'Their skin feels like it's crawling': What to expect during the 3 stages of opioid withdrawal

9nong/ShutterstockExcessive sweeting, muscles aches, and restlessness are all signs of early opioid withdrawal.
  • Early opioid withdrawal symptoms include restlessness, anxiety, insomnia, and muscle aches.
  • Late opioid withdrawal symptoms are more serious and involve vomiting, diarrhoea, and a rapid pulse.
  • Medications like methadone and clonidine can help ease opioid withdrawal symptoms.
  • Visit Insider’s Health Reference library for more advice.

Opioids are a class of highly addictive drugs that can cause both severe mental and physical withdrawal symptoms.

Examples of opioids

  • Prescription medications like codeine, oxycodone, hydrocodone, and morphine
  • Illegal drugs like heroin and fentanyl

On average, it takes a couple of weeks to develop a physical addiction to opioids, however, even just five days of prescription opioid use can have physiological effects.

Here’s what you need to know about opioid withdrawal and how to treat it.

Opioid withdrawal symptoms

Opioid withdrawal symptoms depend on several factors, including the stage of withdrawal and the type of opioid you’re taking.

Three stages of opioid withdrawal:

  • Early stage. This usually starts 6 to 30 hours after the last dose.
  • Peak period. This is characterised by the most intense symptoms, which start about 30 hours after the last dose.
  • Late withdrawal. In this stage, the intensity of symptoms begins to decline.

The withdrawal process can be difficult and painful, according to Colleen LaBelle, CARN, addiction specialist and certified nurse at Boston Medical Centre and director of the OBAT program.

Early symptoms of opioid withdrawal can last anywhere from several hours to days.

Early symptoms of opioid withdrawal

  • Muscle aches
  • Excessive sweating
  • Lethargy
  • Runny nose
  • Anxiety
  • Extreme cravings for the drug
  • Restlessness
  • Insomnia

“At the beginning, people feel uncomfortable and can’t sit still,” LaBelle says. “Their skin feels like it’s crawling.”

Over time, she says, those feelings progress into more serious and debilitating symptoms.

Later symptoms of opioid withdrawal may begin after the first day lasting to around day five, but this varies widely.

Late symptoms of opioid withdrawal

  • Dilated pupils
  • Rapid heartbeat
  • Diarrhoea
  • Nausea and vomiting
  • Goosebumps
  • Abdominal cramps
  • High blood pressure

The later symptoms are especially dangerous, LaBelle says. If not managed properly with medical attention and medication, nausea and diarrhoea can lead to severe dehydration and, in severe cases, even death.

In fact, opioid addiction — or opioid use disorder — has led to a national crisis, claiming the lives of hundreds of thousands of Americans.

How long does opioid withdrawal last?

Opioid withdrawal typically lasts 4-10 days on average, depending on the type of opioid.

Important: For some people, the symptoms may persist for months after they stop taking the drug. This is known as post-acute withdrawal syndrome.

Short-acting opioids like oxycodone, hydrocodone, and heroin, usually have a different withdrawal time than longer-acting opioids like buprenorphine and methadone.

  • Short-acting: Severe physical withdrawal symptoms typically start 6 to 12 hours after the last dose and 12 to 24 hours after extended-release, also referred to as longer-acting. Once withdrawal starts, the physical symptoms typically last 5 to 7 days and are the worst around days 2 to 4.
  • Longer-acting: The longer-acting opioids bind more tightly to the opioid receptors in the brain. The result is longer withdrawal, which usually starts around 24 to 36 hours and can last up to 2 weeks.

People who want to stop taking opioids should do it with the assistance of a doctor, LaBelle says. A medical professional will regularly monitor your pulse, blood pressure, and temperature, and prescribe medications that can help manage withdrawal symptoms.

Aside from painful physical symptoms, withdrawal can cause severe mental and social distress. Anxiety, nervousness, depression, and dysphoria — or general unhappiness or uneasiness — are all common symptoms of opioid withdrawal.

Key signs of opioid addiction

  • Inability to control opioid use
  • Drowsiness
  • Changes in sleep habits
  • Weight loss
  • Frequent flu-like symptoms
  • Decreased libido
  • Lack of hygiene
  • Changes in exercise habits
  • Isolation from family or friends
  • Stealing from family, friends, or businesses
  • New financial difficulties

Treatment and support for opioid withdrawal

Doctors can prescribe medication to help ease the symptoms of withdrawal.

Medications for opioid withdrawal

  • Methadone: Methadone is a synthetic opioid, meaning it was created in a lab rather than derived from a plant. It offers the same pain-relief as other opioids, but what makes methadone unique is that it doesn’t come with the same high — except in very high doses. Patients must receive methadone under the supervision of a physician. It can cause sleepiness, dizziness, and nausea.
  • Buprenorphine: Buprenorphine works similarly to methadone and has the same potential side effects. However, research has found that while it is comparable to lower doses of methadone, buprenorphine may be less effective in higher doses than methadone. If the patient requires higher doses, methadone will likely be a better treatment option.
  • Clonidine: Clonidine belongs to a class of medications used for hypertension, or high blood pressure. It works by blocking chemicals in the brain and reducing uncomfortable symptoms of opioid detoxification. It can cause vomiting, weakness, headache, and constipation.
  • Vivitrol:This medication works by blocking the pleasurable effects of opioids. Like the other medications, it can cause dizziness, headache, and vomiting.

“The side effects for all of them are pretty minimal,” LaBelle says. “It’s about what works best in what setting.”

For example, methadone — unlike the other options — must be administered by a professional at a clinic, making it an ideal option for people who should be more closely monitored.

Although people can go through withdrawal at home, simply ridding your body of the drug does not address the psychological issues associated with addiction, and therefore may not have lasting results.

General advice: Going through withdrawal in a medical setting is ideal because it provides not only medication assistance but also social and emotional support, which are key to long-term recovery LaBelle says.

Groups like Narcotics Anonymous, SMART Recovery, and outpatient addiction programs can provide people with support from others who are fighting the same battle.

Insider’s takeaway

Opioid addiction, like any other type of addiction, is incredibly powerful. The decision to seek help can come with painful withdrawal symptoms that should be managed by a professional.

There are many resources that can help with the process like the Substance Abuse and Mental Health Services Administration.

“It’s incredible to watch people get well and put their lives back together, but it requires a lot of structural support and addressing underlying issues,” LaBelle says. “Try not to go through it alone and engage in treatment.”

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