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Opioid Withdrawal and Recovery

Opioid Withdrawal and Recovery

There is no discussing the problems of opioid addiction without mentioning withdrawal. And with the opioid crisis going so rampant that the U.S. Senate has passed sweeping legislation to fight it, it might be more important than ever to be knowledgeable about problems arising from addiction. What happens in the human body after taking opioids for a while and then stopping?

As with any other substance addiction, the symptoms of withdrawal syndrome can range from mild to severe. However, most people aren’t aware of how withdrawal works and what can be done to speed up recovery. It’s entirely possible to recover both from opioid addiction and withdrawal syndrome, but it takes time, persistence, and proper treatment.

What Is Withdrawal?

Withdrawal syndrome defines as a group of predictable symptoms that follow an abrupt removal of a psychoactive substance, and it can occur even when there is a rapid decrease in the regular dosage. In other words, those who are used to taking a specific substance and have been doing it regularly for a time can develop withdrawal syndrome after they stop taking it or decrease their dose. It’s a symptom of becoming physically dependent on the drug, which means that the body can no longer make up for the substance in a natural way.

Generally speaking, the withdrawal will usually bring about an increase in activity of the physiological functions that the drug suppressed, or a decrease of the functions that it stimulated. In the case of opioids, their role of suppressing pain means that the person experiencing withdrawal will be in pain.

Opioid Withdrawal: Symptoms and Risks

In opioid addicts, the brain begins to adapt to a regular dose of the drug. It slowly increases their tolerance, so they start needing more and more of the drug, increasing the dosages to get the same effect. Once physical dependence rolls in, it’s likely that the person will experience withdrawal once they stop taking the opioid.

Opioid withdrawal can be extremely severe. The symptoms can begin as early as 4 hours after the last dose (with certain opioids), up to 72 hours since the previous opioid dose. It includes both physical and emotional symptoms and can be excruciating to endure. There are two main stages of opioid withdrawal: acute and post-acute.

Acute Opioid Withdrawal

Acute withdrawal is the first phase of opioid withdrawal. It usually begins around 12 hours after the last dose of opioids, if they’re short-acting. For long-acting opioids, it might take up to 30 hours. Acute withdrawal includes a range of mostly physical symptoms.

It starts with agitation or anxiety along with drug cravings, continuing into sweats, fever, and muscle aches. Other symptoms may include sleep disruption, and increased blood pressure and heart rate. A person going through acute opioid withdrawal might also experience stomach pain and cramps, nausea, vomiting or diarrhea, followed by shivering and goosebumps.

Physical symptoms that mark the acute withdrawal stage usually resolve themselves within five days, so the worst will be over after that. Still, there is also the post-acute withdrawal stage to worry about.

Post-Acute Opioid Withdrawal

Post-Acute Withdrawal Syndrome or PAWS for short can last up to two years. During this stage, the person going through withdrawal will mostly experience emotional symptoms. It is due to the absence of opioids as their brain function and chemistry slowly returns to a healthy state. During this time, the levels of brain chemicals will fluctuate, which causes various emotional symptoms:

  • Anxiety
  • Irritability
  • Mood swings
  • Low energy and enthusiasm
  • Tiredness
  • Disturbed sleep
  • Variable concentration

Fortunately, these symptoms don’t manifest all the time. Recovery takes a long time, and post-acute withdrawal symptoms will at first change rapidly. Eventually, good stretches start, where the person isn’t experiencing any negative withdrawal symptoms. However, there will also be periods when symptoms come back with varying intensity. A post-acute withdrawal episode usually lasts for a few days, and it has no specific triggers.

Patience and self-care go a long way in helping people through the post-acute withdrawal syndrome. It’s important to approach the symptoms as a sign of recovery. The brain is adjusting to an opioid-free life, and will eventually get the chemical balance right. If a person resents the symptoms instead of taking a more positive outlook, it can be a trigger for relapse as soon as an episode hits. Allowing this to happen destroys all of the progress made by the brain during recovery, and the process will have to start over.

Drug Replacement

It’s sometimes advised to use a replacement drug for opioid addicts in recovery. These replacement drugs are meant to be the stepping stones that will help reduce the impact of withdrawal symptoms as well as prevent relapse. Usually, medicines that replace opioids or are used to block opioid effects are opioid agonists, at least partial. That means that they bind to opioid receptors in the body, but don’t activate them, which allows them to ease withdrawal symptoms or even revert an overdose. Suboxone is one such replacement drug, containing buprenorphine and naloxone, which are effective at mitigating the effects of drug dependence.

However, it’s important to note that recovery with replacement drugs will take longer and that there will still be withdrawal when the user wants to start weaning off of replacement drugs.

Support Matters

During the withdrawal stages, the importance of proper support is critical. Addiction recovery services and drug detox can help immensely in this difficult time, providing an option for safe recovery and a good starting point to staying off drugs in the long run. Even in the difficult weeks and sometimes years of the post-acute withdrawal, recovering addicts need all the support they can get, to prevent relapse, depression and suicidal ideation that might sometimes trouble them.
Recovery from opioid abuse is long, hard and fraught with difficulty, but ultimately more than worth it. It’s possible to live a healthy life again and not be dependent on dangerous substances. Improving options for safe recovery should be one of the priorities in fighting the opioid crisis and preventing further lethal outcomes.

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