Opioid & Opiate Addiction & Withdrawal

It started with a few pills to alleviate pain from an injury or some chronic disease. You’re able to get back to your life now that the pain is managed. Then the feelings of euphoria kick-in. The high from the pain pills feels great. They were prescribed by your doctor, so this must be safe – even if you take an extra one or two here and there. Next thing you know, you can’t live without that feeling. It’s all you can think about. You crave the drug, take more than you are supposed to, and continue using despite the negative effect it is having on your life.

You’ve become addicted to opioids or opiates.

Millions of people use opioids every year for pain management. Misuse of them leads to addiction, health problems, overdose, and sometimes death. The abuse rate has steadily increased over the last few years and has led to a severe epidemic in the US. Opioids are easy to get hooked on, but hard to stop. You are not alone. There is help.

What is an Opioid?

Opioids & opiates, also known as narcotics, are a class of pain-relieving drugs such as prescribed medications and the illegal drug heroin. Opioids work by interacting with receptors in the body and brain, which control pain and reward sensations. When opioids interact with specific receptors, the reaction alleviates feelings of pain and boosts feelings of pleasure, resulting in a “high.”

More About Opioid Addiction

Alternative and Street Names

There are numerous opioids both naturally and synthetically produced and used. Some of these are pure while others are mixed with different drugs such as acetaminophen.

“Opiate” vs. “Opioid”

Oftentimes, the terms opiate and opioid are used interchangeably. However, there is a difference.

Opiates are formed naturally from the poppy plant and include heroin, codeine, and morphine.

Opioids, on the other hand, are synthetically made, and include fentanyl, hydromorphone, hydrocodone, methadone and oxycodone. Prescription combinations that are commonly abused include Lortab, Norco, Oxycontin, Percocet, Roxicet, Vicodin, and Tylenol #3 and #4.

Common street names

Pain killer
Happy Pills
Percs
Vikes
Oxy
White Stuff
Roxis

There are dozens of other prescription combinations containing opioids and dozens of other opioid street names used in order to avoid detection. Both heroin and illicit prescriptions are sold illegally. However, we will focus mostly on prescription opioids and discuss heroin separately in another article.

Common Ways Opioids are Used

Most opioids are taken in pill form, whether bought on the street or prescribed by a doctor. Another common method of ingestion is via injection with a needle. Sometimes pills are crushed and snorted or smoked.

How it Works

Both opiates and opioids attach to specific receptors in the body and brain that control our pain and reward sensors. The activation of these receptors reduces the intensity and feeling of pain and can intense feelings of pleasure.

Effects & Side Effects of Opioid Usage

When taken as prescribed, legal opioids help diminish the intensity and feeling of pain. When larger doses are taken or doses are taken more frequently than prescribed, a “high,” or euphoric feeling of relaxation and pleasure may occur. The intense feeling of pleasure varies depending on the type of opioid used and how much of the drug is ingested.

Immediate effects of usage

heavy feeling in limbs
nausea and vomiting
intense itching
drowsiness
cloudy or foggy mental function
slow heart beat
slow breathing or shortness of breath
coma
anxiety
headache

Long-term Effects of Usage

Frequent and long-term use of opioids can lead to physical dependence and addiction. It can cause negative effects on the heart, the brain, and the cardiovascular system, resulting in heart attacks and heart disease. Opioid usage also causes intestinal issues, constipation, bloating, abdominal distention, bowel obstructions, and hemorrhoids.

Tolerance also occurs, which leads to increased dosages needed to obtain the same high or maintain the high needed to ward off withdrawal symptoms.

Opioid Abuse Statistics in the US

Over 10.3 million people are estimated to have misused opioids in 2018 with nearly 2 million new reports of abuse per year. Two million people suffer from opioid abuse disorder in the US and over 15 million worldwide. 130 people die every day from opioid drug overdoses, totaling over 40,000 overdose deaths per year. Opioids are obtained both legally and illegally, with 18-25 year olds comprising of the highest non-prescribed usage, and people over 26 make up the highest number of abusers prescribed opioids. 80% of heroin users began with a prescription to opioids for pain relief. The number of people dying from opioid overdose exceeds that of any other drug in the US, at a rate of over 60% of all overdose deaths being tied to opioids, and nearly 20,000 deaths a year tied directly to prescription medications.

Opiate Tolerance, Dependence & Addiction

As previously stated, opiate use can lead to dependence, but it is also important to understand the risks of tolerance and addiction. As NIDA has explained, dependence occurs when a person takes a drug repeatedly, because nerve cells adapt to the drug and cannot carry out their usual functions without it.

Dependence can occur when people take opiates for chronic pain, but it is also likely when a person repeatedly abuses opiates, such as by stealing prescriptions that do not belong to them, taking larger doses than a doctor prescribes, or buying opiates illegally from a street-level drug dealer.

Closely related to dependence is tolerance, which occurs when people take opiates over the long-term. With repeated use, they will need larger doses to get the same pleasurable effects from opiates. As people take larger doses and the brain adapts to the presence of opiates, dependence can develop, and while dependence does not always lead to addiction, it can increase a person’s risk of addiction.

Dependence is seen as a physical condition that occurs when the body cannot function properly without drugs, whereas addiction is a behavioral condition in which a person compulsively seeks out drugs, such as opiates, despite negative consequences. While people probably think of heroin when they hear about opiate addiction, the reality is that prescription opiates can also be addictive and dangerous.

Opiate Addiction

When a person develops an opiate addiction, whether it involves prescription opiates or illegal drugs like heroin, an addiction professional will diagnose an opioid use disorder. This is the clinical term for an opiate addiction, and it is based on diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders.

According to the criteria, a person who has two to three symptoms has a mild opioid use disorder, whereas someone showing four or five symptoms has a moderate opioid use disorder. Someone who meets six or more diagnostic criteria has a severe opioid use disorder.

Opiate Addiction Symptoms

Taking more opiates than a person meant to take
Being unable to control opiate use
Strong opiate cravings
Continuing to use opiates even when it causes or worsens physical or mental health problems
Giving up usual activities to use opiates
Spending large amounts of time using opiates, seeking them out, or recovering from opiate use
Being unable to fulfill duties at work or home because of opiate use
Using opiates even when it causes relationship problems
Use of opiates in physically dangerous situations, such as driving while under the influence
Developing an opiate tolerance
Going through opiate withdrawal when drug use is stopped or reduced

While a person who takes opiates as prescribed, especially for short periods of time, may never develop any of the above symptoms, a person who misuses them, whether by purchasing illegal drugs or by taking larger doses of a medication than a doctor prescribes, is at risk of developing problems with opiates, up to and including a clinical disorder.

Signs of Addiction

Opioid addiction can be described as a strong, compulsive desire to take opioids longer than prescribed. Some people are at higher risk of becoming addicted to opioids than others. Those who have been addicted to other drugs or substances in the past, those who suffer from psychiatric conditions or depression, those who take more medicine than prescribed, take other people’s medicine, have taken medicine to get high, or take drugs in a way they are not supposed to, have a higher risk of becoming dependent on opioids.

Those who have certain personality traits such as impulsivity and sensation-seeking are also at higher risk. Also, there is a higher risk among individuals who have a family history of substance abuse and those who live with addicts. Another factor that leads to high risk of addiction is the length of time users are prescribed prescription opioids.

Signs of opioid abuse do not display immediately and individuals are not always aware that they have developed a dependence. Signs that you or a loved one have become addicted to opioids, include uncontrollable cravings, inability to control use despite negative effects on life and relationships, and behaviors that center around opioid use.

Other signs of dependence include taking more than prescribed or taking opioids more frequently than prescribed. Use of drugs such as heroin can immediately lead to addiction and have no medical necessity. If you or someone you love is using heroin, please contact a doctor or addiction recovery center immediately.

Opiate Withdrawal

Opiate withdrawal is a condition that can make it difficult to stop using opiates, and it can occur with a variety of drugs in this class. People often need professional assistance to help them cope with opiate withdrawal symptoms and achieve lasting abstinence from these drugs. Withdrawal can be uncomfortable, but detox programs can make it manageable and allow people to begin their journey toward recovery from opiate abuse and addiction.

Before learning about opiate withdrawal, it is helpful to understand what opiates are. According to the National Institute on Drug Abuse (NIDA), opiates are a class of drugs that includes heroin, which is an illegal substance, as well as prescription pain medications like OxyContin, Vicodin, codeine, and morphine. Fentanyl, a powerfully strong synthetic drug that is up to 100 times more potent than morphine, is also an opiate drug.

Despite some differences among the different types of opiate drugs, they are similar from a chemical standpoint, as they all act on the brain’s opioid receptors to relieve pain. They achieve this by blocking pain signals. While these drugs do have legitimate medical purposes, the problem with the opiates is that they can make a person feel euphoric, because they release levels of a brain chemical called dopamine, which has a pleasurable effect.

This means that some people may abuse opiates in order to feel high. Abusing opiates that are not prescribed can have lasting consequences, such as addiction. Unfortunately, NIDA reports that people can also become dependent upon opiates even when they take the drug under the care of a doctor. This means that their bodies adapt to the presence of opiates and cannot function normally without them.

As indicated in the diagnostic criteria, opiate withdrawal is one of the symptoms of an opiate use disorder, and withdrawal symptoms can make it difficult for a person to stop using, even if they are taking legally prescribed medication. Withdrawal can be very uncomfortable, and according to the World Health Organization, it includes the following symptoms.

Signs of Opioid Withdrawal

Anxiety
Chills
Sleep Problems
Hot or Cold Flashes
Sweating
Runny Nose
Watery Eyes
Rapid Heartbeat
Bone & Muscle Pain
Gastrointestinal Problems like Diarrhea, Nausea, or Vomiting

People who are preparing for or undergoing opiate withdrawal often wonder about the opiate withdrawal timeline, or how long opiate withdrawal lasts. The length of opiate withdrawal will vary based upon what type of drug a person was using. This is because some opiates, such as heroin, are short-acting, meaning their effects appear quickly but also fade quickly. On the other hand, some opiates are longer acting.

As the World Health Organization has explained, withdrawal from short-acting opiates typically begins 8 to 24 hours after a person stops using and lasts for four to 10 days. With longer-acting opiates, withdrawal may not appear for up to 48 hours after a person stops using, but it can last for 10-20 days. According to the Food and Drug Administration, extended release opiate tablets are long-acting, and drugs such as oxycodone, oxymorphone, hydromorphone, morphine, and fentanyl are available in extended release versions.

Some prescription opiates come in both extended release tablets and immediate release versions, which are short-acting, so the opiate withdrawal timeline may vary not only between specific drugs but also between different formulations of the same drug.

How Long Does Opiate Withdrawal Last?

The specific length of an opiate withdrawal largely depends on the person. Factors such as dosage intake, length of use, and over health of the individual all contribute to how long an opiate withdrawal could last. With “short-acting” opioids such as heroin, initial symptoms of withdrawal can be seen during the first 8 to 12 hours after last use, peak at 1 to 3 days, and could last five to seven days. Other “short-acting” opioids such as morphine, fentanyl, oxycodone, and hydrocodone can see initial withdrawal symptoms from 8 to 24 hours after last use, and could last 10 days.

Individuals who take “long-acting” prescription opioids could see symptoms around 24 to 36 hours after last use, after two to three days a significant decrease in symptoms can be seen as they subside, and the total withdrawal duration could last 14 days.

In addition to the data presented above, it is important to note that all symptoms and length of withdrawal solely depend on the individual and their state of overall health at the time of the last usage. Therefore it is difficult to give an exact length of time for an individual to reach total resolution/closure with their opiate withdrawal.

Treatment for Opiate Withdrawal

Given the fact that people who are abusing or addicted to opiates will develop uncomfortable withdrawal symptoms when they stop using, it is often necessary for people to seek treatment to help them manage these symptoms and move toward abstinence. A professional detox program can provide people with the care they need to get through opiate withdrawal.

During a detox program, medical staff provide supervision, monitor patients’ health, and give medications and treatments as necessary to address withdrawal symptoms. According to the World Health Organization, detox programs typically analyze patients using a withdrawal scale. Those who have minor withdrawal symptoms will receive proper nutrition and drink plenty of fluids, and they make take medications to alleviate specific symptoms. For example, they may take sleeping pills or take ibuprofen to manage pain.

On the other hand, if withdrawal symptoms are moderate or severe, a doctor in a detox program may prescribe a medication specifically to help with opiate withdrawal. Two medications commonly used in the treatment of opiate withdrawal are buprenorphine and naloxone.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), buprenorphine is a partial opioid agonist drug, meaning that it has a euphoric effect, just like other opiate drugs, but its effects are less intense. Buprenorphine’s chemical formulation also makes it less likely that people will abuse this drug, and it works by reducing opiate withdrawal symptoms and drug cravings.

Methadone, according to SAMHSA, is a full opiate agonist, and it has long-lasting effects. Like buprenorphine, methadone alleviates opiate cravings and withdrawal symptoms. It also blocks the effects of opiate drugs. Buprenorphine may be preferred to methadone, as the laws governing its use are less restrictive.

For patients taking buprenorphine for opiate withdrawal, the World Health Organization recommends the following dosing schedule during a detox program.

Buprenorphine Dosing Schedule

Day 1: 6 mg
Day 2: 8 mg
Day 3: 10 mg
Day 4: 8 mg
Day 5: 4 mg

For opiate detox with Methadone, the following regimen is recommended.

Methadone Dosing Schedule

Days 1-4: 30 mg
Days 5-8: 35 mg
Day 9: 30 mg
Days 10-15: Reduce dose by 5m daily until it reaches 0 mg on day 15.

While the above are common or recommend dosing schedules, the specific dosage of medication given during opiate detox will vary based upon a patient’s needs. That being said, while some patients may take one of the above medications for a short period of time and then taper off during detox, other patients will continue to take a maintenance dose over the long-term, even after completing withdrawal and detox. This is because medications like buprenorphine and methadone can help people to stay in treatment and remain abstinent from drugs.

In addition to buprenorphine and methadone, some people undergoing a detox program for opiate withdrawal may be treated with lofexidine. This is a non-opiate drug, and it can treat the physical symptoms associated with withdrawal from opiates. In fact, it is the first medication made specifically for the treatment of opiate withdrawal. This option is available when people do not have access to buprenorphine or methadone or are unable to take one of these medications.

Opiate Tapering

While people may misuse heroin or prescription opiate drugs and require the support of a detox program and medications to help them stop using, there are cases in which people who use opiates exactly as prescribed will never develop an addiction or abuse their medications. Despite using opiates properly, there is still a possibility that people can become dependent upon these medications. When dependence occurs, people can still experience withdrawal symptoms, even if they are not addicted to or abusing their prescriptions.

In some cases, a person who has been using prescription opiates under the care of a doctor will decide to discontinue the use of these medications , but instead of completing a detox program, the patient will work with a doctor to taper the daily opiate doses. This allows the body to slowly adapt to lower and lower dosages, so a person does not experience intense withdrawal symptoms.

According to experts, there is no single method that is best for tapering, but it is important to involve a doctor in the process. The best tapering method will vary between patients and based upon the type of medication a person was taking. Patients who have been using opiates for long periods may need more gradual tapering regimens to avoid withdrawal. A taper from a short-acting opiate may involve decreasing a daily dose by 10% every 3-7 days or by 25% weekly.

On the other hand, tapering from a long-acting drug may involve decreasing a dose by 20-50% per day until a daily dose of 45 mg is reached, and then decreasing by 15 mg every 2-5 days. Tapering regimens can be adjusted if a patient starts to withdraw. In some cases, a doctor may replace the patient’s usual medication with methadone and use this drug during the taper.

Protracted Opiate Withdrawal

While most people think of the intense but relatively short-lasting symptoms associated with opiate withdrawal, there are other opiate withdrawal effects that can last for a longer period of time. When people experience unpleasant side effects beyond the initial withdrawal and detox period, this is called protracted withdrawal or post-acute withdrawal syndrome.

According to the Semel Institute for Neuroscience and Human Behavior at UCLA, protracted withdrawal is especially common with opiates, and people may experience symptoms for months after they stop using drugs. Furthermore, about 90% of people in treatment for opiate abuse will experience some form of protracted withdrawal.

Protracted Opiate Withdrawal Symptoms

The side effects of protracted opiate withdrawal include mental health symptoms like mood swings, sleep problems, and anxiety. Additional specific symptoms include:

Difficulties with problem-solving, memory, and learning
Irritability
Depressed mood
Social problems
Sensitivity to stress
Relationship difficulties
Drug cravings
Apathy

Since drugs like buprenorphine and methadone can help to alleviate cravings, they may be helpful for reducing the effects of protracted withdrawal. Some people may continue to take these medications for a year or more after they stop using drugs, in order to help them maintain abstinence. In addition, because the symptoms of protracted opiate withdrawal include mental health problems like depressed mood, anxiety, and distress, it is beneficial for people to undergo therapy to address these issues and any underlying problems that led to opiate abuse and addiction.

Relapse prevention groups may also be beneficial and help people to learn how to identify triggers for relapse and handle the effects of drug cravings and mood swings without relapsing. Psychological and behavioral interventions are helpful not only for treating protracted withdrawal, but also for treating opiate use disorders in general. Completing a detox program and getting through the initial unpleasant withdrawal symptoms is only the first step toward recovering from an opiate addiction. Ongoing psychological and behavioral treatment is needed to treat the underlying addiction.

Opiate withdrawal is uncomfortable and can happen when a person uses these drugs over the long-term, regardless of whether the person takes prescribed opiate medications, buys prescription drugs off the street, or abuses illegal drugs like heroin. When a person stops using opiates after ongoing use, the body cannot function properly without the drugs, and symptoms like nausea, pain, and sleep disturbances can appear and be rather intense.

Fortunately, these symptoms usually pass within a week or so with short-acting drugs, and within about two to three weeks with long-acting opiates, and detox programs can make them much more manageable. Medications taken during detox, including buprenorphine, methadone, and lofexidine, can alleviate withdrawal symptoms so a person can detox from opiates as comfortably as possible. When a patient transitions to ongoing therapy after completing detox, he or she can fully recover from opiate addiction and avoid future complications, such as drug abuse and opiate withdrawal.

Withdrawal Side Effects

The body adapts to continued usage of opioids, causing mild to severe withdrawal effects if the drug is stopped or reduced. These withdrawal symptoms may begin within 24 hours of the last dose. In order to break away from the addiction, abusers should be monitored by a doctor or addiction recovery specialist.

Opiate withdrawal symptoms

restlessness
muscle and bone pain (sometimes even stronger than before opioid use)
insomnia
diarrhea
vomiting
cold flashes with goose bumps (“cold turkey”)
leg movements and twitches
loss of blood pressure
discolored tongue
constipation
disoriented feelings
delirium
stomach cramps

90% of opioid abusers experience a set of impairments during withdrawal called Post-Acute Withdrawal Symptoms or Post-Acute Withdrawal Syndrome, or PAWS. PAWS consists of weeks and sometimes months of impairments such as anxiety, mood swings, and insomnia. Scientists believe that the physical changes to the brain that occur during opioid abuse are responsible for the PAWS symptoms. These symptoms may fluctuate in severity and may disappear and reoccur.

Opiate PAWS symptoms

Difficulty with cognitive tasks such as learning and memory recall
Irritability
Anxiety or panic
Depressed mood
Craving the substance
Sleep disturbance
Increased sensitivity to stress
Obsessive-compulsive behaviors

PAWS can last for months and sometimes even years. Symptoms can occur as a response of stress triggers or for no reason at all. Scientists believe that the brain’s capacity to deal with stress is reduced with prolonged substance abuse and withdrawal symptoms.

Treatment for PAWS typically occurs over a long period of time, consisting of behavioral therapy and sometimes medications, which help manage the symptoms.

Opioid Treatment & Detox

Generally, treatment for opioid abuse consists of detoxification, cognitive behavioral therapy and medication-assisted treatment (MAT). Doctors administer specific drugs to help alleviate withdrawal symptoms and minimize opioid cravings during the detoxification process. Drugs such as methadone, naltrexone, and buprenorphine have been successful in helping opioid addicts recover.

Getting Help

Opioids are one of the most subtly addictive drugs available. Many abusers believe that opioids are safer than other drugs, or that they are not addictive by only taking opioid pills. However, misuse of any kind can lead to addiction.

If you or someone you know struggles with addiction to opioids or have begun using opioids in any form other than prescribed, it is critical that you seek help as soon as possible by contacting a local addiction clinic or the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357.

Opiate Addiction & Withdrawal FAQs

How do people get addicted to opioids?

Individuals usually get addicted to opioids by taking more of the substance than is prescribed, taking it for longer than prescribed, or more often than prescribed. Heroin is an illegal opioid, which can cause an individual to get addicted after the first attempt.

Why are opioids addictive?

Opioids are addictive because they create a feeling of euphoria, which leads abusers to seek more of the drug in order to maintain the same high.

How addictive are opioids compared to other substances?

Opioids, with the exception of heroine, aren’t immediately as addictive as other substances. Alcohol, cocaine, and amphetamines are far more addictive. However, once dependency has been formed, opioid addiction can be difficult to break.

What is opioid abuse?

Opioid abuse is the misuse of legal opioids to obtain a high or use of illegal opioids such as heroin. Abuse includes taking more of the substance than prescribed, taking it more often than prescribed, or taking opioids illegally obtained from someone else.

Why do people take opioids?

Legal opioids, such as pain-relieving drugs, are used to alleviate pain after surgery, injury, or due to chronic illness.

Why do people abuse painkillers?

In addition to alleviating pain, painkillers can create a sense of pleasure or euphoria, also known as a high. People end up abusing painkillers because their brains develop a tolerance, and they must ingest higher doses of the drug in order to obtain the same high.

How many opioid addicts are in the US?

There are nearly 2 million people addicted to opioids in the United States.

What are symptoms of opioid withdrawal?

Symptoms of opioid withdrawal include flu-like symptoms, such as aches and pains, twitching, stomach cramps, heart pounding, insomnia, yawning, runny eyes, and feelings of coldness.

Can you die from opioid withdrawal?

Opioid withdrawal can result in death if a person is not properly treated for withdrawal symptoms, such as dehydration caused by persistent diarrhea or vomiting.

Can someone be saved from an opioid overdose?

Yes, someone can be saved from an opioid overdose if certain drugs, such as naloxone, are administered in time.

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Hopkins Medicine. Signs of Opioid Use and Abuse. https://www.hopkinsmedicine.org/opioids/signs-of-opioid-abuse.html

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Mayo Clinic. How Opioid Addiction Occurs. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372

Semel Institute for Neuroscience and Human Behavior. Post Acute Withdrawal Syndrome (PAWS). https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS

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