The dangers of opiate addiction are well-known. With overdose deaths continuing to rise, the elevated role of dangerous synthetic opioids like fentanyl and carfentanil and the continued abuse of prescription medications, millions of Americans are straddling a line between life and death every day.
Due to the dangers of opioid abuse and the significant consequences to life, love, and employment that can accompany drug addiction, many substance users want to get clean. However, this is often easier said than done. Overcoming opioid effects, including the painful process of withdrawal, can be a significant hurdle that isn’t a walk in the park for anyone. If you or someone you love is living with an addiction to heroin or prescription opioids, this is what you need to know about the withdrawal process and the withdrawal timeline.
Physical Opioid Dependency
Opioids, like other easily abused substances, are enjoyed primarily for their side effects. When high on drugs like heroin, users feel euphoric, carefree and on top of the world. However, addiction goes far beyond the sensations of intoxication.
Opioid use actually changes the chemistry of the brain, influencing the ways in which sensations are processed. When in use, opiates bind to receptors within the brain, reducing sensations of pain and increasing feelings of euphoria. However, over time, the body builds up resistance to the effects of opioids, and increased use is required to stimulate the same response. When opioids are not in use, the body is thus unable to feel pleasure normally due to the effects of high levels of opioids on the receptors throughout the nervous system.
The negative side effects that come from a lack of access to substances are known as withdrawal — and the associated symptoms can be very hard to handle.
Going Cold Turkey
To some drug users, cold turkey seems like the easiest avenue. It requires no money and can be done at home by yourself, so this is often the preferred method for those quitting for the first time. But while some people can successfully withdraw from opioids by quitting without assistance, most can’t.
For most users, all the determination in the world isn’t enough to stand up to the pain of withdrawal. As soon as the worst of the symptoms set in, many users are willing to do whatever it takes to access additional drugs. As the withdrawal process can be at its worst for a week or more, many people are unable to withstand this kind of experience, especially when attempting to balance school, work or family.
Unfortunately, trying to quit and failing can be a detriment to future attempts to get clean. Intimate knowledge of the unpleasant nature of withdrawal and the stress the process can cause makes some opioid users believe that quitting isn’t a possibility, even in a professional setting, increasing the likelihood of ongoing addiction and overdose.
Withdrawal From Opioids
Withdrawing from opioids is an extremely unpleasant process. With the potential to last for weeks, opioid withdrawal takes both physical and mental strength to navigate. While withdrawal does manifest differently from one individual to another, the most common symptoms include:
- Aching muscles
- Anxiety and recklessness
- Runny nose, excessive sweating, and eye tearing
- Extreme nausea and flu-like symptoms
- Insomnia and fatigue
- Rapid heartbeat
- High blood pressure
When combined with strong cravings for additional drugs, these symptoms can be almost debilitating, standing in the way of all aspects of normal life.
The Withdrawal Time Line
For most users, opioid withdrawal follows a relatively predictable timeline. The initial week to two weeks of withdrawal is known as acute withdrawal.
First 48 Hours
The first symptoms of withdrawal set in within six to 12 hours after ceasing use. Initial side effects include muscle aches, chills, sweating, eye tearing, and anxiety. These symptoms continue to worsen over the next 24 to 48 hours, with nausea and flu-like symptoms developing. In this time, cravings will intensify significantly; it will be challenging for those ceasing use to focus on anything but opiates.
During this period, it is virtually impossible to go to school, work or attend family events. Most users attempting to go cold turkey through the first stages of withdrawal are reliant on staying in bed or on the couch.
72 to 120 Hours
Days three to five in the withdrawal process are often considered the worst period in withdrawal. Symptoms usually peak at this point, with gastrointestinal distress, anxiety, sweating and insomnia reaching their worst. Those withdrawing may have trouble focusing on something as simple as a TV program or a book due to the discomfort.
In this time, sleeping, keeping food down and staying comfortable is very challenging. Most people who relapse during withdrawal do so before or during this period.
120 Hours and Beyond
After 120 hours, the effects of withdrawal begin to lessen in intensity. Insomnia will start to resolve, flu symptoms will alleviate and nausea will be reduced to the point that eating normally may become possible. Cravings will persist, but they will be much milder than at the start of the process.
Symptoms will continue to decrease over the next three to five days. By around two weeks, the worst of withdrawal will be over.
An acronym for post-acute withdrawal syndrome, PAWS follows the acute withdrawal phase and describes anything beyond the first one to two weeks of withdrawal. While the worst of the symptoms will have ceased after the first seven to 10 days, PAWS can continue for months and even years. Encompassing anything from mood swings and challenges concentrating to trouble sleeping. How PAWS manifests will vary from person to person but can play a role in relapse.
PAWS episodes can come and go, often lasting several days at a time. There are generally no triggers for episodes; symptoms can come and go for as long as two to three years.
The challenges with going cold turkey alone are well-documented, which is why most professionals encouraged supervised withdrawal instead.
As the name implies, supervised withdrawal occurs within a professional treatment center under the watchful eye of doctors and nurses. Instead of letting symptoms run their course, addiction medicine specialists can provide medication and therapy that can make withdrawal easier to manage. These include over-the-counter pain medication, medication to facilitate sleep, fever reducers and prescription medications, like Naltrexone, which can reduce the effects of opioids in the body.
With the support of professional resources, it’s possible to minimize the discomfort of withdrawal, improving the likelihood that recovering substance users will stay clean.
Tapering in a Supervised Setting
In some cases, a medical professional may suggest tapering. A way to reduce reliance on substances slowly rather than cutting off supply directly, tapering making withdrawal safer and more comfortable.
In a tapering situation, a doctor will provide opioids in progressively smaller doses, sometimes daily and sometimes over a longer period of time, depending on the circumstances. This process will still be uncomfortable but will help users adapt to smaller and smaller doses until transitioning to nothing at all feels as natural as possible. Withdrawal symptoms are far milder when using a tapering process, making the quitting process more bearable and more likely to succeed over time.
Tapering isn’t necessary for everyone but can be a great choice for those who have tried multiple times to quit without success or who have been using opioids for an extended period of time.
Why Professional Help Matters
Relapse is a risk for drug users of all kinds. Around 40% to 60% of users will relapse sooner or later, but quitting in the right environment can improve the likelihood of overarching success. Attempting to quit alone can compound the effects, intensifying symptoms of withdrawal and reducing the chance of making it to the other side.
Supervised cessation, on the other hand, can do the opposite. With monitoring by professionals in a comfortable environment without distractions or access to opioids, users can overcome withdrawal in the easiest way possible. Building recovery on a strong foundation supervised withdrawal and, if necessary, tapering can help those with substance use disorders to quit opioids — and stay clean for good.
If you or someone you love is living with an opioid dependency, professional supervision can make all the difference. With the ability to manage withdrawal symptoms to increase comfort, it’s possible to set up recovering substance users for success. Please contact FHE Health today to learn more about overcoming addiction in a safe, secure and professional facility.