Opioid addiction is a chronic disease that can lead to serious health, social, and financial complications. Opioids are medications that work on the central nervous system to create pleasurable effects and pain relief. Some opioids are legally prescribed to treat serious and chronic pain. While others, such as methamphetamine, are illicit substances that are abused.
Opioid addiction is identified by an intense, compulsive need to use opioids even though they are no longer medically necessary. Opioids possess a high potential for addiction and dependence even when administered and used as prescribed by a health care professional. Individuals with opioid use disorder (OUD) prioritize getting and using the substance over other things in their lives, which can harm their professional and personal relationships. Opioid withdrawal syndrome is a potentially fatal condition caused by opioid dependence.
In the United States, almost 50,000 people died from opioid-related overdoses in 2019. The abuse of opioids is a serious national crisis that negatively impacts public health and social and economic welfare. According to the Centers for Disease Control and Prevention (CDC), the overall economic burden of prescription opioid misuse in the United States is estimated to be at $78.5 billion a year, including healthcare expenses, lost income, addiction recovery treatment, and criminal justice involvement.
What Is Opioid Withdrawal?
When an individual becomes physically dependent on opioid painkillers, he or she may feel compelled to continue taking the medication to function normally. Abrupt cessation or reduction of the medication can result in various unpleasant symptoms known as opioid withdrawals. Withdrawal symptoms are dependent on various factors, including:
- The type of opioid exploited
- The individual’s drug tolerance
- The duration of their abuse
- Polydrug abuse
- Patient’s medical history
- Co-occurring disorders or mental health disorders
Although withdrawal symptoms aren’t usually life-threatening, they may trigger significant physical and psychological discomfort for the individual experiencing them.
The Effects of Opioid on the Body
Opioids bind to opioid receptors found in the brain, gastrointestinal tract, and spinal cord. Opioids exert their effects as they bind to these receptors. The brain also produces its own natural opioids, which are essential for pain relief, reduced respiratory rate, and the prevention of anxiety and depression.
However, the body does not produce opioids in significant quantities to treat the pain associated with a fractured leg. Nor does it produce opioids in large quantities to trigger an overdose. Opioid medications and illicit drugs are synthetic versions of these naturally occurring opioids.
These drugs may have a variety of effects on the body, including:
- Opioids can slow down breathing by affecting the brainstem, which regulates functions such as breathing and heartbeat.
- Opioids may produce feelings of pleasure or relaxation by acting on specific brain areas known as the limbic system, which regulates emotions.
- Opioids work by affecting the spinal cord, which sends signals from the brain to the rest of the body and vice versa.
What Causes Opioid Withdrawal?
According to the National Institute on Drug Abuse (NIDA), prescription opioids have similar effects to heroin. Therefore, when you take opioid medications for an extended period, the body becomes desensitized to the effects and will require more medication to produce the same effect as before. This formation is known as tolerance.
Long-term usage of these medications alters the function of nerve receptors in the brain, and all these receptors become dependent on the medication to function. If you feel physically ill after discontinuing an opioid medication, this may indicate a physical dependence. Withdrawal symptoms are the body’s physical response to the medication’s absence.
Many people become dependent on these medications within a short period. In some scenarios, people may be unaware of their dependence since opioid withdrawals closely resemble flu-like symptoms.
Symptoms of Opioid Withdrawal
Depending on the severity of one’s addiction and dependence, the symptoms can vary. In addition, many factors affect how long a person will experience withdrawal symptoms. As a result, everyone’s experience with opioid withdrawal is unique. Nonetheless, there is a general timeline for symptom development.
Early signs usually appear within the first 24 hours of discontinuing the medication and include symptoms, such as:
- Anxiety
- Lacrimation (eyes tearing up)
- Runny nose
- Muscle aches
- Restlessness
- Excessive sweating
- Yawning very often
- Inability to sleep
Withdrawal symptoms may peak after the first few days. Symptoms may include:
- Goosebumps on the skin
- Nausea and vomiting
- Diarrhea
- Abdominal cramping
- Dilated pupils and possibly blurry vision
- High blood pressure
- Rapid heartbeat
While uncomfortable and painful, symptoms normally subside within 72 hours; some may experience them for a week.
Babies born to mothers who are addicted to opioids or who have used them while pregnant often develop withdrawal symptoms as well. This may include:
- Dehydration
- Vomiting
- Digestive issues
- Poor feeding
- Seizures
It’s crucial to note that different medications stay in the bloodstream for varying periods and may affect the withdrawal process. The duration of your symptoms is determined by the frequency of use and the extent of your addiction, as well as individual considerations such as your general wellbeing.
For example, heroin is generally eliminated quickly from the bloodstream, and withdrawal signs can appear within 12 hours after the last usage. On the other hand, it may take up to a day and a half for symptoms to appear if you have been taking methadone.
Risks of Opioid Withdrawal
Although symptoms of withdrawal aren’t life-threatening, withdrawal complications left untreated can turn fatal. For example, dehydration, heart failure, and hypernatremia (an elevated blood sodium level) can occur due to frequent vomiting and diarrhea. If you vomit and then breathe in stomach contents into your lungs, you can experience aspiration, resulting in choking or a lung infection.
The most serious risk of withdrawal is relapse. Since the detox process decreases the tolerance to the medication, resuming the same dose of opioids you previously took may result in an opioid overdose. According to the Centers for Disease Control and Prevention (CDC), more than 70% of the 70,630 drug overdose deaths in 2019 involved an opioid.
Opioid Withdrawal Treatment
The physical dependence on opioids can be diagnosed by your doctor depending on your symptoms and a physical test. Since it can be difficult to quit opioids safely, patients are highly advised to seek the assistance of a physician or addiction specialist. Treatment for opioid withdrawal involves medical detox followed by counseling, family and individual therapy, education, and support groups.
During detoxification, your doctor may prescribe medications to help alleviate certain withdrawal symptoms. Medications used during the detox process may include:
- Lofexidine
- Methadone
- Buprenorphine
- Naltrexone
- Clonidine
Some conditions, such as fever, headaches, or joint discomfort, may be treated with over-the-counter medications such as ibuprofen.
While medications can significantly help with the management of opioid withdrawal symptoms, certain day-to-day activities can also help you through your recovery process. These may include simple tasks such as:
- Moderate exercise, such as walking
- Healthy diet
- Activities that reduce stress and anxiety, such as meditation
- Plenty of water or other fluids to prevent dehydration
Regardless of the severity of addiction or dependence, opioid use disorder can be effectively managed and overcome with a comprehensive treatment program. While the process may seem daunting, the befits you reap are life-changing.