legally prescribed medications, including hydrocodone and oxycodone, as well as certain illegal drugs such as heroin and illicitly manufactured fentanyl.1
Opioid drugs bind to and activate receptors in the brain, resulting in several neurochemical changes that lead to pain relief as well as an increase in dopamine neurotransmitter activity.2 Opioid-associated increases in dopamine activity strongly reinforce continued use of the drug, making the user want to recreate the experience time and again—which helps to explain their inherent potential for misuse and addiction.2
While they can be safe and effective for short-term use for pain management and certain other medical issues, people commonly divert prescription opioids for non-medical misuse.2 Because of their reinforcing effects, continued opioid misuse may lay the groundwork for the eventual development of the compulsive patterns of use associated with opioid addiction or, more technically, opioid use disorder (OUD)—a condition marked by continued opioid use despite the clinically significant distress or impairment that such use leads to.3
Opioid addiction is a serious public health crisis in the United States, and many of those who struggle with opioid addiction find it especially challenging to not use the drugs because of the uncomfortable withdrawal symptoms that develop when use slows or stops. Due to concerns for comfort and safety, attempts to cope with opioid withdrawal at home and/or alone are seldom advisable by medical professionals.4 Instead, a professional detox allows for close monitoring of people during this difficult time and medical intervention to ease opioid withdrawal symptoms more comfortably and safely.
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What Happens During Opioid Withdrawal?
There is a progression that often takes place when people use opioids. Repeated use of opioids, even those prescribed by a doctor, can lead to a physiological development known as opioid dependence.2
Opioid dependence develops as the brain adapts to the presence of these drugs and, as a result, people come to rely on the drug to feel and function relatively normally.2 When someone is dependent on opioids, the absence of these drugs can result in physiological changes that underlie what’s known as opioid withdrawal.2 People with significant dependence to opioid drugs may experience withdrawal symptoms as quickly as a few hours after the drug was last taken.2
Symptoms of opioid withdrawal may include:2,3
- Muscle and bone pain.
- Diarrhea and vomiting.
- Intense cravings.
- Problems with sleep.
- Psychological distress.
- Cold flashes.
- Uncontrollable leg movements (i.e., “kicks”).
Left unmanaged, opioid withdrawal can become increasingly severe and unpleasant. Though opioid withdrawal is seldom life-threatening, certain medical complications could develop. These complications, should they arise, could require more emergent attention and medical management.4
Potential opioid withdrawal complications include pronounced dehydration and electrolyte disturbances as a result of severe gastrointestinal distress and resultant diarrhea and/or vomiting, as well as exacerbations of underlying cardiac illnesses as a result of abnormally elevated nervous system arousal, as evidenced by signs such as profuse sweating, tachycardia (rapid heart rate), and hypertension (high blood pressure).4
To mitigate the unpleasantness of severe opioid or opiate withdrawal and to avoid complications, many benefit from professional help instead of trying home remedies in an attempt to manage symptoms on their own.
What Helps with Opioid Withdrawal?
Though complications and immediate risks to health may be somewhat rare, dealing with opioid withdrawal may be extremely uncomfortable. Managing opioid withdrawal is an important step in early recovery, but by taking the precaution of following doctor’s recommendations or otherwise seeking professional treatment, you can ensure that you have access to proper medical care and monitoring to ease this difficult period. In addition to undergoing a supervised detox or seeking the care offered from a professional drug detox center, these tips on how to cope with opioid withdrawal might also help your detox and treatment process go more smoothly.
Managing Cravings and Removing Temptation
Opioid cravings can be especially intense in the beginning stages of withdrawal. Even if a person’s symptoms aren’t life-threatening, opioid withdrawal can be severely unpleasant. Medication-assisted treatment (MAT) is often suggested to help mitigate opioid withdrawal symptoms and cravings; there is no reason for someone to suffer unnecessarily during this difficult process.4
Attempting to go through opioid withdrawal at home can leave you surrounded by drug triggers, your stash, the routines you had around drug use in the home, and other temptations that can decrease your chances of success. Going to a treatment center or facility can remove common triggers and temptations while providing a safe environment for you to detox. Healthcare professionals can monitor withdrawal symptoms and address them as they arise, easing opioid withdrawal and increasing a person’s chances of success.
Do Drink Water
People withdrawing from opioids could be at an increased risk of dehydration, which in some cases can progress to quite serious levels. Because common symptoms of opioid withdrawal include diarrhea and vomiting, a person could quickly become dehydrated during this time.3 Dehydration is another reason it can be beneficial for someone to a detox center to cope with opioid withdrawal symptoms. If someone can’t keep down liquids, at least IV fluids can be administered in a healthcare setting or treatment center.
Do Not Go It Alone
Opioid withdrawal can be both physically and mentally trying. Treatment of opioid withdrawal is best managed with a team of people that may include physicians, nurses, therapists, social workers, and other healthcare professionals.3 Following a detox protocol prescribed and monitored by medical professionals can help you best manage the physical symptoms of opioid withdrawal and address any acute symptoms or emergencies that may arise.
Psychological symptoms of withdrawal can be consuming, and therapists and counselors in rehab can offer emotional support and behavioral tools to help during this time.4
Do Take Medications as Recommended
Medications for addiction treatment (MAT) can help manage withdrawal symptoms and is a vital element of treatment for many people. The FDA has approved several medications to treat OUDs that have proven to be extremely effective.5
MAT includes pharmacological intervention in conjunction with counseling and behavioral therapies to provide a “whole person” approach to substance use disorders (SUDs).5 Medications relieve physical withdrawal symptoms and psychological cravings. Some medications are safe to use for months or years.5
FDA-approved medications for opioid use disorder (MOUDs) include:5-8
- Buprenorphine: A partial opioid agonist, buprenorphine can help diminish withdrawal symptoms and cravings, with less risk of eliciting rewarding euphoric effects of its own, less potential for misuse, and an increased margin of safety in terms of overdose.
- Methadone: A long-acting full opioid agonist, methadone helps to reduce cravings and prevent the onset of opioid withdrawal. Via the development of cross-tolerance, methadone blunts or altogether blocks the effects of any other opioids in the brain, should they be used while on treatment.
- Naltrexone: Naltrexone is not an opioid agonist but an antagonist. It binds to and prevents the activation of opioid receptors in the brain, thereby blocking the euphoric and sedative effects of opioids, while reducing and suppressing cravings.
It is crucial to take medications for opioid withdrawal as prescribed.
Do Not Stop After Detox
Detox is just the first step in recovery and is not a substitute for more comprehensive rehabilitation efforts. Sticking with treatment after detox for an adequate period may help an individual in their long-term success with sobriety.9 Addiction treatment will likely include individualized behavioral counseling, group therapy, and in some cases, pharmacological interventions.9
It is important to remember that recovery from addiction is possible, but it is a life-long process that takes commitment and hard work. Learn more about opioid addiction treatment and take the first step to getting the help you need.
- National Institute on Drug Abuse. (n.d.). Opioids.
- National Institute on Drug Abuse. (2021). Prescription opioid drug facts.
- Dydek, A., Jain, N., & Gupta, M. (2022). Opioid use disorder. StatPearls Publishing.
- Substance Abuse and Mental Health Services Administration. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, number 45.
- Substance Abuse and Mental Health Services Administration. (2022). MAT medications, counseling, and related conditions.
- Substance Abuse and Mental Health Services Administration. (2022). Buprenorphine.
- Substance Abuse and Mental Health Services Administration. (2022). Methadone.
- Substance Abuse and Mental Health Services Administration. (2022). Naltrexone.
- National Institute on Drug Abuse. (2018, January). Principles of effective treatment.