Opiate Withdrawal Timeline
Opiates are sedating painkillers that are highly addictive. In addition to pain relieving properties, opiates produce an intense sense of euphoria and safety, which is a key reason for its growing popularity. While many opiates are used in the manner in which they were intended for the duration prescribed without problems, certain users fall into opiate addiction.
According to the National Institute on Drug Abuse (NIDA), there are between 26.4 and 36 million people worldwide that abuse opiates, be it prescription pain relievers or illegal drugs, such as heroin. In 2015, in the United States alone, approximately 2 million people are addicted to opiates according to figures released by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The opiate withdrawal timeline can be long and daunting depending on the severity of opiate use. The use of opiates changes the way the opiate user’s brain chemistry functions. This often leads to psychological and physical dependency on the drug, when the opiate is not present in the user’s system, the person will experience what are called withdrawal symptoms.
Treatments for Opiate Withdrawal
There are a number of paths and programs that can help a person to recover from opiate addiction. The path chosen not only depends on the person, but also on the level of addiction. Recovery approaches include:
- Narcotics Anonymous 12-step program, providing support from people dealing with the same withdrawal struggle.
- Behavioral therapies, such as cognitive behavioral therapy (CBT), to help with coping skills, contingency management, and provides vouchers in exchange for negative drug tests.
- Rehab or detox centers help you through the withdrawal process and provide long-term skills to continue to deal with the prevention of opiate abuse once the rehab process is finished. In general, research has indicated that the majority of addicts need a minimum of three months of treatment to have the best possible opportunity of staying away from the use of opiates.
- Medication-assisted therapy, predominantly for severe opiate addictions. Medications, such as Methadone can help to taper the removal of opiates from the body.
The Signs of An Opiate Withdrawal
The symptoms of opiate withdrawal can range from mild to severe, depending on how addicted to the drug the user is. A person’s dependency can be linked directly to a number of factors:
- How long the drug user has been taking the opiate.
- The level of the dose.
- Which particular opiate was being taken.
- How the opiate was being taken.
- Any underlying medical conditions and/or any mental health issues.
- Some environmental and biological factors, i.e. any family history of addiction.
- Any previous trauma experienced and/or unsupportive, stressful surroundings or lifestyle.
Withdrawing from opiate addiction can be one of the hardest phases of life but it is important to remember that (a) you are not alone, and (b) there are many individuals and organizations ready to help you every step of the way.
The American Society of Addiction Medicine report that around 9% of Americans will abuse opiates at some point in their lifetime and a large part of succeeding in withdrawing from the use of opiates is to understand the process and what it entails. An opiate addict is likely to experience not only the physical effects, which are only a short part of the withdrawal process, but also the mental and long-term effects which may well be around for a lot longer. But it is important not to give up. The length of the withdrawal process will vary depending on the level of addiction and the determination of the individual to overcome the addiction.
Opiate Withdrawal Timeline
How long opiate withdrawal lasts depends on several factors from opiate dosage and length of use to the age of the opiate user. Opiate withdrawal can be mild, moderate, moderately severe or severe and this is usually determined by using a diagnostic tool, such as the Clinical Opiate Withdrawal Scales (COWS) to evaluate the specific symptoms and the opiate user’s history.
The early withdrawal symptoms in the first or acute withdrawal phase are predominantly physical and usually the worst; sometimes lasting only a matter of hours or a few days but can be as long as 4 weeks. These include:
- Muscle aches and tearing up.
- Anxiety and agitation.
- Problems with sleeping and sleep patterns.
- Excessive yawning.
- Hypertension and a racing heart rate.
- Fever and sweats.
- Nose running.
- Restless leg syndrome.
- Digestive discomfort or pain.
- Dilated pupils.
It is at this stage that most addicts may give up as the headaches, body pains and aggression elements of the withdrawal take effect.
Sleep may help and is a great cure-all but this might be difficult in the early stages of opiate withdrawal. The aim is for around eight hours of sleep a night but this may not be accomplished until the later stages of opiate withdrawal. However, the more the person can try to relax, rest and sleep, the more energy will be created to focus on opiate detox. If working, aim to reduce the workload for a short while to allow the body to recover from any physical symptoms.
During the opiate addiction withdrawal phase, the body will be nutrient deficient. The Iranian Journal of Public Health’s study indicated that opiate users were likely to have reduced levels of calcium and magnesium, which may contribute towards muscle spasms and pain. Low levels of potassium indicate restless leg syndrome and eating bananas will increase potassium levels and alleviate this symptom. It’s highly likely that whilst being dependent on opiates, a healthy diet was not high on the agenda. It is also likely that during the first phase of withdrawal, there is a loss of appetite but it will return and when it does, make sure healthy foods and liquids are on the menu. Avoid processed foods, eat plenty of vegetables, beans, legumes and protein, and drink plenty of water to aid liver support. The types of healthy foods include:
- Leafy greens.
- Wild fish.
- Nuts, seeds and olive oil.
Taking multivitamins or supplements where nutrient levels are low will help to ease the symptoms of opiate withdrawal. For serious opiate addiction, it is worth going to a detox center, either as an outpatient or inpatient. These outpatient and inpatient rehab centers are well-equipped to help with the early phases of opiate withdrawal. In some severe cases of addiction, detox centers and/or physicians may recommend using medications that have been developed to help treat opiate addiction, particularly through the first phase of withdrawal, in order to slowly taper the removal of opiates from the body.
Withdrawal symptoms for the second phase or post-acute withdrawal, usually last a week to 10 days – although this phase can be as long as 2 years, and include:
- Nausea, vomiting and diarrhea.
- Drug cravings.
- Stomach cramps.
At this point, some of the psychological withdrawal symptoms start to appear and these may well continue far longer than the physical signs. It is important to ensure that there is plenty of therapy and mental health support for the opiate user in withdrawal. Over a short period of time, the physical pains will start to dissipate. Healthy foods will help as well as some form of light exercise and plenty of support. Withdrawing from opiate use can be a painful experience and some people may need the help of a medical detox program under close supervision, including the monitoring of blood pressure, body temperature, heart rate and respiration levels, in order to regulate the body’s brain function.
Opiate Withdrawal Tips
Once you’ve taken the big step to break the cycle and ‘get clean’ from opiate addiction, get together with other people that are going through the same process. Joining groups such as Narcotics Anonymous and getting involved in their 12-step meetings to stop using opiates will help the recovering opiate user with vital support. Other tips include:
- Have a strong support system and don’t be afraid to ask for help. Whether it’s family, friends, support groups or a doctor, having a network of support is vital in sticking to a recovery plan.
- Be honest and practice sharing the way you feel.
- Avoid high risk and/or stressful situations.
- Learn ‘relapse prevention’ strategies for those difficult times.
- Take one day at a time in the recovery process.
- Stay hydrated – the symptoms of diarrhea and sweating can lead to dehydration. It’s important to drink plenty of water and fluids as well as increased hydration drinks, such as sports drinks, which will increase the levels of electrolytes that can be lost due to dehydration.
- Take a hot bath– relaxing in a hot bath with a little bit of Epsom salts will help to relieve those muscle aches, headaches and any back pain. However, if experiencing fevers, hot or cold flushes, avoid a hot bath and use a heating pad on aching muscles instead.
Many recovery programs recommend taking light exercise. Keeping moving can help to alleviate some of the early withdrawal symptoms and releases serotonin, which may reduce some of the negative feelings that may be experienced. Light exercise can be something simple, like a short walk, or perhaps a low impact exercise class. Doing exercise may also help to focus on different aspects of life instead of the withdrawal symptoms, and reduce the feeling of helplessness.
For some, the withdrawal symptoms don’t always disappear and the withdrawal timeline may well go far beyond the average, sometimes long after the opiates have been processed and removed from the body. When all acute symptoms have gone and only persisting symptoms remain, it can be known as post-acute withdrawal syndrome or PAWS. These symptoms include depression, fatigue and poor sleep, irritability, anxiety and not able to make decisions clearly.
Handling the Cravings
Many of the opiate treatments focus on how to handle the opiate cravings that are experienced during withdrawal. Strategies to help can be broken down into three groups:
- Behavioral – focus on changing behavior to reduce the potential of a relapse. By delaying the reaction to the craving and finding a distraction, that is, exercise or entertainment, helps to resist the urge to relapse.
- Cognitive – based on changing and acknowledging self-talk before, during and after any cravings. It has been found that by talking positively about your ability to manage cravings, it reduces the potential of a relapse.
- Relaxation – relaxation skills, like guided imagery and deep breathing, can help to reduce stress and thereby, decrease any cravings.
Medications to Help Treat Opiate Withdrawal Symptoms
There are some over-the-counter medications that can help to treat the symptoms of opiate withdrawal if the other methods aren’t working. If you’re suffering with diarrhea, this could be relieved with a non-prescriptive medication like Imodium AD which contains loperamide. Others include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) which include ibuprofen, naproxen and aspirin.
- Anti-nausea medications, such as Pepto Bismol.
- Topical analgesics like Tiger Balm or Ben Gay.
- Naturally-derived sleep supplements including melatonin or Valerian root.
However, be aware that these types of drugs may interact with any others you are taking to help with either a medical condition or opiate withdrawal so, always consult a doctor first.
If the opiate addiction is severe, doctors of rehab detox centers may prescribe medications that have been specifically developed to help with the opiate withdrawal, such as Methadone, Suboxone or Revia, which is predominantly used to reduce opioid cravings and prevent the high experienced.
Methadone is the most well-known of these medications and is used to reduce the effects of the euphoric high that is experienced with the use of opiates, but not eliminate them entirely. Whilst the effects are similar to heroin, they are far less intense and last far longer, up to 24 hours. But there are side effects which include:
- Lethargy causing reactions to be much slower and movements more exaggerated.
- Mood swings ranging from depression to mania, particularly as the effect of Methadone wears off.
- Pinpoint pupils.
- Respiratory depression.
It is possible to overdose when using Methadone and the symptoms can include breathing difficulties, low blood pressure, muscle twitches, vomiting and nausea, bluish lips and fingertips, and coma. Methadone should not be mixed with any other substances, including benzodiazepines and alcohol. Any misuse of Methadone can lead to dependency as the drug is similar to heroin.
Suboxone is similar to Methadone and has similar side effects. For some opiate addicts, coming off these medication drugs can be just as difficult as withdrawing from the opiates themselves and this may not be the best approach to opiate withdrawal.
Making the decision to stop using opiates and entering an opiate withdrawal process is a big step to becoming healthy again. Go to a treatment center, join a group, get the support of family and friends and don’t give up. Withdrawing from opiate abuse is not easy, but with support and help, opiate withdrawal success is achievable.