Detox & Withdrawal from Opiate | Opioid Addiction

Content Overview

Due to the way that opiates affect the brain and the rest of the body, withdrawal can be complicated. This is particularly so if you are physically and psychologically dependent on your medication. For most people, a medical detox programme is necessary; partaking in such a programme means that the severity of the withdrawal process can be effectively managed, and safety and comfort can be assured.

Developing an opiate addiction means that you are likely to have a physical or psychological dependence or both. This means that if you try to quit your medication, or significantly cut back on the amount that you are taking, you will likely experience a range of withdrawal symptoms. These could end up being quite unpleasant.

To overcome an opiate addiction, you will more than likely require a detoxification, which is a natural process employed by the body to expel the remaining traces of a chemical substance that built up over time. Detoxification can be difficult though, so it is usually advisable to complete the process in a supervised facility where staff can ensure your comfort and safety at all times.

Opiates vs Opioids – What’s the Difference?

Most people use the terms opiates and opioids to refer to all types of drugs that are derived from opium, but there are differences between the two. Opiates technically refer to natural drugs that come from the poppy plant and include codeine, morphine, and heroin.

Opioids used to refer to synthetic versions of drugs derived from opium only, but these days the term is used to described both natural and synthetic versions. So any substance that binds to the brain’s opioid receptors can be classed as an opioid. Synthetic opioids include drugs such as methadone, fentanyl, oxycodone, and hydrocodone.

So, while all opiates can be classed as opioids, not all opioids are opiates. Having said that, while there are differences between the two, most people use the terms interchangeably to describe all medications and drugs that derive from the poppy plant.

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Opiate Withdrawal

Withdrawing from opiate medications can be difficult because of the way in which these drugs change certain structures of the brain. Repeated use of opiates means that the brain comes to rely on it and may be unable to function normally without medication. When that medication is withdrawn, a variety of symptoms can occur, and these will range from mild to severe in their intensity.
As the body and brain try to adjust to life without opiates, it is quite common for withdrawal symptoms to occur. These are usually the result of the body trying to get back to normal. Moreover, while the symptoms associated with opiate withdrawal are rarely life-threatening, they can be very unpleasant and be enough to cause some people to return to the drug they were abusing.

Opiate Withdrawal Symptoms

The symptoms that occur during an opiate withdrawal are typically graded from 0 to 3. Grade 0 symptoms are typically mild in nature while Grade 3 symptoms are classed as the most severe. These symptoms can include, but are not limited to:

Causes of Opiate Withdrawal

When you first started taking opioid medication, your brain and body would have tried to resist the changes that were taking place within. Opioids work by slowing down various physiological functions so in response, your body and mind would have attempted to resist by speeding up while trying to equalise the discrepancy.

As the effects of the drug wore off, your body would have tried to get back to normal, possibly leaving you feeling edgy or uncomfortable. A common response to these feelings is to take more of the drug to alleviate these symptoms, but this then makes it harder for the body to get back to normal.

With continued abuse of opioids, the brain and body’s tolerance to them increase. This means that in order to achieve the feelings you desire, you will need to take larger doses of the drug. However, in doing this, your body and mind will become dependent on the substance for you to feel normal. When you try to stop taking opioids, you are likely to experience withdrawal symptoms that are partly to do with your body and brain trying to function without the medication and partly to do with them trying to restore some semblance of normality.

Treatment for Opiate Withdrawal

Opiate withdrawal can be treated in a number of ways. In some detox clinics, medication will be used as a replacement for the drug that is being withdrawn. It is common practice for substitute opiate drugs to be prescribed as these can help to minimise the severity of the symptoms that occur.

Other medications to ease symptoms may also be prescribed while it might also be appropriate for holistic therapies such as mindfulness or meditation to be used to relieve some of the symptoms (such as drug cravings, anxiety, and depression).

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Long-term use of opiates can cause a physical dependence, as can taking them in high doses.

You may have already noticed certain unpleasant symptoms in between doses of your medication. It is often the presence of withdrawal symptoms that sends many people back to the drug and they then get caught in a cycle of abuse and withdrawal that they struggle to break free from.

Nonetheless, opiate withdrawal can work; if it is handled correctly. It is advisable to seek help if you want to quit opiates. You will need support and it may be appropriate for you to be given a substitute medication to help ease the symptoms of withdrawal.

While there is no doubting the fact that withdrawing from opiates can be uncomfortable and unpleasant, you should know that these feelings will pass. You will get better provided you stick with the detox process. It might be easier to return to your medication because you know that the symptoms will almost instantly subside, but this can make it even harder to quit the next time.

However strong your desire to return to opiates, if you resist you will reap the rewards. Know that overcoming addiction is a process and not an instant fix. With support and care from the staff at a detox clinic or an attendant at home, you can make it through the process.

Medications for Opiate Withdrawal

If you are going through opiate withdrawal in a detox clinic, medications may be used to help make the process safer and more comfortable for you. Some detox providers prefer to use substitute opioid drugs to help you withdraw from the drug you are addicted to.

The introduction of another opioid that will also act on the opioid receptors in the brain can help to minimise the impact of withdrawal, often preventing certain symptoms from occurring. While the drug you are addicted to is withdrawn, the other opioid is introduced. Once you are free from the original drug, the substitute can then be gradually reduced before a dependence to that occurs.

Methadone is typically prescribed to help with the withdrawal from a moderate to severe opiate addiction; it is commonly used in the treatment of heroin addiction. While methadone acts on the same receptors as other opioid drugs, it does not induce the same high, which helps to reduce cravings and certain withdrawal symptoms. Nevertheless, because there is a risk that an addiction to methadone could occur, it is always used with caution and, ideally, reduced gradually.

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Buprenorphine is another type of drug that can be introduced during opiate withdrawal to minimise symptoms. The risk for addiction is lower with buprenorphine, which often makes it a preferable treatment. It is generally not administered until withdrawal symptoms have already begun though.

Other medications can be used during an opiate withdrawal to help ease discomfort associated with symptoms. For those experiencing flu-like symptoms such as chills, fever, sweating, and diarrhoea, medications such as aspirin, ibuprofen, and naproxen may be administered.
Your detox provider could also prescribe medication to help you sleep as well as anti-nausea medications and anti-depressants to ease symptoms of depression and anxiety.

Opiate Withdrawal Psychosis

Psychosis is the term given when one loses touch with reality. It is an abnormal condition of the mind that results in the affected person being unable to tell what is and what is not real. Symptoms can include:

Hallucinations

Whereby a person sees, hears, or feels things that are not there. Some individuals suffer false beliefs, which can cause them to harm not only themselves but also those around them too.

Panic and desperation

While withdrawing from opiates; some will experience severe anxiety and hopelessness.

Bad decision-making

Opiates can change the way the brain works, sometimes with the effect of logical thinking being severely impaired.

"Insanity"

uring withdrawal, many can be described as suffering from ‘insanity’, whereby they will beg, plead, demand, and manipulate in a bid to get the drug they are craving.

When opiate withdrawal psychosis is severe, patients can become unpredictable and paranoid; many will believe that others are out to get them. They become completely disconnected from reality and unable to think clearly. They will go to any lengths to get the thing they desire most in the world – the drug they have been using.

Medical Detox from Opiate as Part of a Whole Treatment Plan

Overcoming addiction to opiates is a two-part process that begins with detoxification. To start your journey towards sobriety, you will need to quit opiates – this process is known as detox.

For most people, a medical detox will form a part of an overall treatment plan as it is considered the safest way to break free from these drugs. While it is possible to detox from opiates at home, it is considered by most to be more difficult and the chance of a return to opiate use will be much higher. This is quite apart from the fact that it can also be extremely dangerous without medical professionals in attendance.

Medical detox is the best way to ensure your comfort and safety. In a detox facility, medical staff will be on hand at all times to react in the event any complications that might arise. Any discomfort you are experiencing can be alleviated with medication if appropriate. Your vital signs will be monitored throughout the process and any issues can be effectively managed there and then.

A medical detox is considered necessary for those with underlying medical issues. If you have chronic health problems such as liver disease, heart disease, or diabetes, your chances of developing severe symptoms will be higher. This means that it will be necessary for you to be under the supervision of medical professionals who can administer appropriate medication. The same is true for those with mental health problems as well as those who have been abusing opiates with other substances such as alcohol or benzodiazepines.

A medical detox is an important part of a whole treatment plan. It is the first step on the road to recovery and allows doctors to make long-term plans in terms of other treatments and medication that may be required going forward.

Opiate Addiction Detox

Detox programmes for opiate addiction are typically inpatient based and include medication and the use of holistic treatments such as meditation and mindfulness to help make the process safer and more comfortable.

As mentioned before, certain medications can make the process of detox easier. The goal of a detox is to allow you to break free from opiates so that you will have a clear mind and body before starting the process of rehabilitation.

Symptoms associated with opiate withdrawal are typically classified according to their severity, with those classed as Grade 0 being the mildest and Grade 3 the most severe. The mildest symptoms usually begin around eight to sixteen hours after the last drug was taken. The more severe symptoms might begin after around thirty hours. Nevertheless, the onset of symptoms will depend on whether the drug being abused was short- or long-acting.

In general, symptoms will start off mild but then become more pronounced as the days go by. They usually peak around two to three days after beginning, before subsiding and easing off. Most people find that the bulk of their symptoms have disappeared after around a week to ten days but there may be some symptoms that continue for weeks or even months, such as muscle aches, sleeplessness, weakness, and anxiety.

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Opiate Detox Protocol

Before your detox begins, a protocol will be put in place that will give you and staff members at the detox clinic a clearer picture of how the process is to take place. The opioid detox protocol should include details about any medications that can be prescribed to ease symptoms and whether substitute opioids should be administered or not.

This plan is typically created by your doctor and other staff members at the clinic, with input from you. It will include dosage instructions and a plan for long-term medication if appropriate. The detox protocol is essential as it ensures that all staff members are aware of your needs and circumstances. If you have any underlying mental or physical health issues, these will be detailed here so that everyone is aware of your requirements.

The withdrawal process can complicate certain health problems such as high blood pressure, so it is vital that a plan is in place before it begins.

Physical Dependence vs. Addiction

Many individuals assume that physical dependence is the same as addiction and believe that if you are physically addicted to a drug you must have an addiction; this is not always true. It can be difficult to tell the two apart, particularly as a physical dependence is often the precursor for addiction and because addiction almost always includes a physical dependence.

Nonetheless, the term dependence refers to the symptoms of tolerance and withdrawal. If you are physically dependent on opiates, for example, you will experience physical symptoms when you try to quit or cut down on your use.

Your body will have adapted to your use of opiates and it will find it difficult to function without them. When you try to cut down or quit, your body will try to get back to normal, which can result in physical symptoms that might make you feel unwell.

In the case of addiction, you will have a compulsive need for the drug despite knowing that it could cause negative consequences. You will be unable to stop even if you desperately want to and your everyday life will be severely impaired by your use of the drug.

Your use of the drug may become your main priority and you may act irrationally or take desperate measures to get your hands on it.

Opioid Epidemic

You may have heard the term ‘opioid epidemic’; it refers to what many are calling a national crisis not only here in the UK but, particularly so, in the US, where thousands of people die every single year because of opioid-related overdoses.

As prescriptions for opioid medications grew in the US, so too did the number of individuals developing a crippling addiction. According to the NationalInstitute on Drug Abuse, more than 115 people die every day in the US after overdosing on opioids.

In the 1990s, drug companies pushed the use of opioid medications for the treatment of moderate to severe pain. They held many conventions and conferences and invited respected members of the medical community, advising them of the benefits of opioid pain relievers. This led to a dramatic rise in the number of prescriptions being issued.

Before the addictive potential of these drugs was fully realised, thousands of people were already struggling to cope with a crippling addiction, and overdose rates started to increase significantly. In 2015 alone, more than 33,000 people died after overdosing on opioid drugs.

Estimates suggest that around 21-to-29 per cent of those who have been prescribed opioid medication for the treatment of chronic pain will abuse their pills while 8-to-12 per cent will develop an opioid use disorder.

It has also been estimated that between 4 and 6 per cent of prescription opioid abusers will move on to heroin and that around 80 per cent of heroin users were originally prescription opioid abusers.

Here in the UK, there are fears that a similar opioid epidemic could occur, with the Royal College of GPs blaming the NHS of fuelling the problem because of a huge increase in the number of opioid medications being prescribed. In 2017 alone, GPs in England prescribed almost 24 million opioids.

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Opiate Overdose

Overdose is a very real threat to anyone abusing opioid medication. Because of the way in which opiates affect the central nervous system and depress functions such as breathing, taking too much can cause respiratory failure and possible death.

Most people who overdose on opiates do so accidentally. This usually occurs when they build up a tolerance to the effects of the drug. When this happens, they will need to take more opiates to achieve the desired feelings. But taking too much can have a negative impact on the functioning of the central nervous system, often leading to a fatal overdose.

The risk for overdose increases when opioids are abused. So taking higher doses than those recommended by your doctor, taking them in a different way than advised, such as snorting or injecting them, or mixing them with other sedative substances can severely raise the risk of overdose. With the risk of death from overdose very high, it is important to be able to recognise the signs so that you can take action. Overdose signs and symptoms include:

  • Slow breathing
  • Trouble staying awake
  • Pinpoint pupils
  • Disorientation
  • Confusion

Opiate Addiction Treatment and Rehab

Overcoming opiate addiction typically almost always requires professional intervention and the completion of both a detox and rehabilitation programme. Once a detox has been completed, it will be necessary to move on to rehab where the issues that caused the addiction will be addressed.

Treatment for opiate addiction usually involves medication, behavioural therapies, and holistic treatments. A comprehensive approach to recovery allows for the mind, body, and spirit to heal as one and is the preferred treatment for most people.

Opiate Addiction Withdrawal and Detox Statistics

  • A study in the US found that as many as 91% of people in recovery from opiate addiction will suffer a relapse.
  • At least 59% of those who relapsed did so within the first week of sobriety.
  • 80% relapsed within a month of finishing their detox programme.
  • In England, of those in treatment for substance abuse, those with a dependency on opiates accounted for the largest proportion of total numbers. 146,536 or 52% of people with a dependency were receiving treatment for an opiate problem in 2016/2017.
  • There was a 12% increase in the number of individuals being treated for both crack cocaine and opiate problems.
  • The median age for patients receiving treatment for opiate addiction was 39.
  • Patients receiving treatment for opiate addiction had the lowest rate of success in 2016/2017 at 26%.
  • The number of patients who died during treatment for opiate addiction increased from 1,693 in 2015/2016 to 1,741 in 2016/2017. This represented a 3% increase.
  • The median age of those who died in 2017/2017 was 45.
  • 74% of opiate patients who died were male.

FAQ

How does opiate withdrawal affect my health?

You are likely to feel unwell during opiate withdrawal. Many people liken opiate withdrawal to having a severe bout of flu. Symptoms such as achy muscles, chills and fever are common. However, these symptoms will pass and when you are free from opiates, you can expect your health to improve.

Will my information be kept confidential?

Whoever provides your treatment for opiate addiction has a duty to protect your private information. Anything that is discussed will be kept completely confidential and if you would prefer if others did not know about your treatment, you can rest assured that they will not find out unless you decide to tell them yourself.

Am I addicted?

Coming to terms with addiction can be tough and many individuals find it difficult to spot the signs of abuse and addiction, particularly in themselves. Nevertheless, if you are worried about your use of opiates and believe you may have an addiction, it is worth taking some time to consider how you use these drugs and how much control you have over your use.

For example, if you are abusing opiates and are taking more than the amount recommended by your doctor to achieve the feelings you desire, then you may be in trouble. However, if you are struggling to control your use of opiates and use them even when doing so could have a negative impact on everyday life, it is likely that you have an addiction.

How serious is opiate detox?

Unlike withdrawal from substances such as alcohol or benzodiazepines, opioid withdrawal is rarely life-threatening or dangerous in and of itself. However, detox can be uncomfortable, and you may suffer from symptoms that are akin to having severe flu.

During an opiate detox, there is the risk that you could develop cravings that are so intense that they become what is known as opioid withdrawal psychosis. This could result in you harming yourself or others due to false beliefs. There is also the risk of overdose if you return to opioid use after a period of detoxification as your tolerance to the effects of the drug can significantly reduce, even after just a few days of abstinence.

Can medications help me detox from opiates?

Medical professionals often utilise a few different medications to help with withdrawal. These can include substitute opioids that will prevent the worst symptoms from occurring or other medications that may ease any discomfort caused by symptoms that do occur.

Can I die from opiate withdrawal?

While the symptoms that occur because of opiate withdrawal are rarely severe enough to cause fatal consequences, your underlying mental and physical health can influence the severity of the process.

Complications are rare and more often than not deaths from opiate withdrawal occur as a result of overdose when an individual makes a return to opiate use after a period of abstinence.

How to detox from opiates?

It is generally agreed that the best way to detox from opiates is in a dedicated detox facility. Within such a facility, medical staff can create a tailored plan that includes medication if appropriate. It may be the case that your dosage of opiates is gradually reduced and a substitute drug is introduced to lessen the severity of the detox. However, your detox provider may feel that a sudden cessation of the medication is appropriate and will administer pharmacological treatment if required.

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