Signs & Symptoms of Opiate Withdrawal
How Common Is Opiate Abuse?
Opiate abuse is incredibly common in the US today. The number of opioid prescriptions, including medications consisting of oxycodone and hydrocodone, rose from 76 million in 1991 to close to 207 million in 2013, per statistics provided by the National Institute on Drug Abuse.
Not everyone who receives a prescription from a doctor uses it properly. In fact, the 2014 National Survey on Drug Use and Health revealed that 4.3 million Americans used a prescription pain medication nonmedically in the month prior to the survey. Additionally, the Foundation for a Drug-Free World published statistics from the 2007 National Survey on Drug Use and Health, showing that 153,000 people were current heroin users in the US; other sources estimate the figure to be as high as 900,000.
The 2014 SAMHSA survey indicated that approximately 1.9 million Americans had a prescription drug use disorder based on their prescription painkiller use in the prior year. The survey also revealed that approximately 435,000 people used heroin regularly in the prior month. Statistics provided by the Foundation for a Drug-Free World showed that opiate addiction, particularly heroin addiction, accounted for 18 percent of drug and alcohol treatment center admissions in the US alone.
Do Opiates Cause Physical Dependence?
Opiates cause physical dependence, meaning the body becomes dependent on the substance to function “normally,” and when the person doesn’t have the drug in the body or reduces the standard dosage, the body reacts physically to the change.
Opiates bind with the opioid receptors in the brain, which are the areas of the brain responsible for the body’s response to pain and reward. This causes the person to feel the “high” or euphoric sensation brought about by opiates. The receptors eventually require more and more of the substance to produce the same effect. When the dosage is lowered or eliminated, the transmitters can’t function as normal, and the brain responds with certain psychological and physical symptoms. Symptoms like nausea, vomiting, and abdominal pain occur because there are opiate receptors in the gastrointestinal tract. Muscle pain occurs because there are opiate receptors found in the muscles.
Physical symptoms of opiate withdrawal include the following:
- Abdominal cramping
- Muscle aches and pains
- Dilated pupils
- Runny nose
- Excessive yawning
- Excessive tearing
A person may experience mental withdrawal symptoms of opiate withdrawal, such as:
- Mood swings
Generally, the physical symptoms of opiate withdrawal begin within 12 hours of a person’s last exposure to the drug, as noted by the University of Maryland Medical Center. However, symptoms may appear as early as six hours after the person’s last dose. Nausea and vomiting tend to occur within the first 24 hours after last use, and withdrawal symptoms peak within 24-48 hours. At this stage, the person is at risk for dehydration if they are not receiving an adequate amount of hydration.
Overall, the physical symptoms last about a week and diminish over time. The mental symptoms of opiate withdrawal may last several months or even years in rare cases. How long mental and physical symptoms last is dependent on the following factors:
- How long the person used the substance
- How often the person used the substance
- The average dose used
- Personal metabolism
Why Is Medical Detox Recommended?
People who quit “cold turkey,” meaning they abruptly stop using opiates of any kind, will experience the symptoms of withdrawal without any relief, which can be incredibly uncomfortable and makes relapse much more likely. To stop the symptoms of withdrawal, people may simply return to using the substance.
If the person does make it through the initial withdrawal process by going cold turkey, they may find the psychological symptoms of withdrawal persist, prompting them to relapse. Intense cravings and lingering anxiety may lead them back to substance use, particularly since they don’t have the tools needed to deal with these triggers to use.
The National Institutes of Health published a study consisting of 109 people who were addicted to an opiate. During the follow-up interview, 91 percent reported a relapse. Within a week of quitting, 59 percent of the individuals admitted to relapsing. An analysis of the study suggested that lack of an aftercare plan greatly affected recovery. The results concluded that those who completed the entirety of a six-week inpatient treatment program delayed relapse significantly. This illustrates that successful recovery is about much more than simply ending the body’s physical dependence on a substance. Psychological issues must be addressed via comprehensive therapy in order to sustain sobriety following withdrawal. This kind of psychological support is given in medical detox programs, and clients are then transferred into comprehensive treatment programs where they can undergo therapy to address the opiate use disorder.
In a medical detox program, relapse isn’t possible during withdrawal since clients do not have access to substances of abuse. In addition, they are under 24-hour medical supervision, ensuring their safety throughout withdrawal. Medications can be given to lessen the severity of withdrawal symptoms, making it more likely that clients successfully complete the withdrawal process. Continual encouragement and support from staff members can also make the process much easier on clients.
Although withdrawal from heroin and other opiates isn’t generally life-threatening, it is possible to experience significant health issues due to complications that occur as a result of withdrawal. For example, it’s possible to aspirate from vomiting, which can lead to an infection in the lungs. Vomiting and diarrhea may cause dehydration and an electrolyte imbalance that can be life-threatening in some instances.
A prevalent concern during at-home opiate withdrawal attempts is the person returning to opiate use due to the discomfort of withdrawal and overdosing as a result. A person’s tolerance for opiates decreases once the substance use stops, and if the person doesn’t take this into account after quitting the drug, it’s possible to easily overdose. This risk is, of course, removed if the person is in a medical detox program where they don’t have access to opiates.
How Does Medical Detox Work?
Generally, replacement medications, like methadone and buprenorphine, are used during opiate detox. Methadone is a slow-acting opioid. Although it works on the same receptors as heroin and other opiates, it doesn’t cause the same euphoric effect. While a person is on methadone, they won’t experience intense withdrawal symptoms so they are able to focus on finding a firm footing in recovery via therapy. Oftentimes, people stay on methadone for months, years, or in some cases, for life. Methadone can be abused.
Buprenorphine is also an opioid-based medication. Like methadone, it activates opioid receptors in the brain to prevent withdrawal symptoms but it doesn’t produce euphoria. The brand name form of buprenorphine is Suboxone, and it consists of both buprenorphine and naloxone. Buprenorphine binds with the opioid receptors in the brain while naloxone serves as a deterrent to abusing the drug. Naloxone is an opiate antagonist, meaning it won’t let other drugs activate the opiate receptors once it fills the receptors. If a person attempts to abuse Suboxone, the naloxone is activated, preventing the person from getting high off the buprenorphine. Hence, the use of naloxone does reduce the risk of a relapse. Suboxone is considered “sticky,” which means it will stick to receptors well and prevent abuse of other opioids.
A study published by Harvard University revealed that 43.8 percent of 160 participants who took buprenorphine were opiate-abstinent at the one-year mark, but an individual’s chance of remaining drug-free ranges from 10 percent to 80 percent, depending on many factors. These factors include:
- Whether the drug of abuse was injected
- Employment status
Specific symptoms of withdrawal may be controlled using medications. For instance, a person may be given anti-nausea or antidiarrheal medications to combat these physical symptoms. Sedatives may be given to help a person sleep. Clonidine may help to reduce muscle aches, runny nose, sweating, anxiety, and cramping. In a medical detox program, professionals assess clients to determine the best course of treatment to keep them comfortable and safe.
Is an Opiate Taper Possible?
In most cases, when replacement medications like methadone or buprenorphine are used, supervising physicians slowly taper the client off the medication over time. Tapers vary in length depending on how much of the medication the person was taking per dosage and per day.
Medical professionals tailor the taper to each client’s situation. If the dosage is reduced too much or too quickly, the practitioner may slow down the schedule. People using opiates shouldn’t taper on their own since it is possible to experience symptoms of withdrawal if the taper isn’t done properly. Before stopping use of opioids, it’s necessary to consult with a medical professional.
Are There Any Natural Remedies for Opiate Withdrawal?
While medication can be vital to the opiate withdrawal process, it does come with potential side effects. In addition, medication is not a “cure” for opiate addiction. It should always be used in conjunction with comprehensive therapy. In therapy, clients will address the issues that led to their opiate abuse and learn how to manage future temptations to return to drug abuse.
Individuals can aid the withdrawal process with natural remedies for healthy living. These lifestyle changes are supported in medical detox programs. For example, individuals should remain hydrated and well nourished throughout the withdrawal process. In some instances, IV fluids may be given in medical detox programs, if needed. Since opiate withdrawal often involves nausea, vomiting, and other intestinal issues, clients may not feel up to eating much. Once stabilized, they will be encouraged to eat a nutrient-rich diet, with adequate amounts of magnesium, vitamin C, calcium, potassium, and vitamin D, in addition to protein and fiber. As clients venture into early recovery, they can begin to stabilize some of the nutritional deficits that are common during active addiction.
Warm showers and time outside in fresh air and sunlight can aid in recovery. Vitamin D can enhance a person’s mood while warm showers soothe muscles and may have a calming effect.
Other holistic approaches include massage, meditation, acupuncture, and chiropractic care. Many medical detox programs feature these complementary services as part of their offerings.
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