For many years there has been a steady flood of dangerous drugs onto our nation’s streets, both urban and rural. These drugs are responsible for the destruction of countless lives every year in the US, not just the lives of those who become trapped in the stranglehold of chemical dependence but those individuals’ friends and family. For every person affected by dangerous and potentially deadly drugs, many loved ones want to see them sober and recovering.
While many deadly substances are abused daily, such as stimulants, benzodiazepines, alcohol, and depressants, the most dangerous group may be opioids. Many different kinds of opioids, such as heroin and fentanyl, are entirely illegal and can only be obtained through illicit means. But some are prescribed by doctors and other medical professionals, often for pain control, which can be equally dangerous and potentially deadly.
The most potent illegal opioids are heroin and fentanyl, both controlled substances listed respectfully as Schedule I and Schedule II. While both have an incredibly high potential for dependence and addiction, heroin has no accepted medical use, while fentanyl supposedly does. Both of these substances are the cause of many opioid overdose situations.
Prescription opioids are the most commonly abused type of prescription drug, and they have the potential to be even more dangerous than purely-illegal types like heroin since a doctor can continually prescribe them to the detriment of the patient. Even though doctors and other prescribing healthcare professionals are often on the lookout for visible symptoms of opioid addiction, many addicts become incredibly skilled at hiding their ‘tells’ and can keep obtaining prescriptions.
Opioids have incredibly powerful effects on the body, due in no small part to the biochemical mechanism by which they work. These effects create not only the perfect attractant and motivation for the user, but they also build an unbelievably strong chemical dependency in the body and brain of the user. In many cases, these withdrawal symptoms can be so strong, and produce intense feelings of discomfort or even pain, that the user is dissuaded from even attempting to quit using them.
Opioid withdrawal symptoms and the timeline they follow will often be unique to the person experiencing them and the type of opioid they are recovering from. In addition, the detox and withdrawal period will be heavily influenced by the half-life of the opioid in the individual’s system and their addiction history. This will include their frequency of use, average dosage, and the time they used the drug.
Generally speaking, the opioid withdrawal will begin within a few hours of the last dose wearing off and happens for about 10-14 days. Those who used higher doses of opioids, or used for longer periods, can generally expect the withdrawal to go a little longer and for the symptoms to be more severe than light users.
The first stage of opioid withdrawal will often start 6-8 hours after the last dose, and it is referred to as the acute withdrawal stage. This stage is often heralded by the beginning of the physical symptoms, often appearing as muscle aches and pains that start light and then build in intensity over the next two to three days. Eventually, these will accompany severe abdominal cramping, vomiting, diarrhea, sweating uncontrollably, chills, and shaking.
This peak in physical symptoms will happen around 3-5 days after the last dose and may also be accompanied by the beginning of the psychological symptoms. These symptoms can often include severe anxiety, panic, and insomnia. The end of the peak will usually be around a week after the last dose when the individual will see most symptoms, physical and psychological, begin to taper off and fade away.
Once the acute withdrawal stage is completed, sometime between 7 and 14 days after the last dose, the individual will enter the post-acute withdrawal stage. For opioid users, this will be the longest-lasting withdrawal stage, as it can stretch for months and even years in extreme cases. While the end of the acute stage is usually acknowledged as the end of the detox process, for many, it is not the end of all symptoms.
After the acute stage is finished, there is a high likelihood that the recovering individual will still experience some lingering mental and psychological symptoms. These will often include depression and occasional cravings to use opioids, but they are usually considered to be quite manageable with counseling and a solid recovery foundation.
The users with the longest history of opioid abuse or a history of using heavily, even for a short while, will often experience the final post-acute withdrawal stage for a relatively long time. This can result in months of reduced sleep quality and general restlessness, reduced concentration and inability to focus, and lingering feelings of depression, anxiety, fatigue, irritability, and even some memory issues. This can feel disheartening when the individual maintains their recovery for the entire time, but as long as they don’t relapse, the symptoms will eventually fade away.
The detox and opioid withdrawal process are incredibly difficult to do without medical help. Not only can trained professionals help reduce the symptoms and increase the individual’s comfort for the entire withdrawal process, but in some cases, they can even help it progress at an accelerated rate by leveraging medical detox. This is where medication is administered that immediately blocks the effects of the opioids present in the individual’s system, forcing an immediate detox and jumpstarting the withdrawal stage.
If someone is officially diagnosed with substance abuse disorder, they will have met at least two of the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders fifth edition. These criteria include:
One of the most important skills is recognizing the symptoms of not just opioid withdrawal but the many other symptoms and signs that may indicate that someone could have an opioid addiction. There are a great many people that have become addicted to one of the many opioids, and almost none of them can hide all of the signs of addiction all the time. In addition, most individuals who develop a dependency and addiction to opioids cannot hide the many negative effects it creates in their life.
All drugs in the opioid family will produce similar effects in someone dependent or addicted, many of which will be incredibly difficult to hide. For those close to an addict, there is the potential to see physical, psychological, and behavioral changes that could indicate addiction.
The physical signs that someone may notice if they are close to someone living with opioid addiction are very similar to those of being drunk and may even be passed off as such by the individual to prevent suspicion. Someone under the influence of opioids will appear to be drowsy or sleepy, or otherwise in a physically depressed state, often uncoordinated and weak, with little ability to focus or concentrate. Their pupils will be unresponsive and highly constricted, and the addict will also frequently become nauseous, itchy, dizzy, and have frequent headaches.
The behavioral signs mostly revolve around the addict trying to get more of their preferred opioids. This can include doctor shopping, stealing prescriptions from others, or getting friends or family members to obtain prescriptions for them.
The psychological signs are often much more difficult to recognize for even those close to the addict. Mood swings are common, as well as irritability and emotional instability. In addition, there is frequently a large degree of anxiety, interspersed with periods of euphoria.
For those with opioid addictions, the most difficult part of recovery is often sticking with it once they’ve decided to get clean. Since opioid withdrawals can be incredibly difficult without help, the first thing to do is reach out now to discuss your needs with an experienced addiction professional confidentially. By leveraging professional help, and a comfortable and clean environment, recovering individuals can build a solid foundation for ongoing sobriety.
Last medically reviewed August 28, 2022