Site Map

Opiate and opioid withdrawal

Withdrawal from opioids; Dopesickness; Substance use - opiate withdrawal; Substance abuse - opiate withdrawal; Drug abuse - opiate withdrawal; Narcotic abuse - opiate withdrawal; Methadone - opiate withdrawal; Pain medicines - opiate withdrawal; Heroin abuse - opiate withdrawal; Morphine abuse - opiate withdrawal; Opoid withdrawal; Meperidine - opiate withdrawal; Dilaudid - opiate withdrawal; Oxycodone - opiate withdrawal; Percocet - opiate withdrawal; Oxycontin - opiate withdrawal; Hydrocodone - opiate withdrawal; Detox - opiates; Detoxification - opiates

Opiates or opioids are drugs used to treat pain. The term narcotic refers to either type of drug.

If you stop or cut back on these drugs after heavy use of a few weeks or more, you will have a number of symptoms. This is called withdrawal.

Causes

In 2018 in the United States, about 808,000 people reported using heroin during the past year. In the same year, about 11.4 million people used narcotic pain relievers without a prescription. Narcotic pain relievers include:

These drugs can cause physical dependence. This means that a person relies on the drug to prevent withdrawal symptoms. Over time, more of the drug is needed for the same effect. This is called drug tolerance.

How long it takes to become physically dependent varies with each person.

When the person stops taking the drugs, the body needs time to recover. This causes withdrawal symptoms. Withdrawal from opiates can occur any time long-term use is stopped or cut back.

Symptoms

Early symptoms of withdrawal include:

Late symptoms of withdrawal include:

These symptoms are very uncomfortable but are not life threatening. Symptoms usually start within 12 hours of last heroin usage and within 30 hours of last methadone exposure.

Exams and Tests

Your health care provider will perform a physical exam and ask questions about your medical history and drug use.

Urine or blood tests to screen for drugs can confirm opiate use.

Other testing will depend on your provider's concern for other problems. Tests may include:

Treatment

Withdrawal from these drugs on your own can be very hard and may be dangerous. Treatment most often involves medicines, counseling, and support. You and your provider will discuss your care and treatment goals.

Withdrawal can take place in a number of settings:

MEDICINES

Methadone relieves withdrawal symptoms and helps with detox. It is also used as a long-term maintenance medicine for opioid dependence. After a period of maintenance, the dose may be decreased slowly over a long time. This helps reduce the intensity of withdrawal symptoms. Some people stay on methadone for years.

Buprenorphine (Subutex) treats withdrawal from opiates, and it can shorten the length of detox. It may also be used for long-term maintenance, like methadone. Buprenorphine may be combined with Naloxone (Bunavail, Suboxone, Zubsolv), which helps prevent dependence and misuse.

Clonidine is used to help reduce anxiety, agitation, muscle aches, sweating, runny nose, and cramping. It does not help reduce cravings.

Other medicines can:

Naltrexone can help prevent relapse. It is available in pill form or as an injection. It also, however, can bring about a sudden and severe withdrawal if taken while opioids are still in your system.

People who go through withdrawal over and over should be treated with long-term methadone or buprenorphine maintenance.

Most people need long-term treatment after detox. This can include:

Anyone going through detox for opiates should be checked for depression and other mental illnesses. Treating these disorders can reduce the risk for relapse. Antidepressant medicines should be given as needed.

Support Groups

Support groups, such as Narcotics Anonymous and SMART Recovery, can be enormously helpful to people addicted to opiates:

Outlook (Prognosis)

Withdrawal from opiates is painful, but usually not life threatening.

Possible Complications

Complications include vomiting and breathing in stomach contents into the lungs. This is called aspiration, and it can cause lung infection. Vomiting and diarrhea can cause dehydration and body chemical and mineral (electrolyte) disturbances.

The biggest complication is returning to drug use. Most opiate overdose deaths occur in people who have just detoxed. Withdrawal reduces the person's tolerance to the drug, so those who have just gone through withdrawal can overdose on a much smaller dose than they used to take.

When to Contact a Medical Professional

Call your provider if you are using or withdrawing from opiates.

Related Information

Sweating
Agitation

References

Kampman K, Jarvis M. American Society of Addiction Medicine (ASAM) National Practice Guideline for the use of medications in the treatment of addiction involving opioid use. J Addict Med. 2015;9(5):358-367. PMID: 26406300 pubmed.ncbi.nlm.nih.gov/26406300/.

Nikolaides JK, Thompson TM. Opioids. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 156.

Ritter JM, Flower R, Henderson G, Loke YK, MacEwan D, Rang HP. Drug abuse and dependence. In: Ritter JM, Flower R, Henderson G, Loke YK, MacEwan D, Rang HP, eds. Rang and Dale's Pharmacology. Philadelphia, PA: Elsevier; 2020:chap 50.

Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf. Updated August 2019. Accessed June 23, 2020.

BACK TO TOP

Review Date: 5/10/2020  

Reviewed By: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

ADAM Quality Logo

A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics. This site complies with the HONcode standard for trustworthy health information: verify here.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2021 A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.