How to Manage Opioid Withdrawal Symptoms
Medically reviewed by Geralyn Dexter, PhD, LMHC
Opiates (derived from plants) and opioids (synthetic versions of opiates) are narcotic drugs used to treat pain. This article will refer to these medications collectively as opioids, as their actions are the same. Opioids are also used recreationally—such as with heroin or the misuse of pain medication.
These drugs can cause physical dependence. Whether used as prescribed or for nonmedical purposes, cutting back or stopping these drugs after prolonged use can cause withdrawal symptoms such as vomiting and diarrhea, anxiety, and sleep problems. Withdrawal symptoms from opioids can be very uncomfortable but are rarely life-threatening.
This article will discuss opioid withdrawal symptoms, signs of opioid use disorder (OUD), hospitalization for severe opioid withdrawal symptoms, managing opioid withdrawal symptoms at home, coping through opioid withdrawal, and opioid detox support.
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Timing of Withdrawal Symptoms
Withdrawal symptoms after stopping shorter-acting opioids—such as heroin—begin within hours of the last dose. Withdrawal symptoms from longer-acting opioids, such as methadone, can begin after several days.
Withdrawal symptoms typically peak at 24 to 48 hours after they start, but they can last days to weeks.
Physical Symptoms of Opioid Withdrawal
Physical opioid withdrawal symptoms may include:
Yawning
Goosebumps
Increased secretion of tears
Runny nose
Muscle aches/tension
Sweating
Nausea
Stomach/abdominal cramps
Vomiting
Muscle spasms/twitching/tremors
Aches and pains
Hot/cold flushes
Sneezing
Headache
Lack of appetite
Increased heart rate (heart pounding)/increased blood pressure
Increased breathing rate
Dilated pupils
Psychological Symptoms
Psychological opioid withdrawal symptoms may include:
Agitation
Drug craving
Psychological distress
Complications
Opioid withdrawal is generally considered non-life-threatening, but complications can occur that may be fatal.
Complications include:
Dehydration, severe fluid loss, and electrolyte imbalances from vomiting and diarrhea
Aspiration (vomiting and breathing in stomach contents into the lungs), which can cause lung infection
A significant complication that is a leading cause of opioid-related deaths is returning to drug use after detox. Withdrawal lowers a person's tolerance to the drug, which means people who have just gone through withdrawal can overdose more easily on a much smaller dose than they used to take.
The withdrawal symptoms and sometimes uncontrolled pain that can occur with rapid discontinuation of opioids can cause some to seek illicit opioids or other substances to ease their discomfort.
The Food and Drug Administration (FDA) has also received reports of suicide associated with the sudden discontinuation or rapid dose decrease of opioids in people who have a dependency on opioid pain medications.
Help Is Available
If you or someone you know is having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. For more mental health resources, see our National Helpline Database.
Symptoms in Dependent Newborns
Neonatal abstinence syndrome (NAS) can occur shortly after birth in infants who were born to a pregnant parent using opioids during pregnancy.
Signs of withdrawal typically begin within 72 hours after birth. Symptoms and their severity depend on several factors, and may include:
Irritability (including excessive or high-pitched crying)
Tremors/trembling
Sleep problems
Poor feeding and sucking
Hyperactive reflexes
Yawning
Stuffy nose or sneezing
Vomiting
Loose stools and dehydration
Increased sweating
It is not recommended to stop opioids quickly during pregnancy, as it can lead to serious consequences such as miscarriage, fetal distress, or preterm labor. Pregnant people with opioid use disorder should discuss their opioid use with their healthcare provider to determine the best course of action for them and the baby.
Do Withdrawal Symptoms Differ Depending on Type of Opioid?
Withdrawal symptoms tend to be similar among types of opioids. Still, the severity, time of onset, and duration of withdrawal symptoms can vary depending on whether the opioids are short-acting or long-acting, as follows:
Short-acting opioids (such as heroin) can have withdrawal symptoms that come on faster (usually within 12 hours) and are more severe but have a shorter duration.
Long-acting opioids (such as methadone) often have withdrawal symptoms that take longer to start (usually within 30 hours) but can last for a longer period of time. They may also be less severe.
Signs of Opioid Use Disorder
If you know someone experiencing opioid withdrawal, it can be helpful to familiarize yourself with the symptoms mentioned earlier so you know what you and they can expect.
It's also a good idea to know the signs of OUD so you can recognize if someone close to you may be experiencing it.
A person with OUD may experience:
Physical dependence on the drug, having withdrawal symptoms if they stop taking it
Cravings (overwhelming physical and emotional urges) for the drug, despite understanding the potential negative consequences of taking them
Increasingly heavy, unhealthy, frequent, or risky use, even though it causes them problems or interferes with their daily life
Note that physical dependence alone does not necessarily mean an addiction or unhealthy use. For example, a person taking opioids as prescribed for cancer pain may become physically dependent on the drug but not have OUD.
Other symptoms include:
Changes in sleep patterns
Drowsiness
Flu-like symptoms
Weight loss
Decreased sex drive
Lack of hygiene
Isolation from family members or friends
New financial difficulties
Stealing from family members and friends
Changes in exercise habits
Hospitalization for Severe Opioid Withdrawal Symptoms
Depending on factors such as the severity of symptoms, withdrawal can take place in several settings, including:
At home (with medical supervision and a strong support system, usually also with medications)
Using detox facilities (facilities set up to help people with detoxification)
In a traditional hospital
Hospitalization typically is needed for severe withdrawal symptoms.
Your healthcare provider will ask questions about medical history and drug use, perform a physical exam, and may run other tests, such as blood tests, an electrocardiogram (ECG), or chest X-ray if they are concerned about other problems.
Treatment
Regardless of the setting, medications may be used to relieve withdrawal symptoms, to taper off opioid drugs, or both.
Medications that a healthcare provider may prescribe include:
Methadone is an opioid that can be used to help withdrawal symptoms and to help treat dependence on other opioids, particularly heroin. Methadone can be used as a maintenance medication, sometimes for years.
Buprenorphine is an opioid used to treat dependence on other opioid drugs, such as heroin, oxycodone, or fentanyl. It can be used for long-term maintenance and is often combined with naloxone (an opioid antagonist that can rapidly reverse opioid overdose) to help prevent dependence and misuse.
Naltrexone can help prevent relapse (but can cause sudden and severe withdrawal if taken while opioids are still in your system).
Clonidine is designed to treat high blood pressure. It can be used to reduce anxiety, agitation, sweating, muscle aches, cramping, and runny nose that are due to withdrawal.
Lofexidine is a central alpha-adrenergic agonist (relaxes blood vessels) and helps manage opioid withdrawal symptoms.
Clonazepam is a benzodiazepine. It can help with anxiety.
Ibuprofen: A nonsteroidal anti-inflammatory drug (NSAID) that can help with muscle cramps.
Bismuth Subsalicylate, Ondanestron, or Prochlorperazine are medications that can help with nausea, vomiting, or diarrhea.
Trazodone or Zolpidem are medications that can help with sleep.
Gabapentin is an anticonvulsant often used to treat nerve pain that is sometimes used for its sedative effects and withdrawal-related pain.
Always talk to your healthcare provider before taking any medications for opioid withdrawal.
What's the Difference Between Opioids and Opiates?
Opioids and opiates have the same actions. The difference is that opiates are derived from plants, and opioids are synthetic.
For example, morphine is a natural opiate, fentanyl is a synthetic opioid, and heroin is a semisynthetic opioid. Both opiates and opioids interact with opioid receptors in the body and brain.
Managing Opioid Withdrawal Symptoms at Home
If you have been taking opioids long term, it's not recommended that you stop taking the medication suddenly or by yourself. Withdrawal from these drugs can be very difficult and may be dangerous when done on your own.
Withdrawal may be done at home, but it should take place under the guidance of your healthcare provider. Talk to your healthcare provider about your treatment goals, and work with them to make a plan for your discontinuation of opioids. Treatment typically involves medications, counseling, and support.
A slow taper off the drugs may help avoid or lessen the effects of withdrawal. Your healthcare provider can help you determine if this is right for you and how best to implement it.
Self-Management Steps
Steps for at-home management of opioid withdrawal include:
Talk to your healthcare provider about your goals and treatment plans. Make sure withdrawal symptom management is part of the discussion.
Follow your healthcare provider's guidelines for what to do while detoxing from opioids and afterward. Ensure psychological support is part of your maintenance plan.
Prioritize follow-up care. Attend all of your appointments, and keep an open line of communication with your healthcare provider and other supports.
Coping Through Opioid Withdrawal
In addition to following the guidelines from your healthcare provider, some ways to help take care of yourself while going through opioid withdrawal are:
Drink plenty of fluids.
Get plenty of rest.
Eat nutritious foods.
Avoid alcohol and illicit drugs.
Avoid medications that make you tired (such as sleeping pills or muscle relaxers).
Stay active, but don't tire yourself out.
Decrease stimulation (limit noise, dim the lights, etc.).
Practice mind-body therapies, such as yoga, relaxation, and mindfulness.
Ask for help and support from friends and family.
It is important to note that after stopping taking an opioid (even for a short period), your tolerance for the drug is lowered, and returning to taking the same amount of an opioid that you took before you stopped could put you at a higher risk for overdose.
It may also be a good idea to talk to your healthcare provider or pharmacist about having a take-home naloxone kit on hand.
Call your healthcare provider or seek immediate medical care if you have new or worse withdrawal symptoms that you can't manage at home.
Opioid Detox Support and Resources
In most cases, treatment doesn't stop after detox. Most people with OUD need long-term treatment, which may include:
Self-help groups
Outpatient counseling
Intensive outpatient treatment (day hospitalization)
Inpatient treatment
Support groups that may be helpful include:
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides information for a number of treatment programs and resources.
Other resources include:
Locator for physicians providing buprenorphine for opioid use disorder
Locator for programs providing methadone for opioid use disorder
Summary
Stopping or lowering the dose of opioids can cause physical withdrawal symptoms (such as vomiting, diarrhea, and sweating), and psychological symptoms (such as anxiety and agitation).
Opioid withdrawal symptoms can be very uncomfortable but are not typically considered life-threatening.
Withdrawal can take place at home, in a detox center, or a hospital. Regardless of the setting, opioid withdrawal should take place under the guidance and care of a healthcare provider who can provide monitoring and prescribe medications to manage symptoms or help you taper off the opioids.
Read the original article on Verywell Health.
