Opiate Withdrawal Stages
Opiate drugs include illegal drugs such as heroin and prescription drugs such as morphine, codeine, oxycodone (Oxycontin), hydromorphone (Dilaudid) and others. Symptoms of withdrawal may result from the discontinuation of opiate drugs or reduction in a habituated dose. Opiate withdrawal follows three characteristic stages, each with associated symptoms.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Early Stage
Physical symptoms of early withdrawal include:
- runny nose
- sweating
- tearing or watering of the eyes
- dilated pupils
- involuntary twitching
- goosebumps
Patients may complain of agitation, anxiety, restlessness or insomnia. Symptoms are initially mild but typically increase in severity over the course of a few hours. Many patients report localized, aching pain in the back, abdomen and legs. Hot and cold flashes are also common, and patients may request blankets.
- Physical symptoms of early withdrawal include: * runny nose
* sweating
* tearing or watering of the eyes
* dilated pupils
* involuntary twitching
* goosebumps Patients may complain of agitation, anxiety, restlessness or insomnia.
Peak
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Symptoms of opiate withdrawal usually increase markedly 36 hours after onset and peak 48 to 72 hours before they gradually subside. Agitation becomes severe, often accompanied by nausea, vomiting and diarrhea. Temperature, respiratory rate and blood pressure are modestly increased.
Ultrasonographic evidence of pancreatitis has been demonstrated in some patients and is presumably attributed to spasm of the pancreatic sphincter of Oddi. In rare cases, seizures have been reported; however, these are more characteristic of withdrawal from alcohol and other drugs 1. The occurrence of seizures should prompt reevaluation of the patient’s history.**
Unlike withdrawal from alcohol and other drugs, opiate withdrawal is generally considered life-threatening only in infants. However, polysubstance abuse is the rule, rather than the exception, among opioid addicts. The duration of withdrawal may be reduced by the administration of opioid antagonists such as naltrexone (Revia) and naloxone (Narcan), but it does so at a cost of intensification of the subjective symptoms.
- Symptoms of opiate withdrawal usually increase markedly 36 hours after onset and peak 48 to 72 hours before they gradually subside.
- In rare cases, seizures have been reported; however, these are more characteristic of withdrawal from alcohol and other drugs 1.
Long Term
After 7 to 10 days, physical signs of withdrawal have typically resolved. Opiate addiction is frequently a chronic, relapsing condition. In one study, fewer than 25 percent of heroin addicts remained abstinent even with methadone treatment. A review of opioid dependence treatment: Pharmacological and psychosocial interventions to treat opioid addiction. Clinical Psychology Reviews. October 30, 2009. ').
- After 7 to 10 days, physical signs of withdrawal have typically resolved.
- In one study, fewer than 25 percent of heroin addicts remained abstinent even with methadone treatment.
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References
- Ropper AH, Samuels MA, "Chapter 43. Disorders of the Nervous System Caused by Drugs, Toxins, and Other Chemical Agents" (Chapter). Ropper AH, Samuels MA: Adams and Victor's Principles of Neurology, 9th ed.
- Gehlbach Brian, Kress John P, "Chapter 14. Pain Control, Sedation, and Use of Muscle Relaxants" (Chapter). Hall JB, Schmidt GA, Wood LDH: Principles of Critical Care, 3rd ed.
- Veilleux JC, Colvin PJ, Anderson J, York C, Heinz AJ. A review of opioid dependence treatment: Pharmacological and psychosocial interventions to treat opioid addiction. Clinical Psychology Reviews. October 30, 2009.
- Opioid Withdrawal. National Center for Biotechnology Information, U.S. National Library of Medicine. Updated: June 4, 2019.
- Nicholls L, Bragaw L, Ruetsch C. Opioid dependence treatment and guidelines. Journal of Managed Care & Speciality Pharmacy. 2010;16(1 Supp B):14-21. doi:10.18553/jmcp.2010.16.S1-B.14.
- Darke S, Larney S, Farrell M. Yes, people can die from opiate withdrawal. Addiction. 2017;112(2):199-200. doi:10.1111/add.13512
- Medline Plus. Opiate and Opioid Withdrawal.
- National Institute on Drug Abuse. Drug Facts: Prescription Opioids.
- Nicholls L, Bragaw L, Ruetsch C. Opioid dependence treatment and guidelines. Journal of Managed Care & Speciality Pharmacy. 2010;16(1 Supp B):14-21. doi:10.18553/jmcp.2010.16.S1-B.14.
- The National Alliance of Advocates for Buprenorphine Treatment. Clinical Opiate Withdrawal Scale (COWS). 2011.
- Wesson DR, Ling W. The clinical opiate withdrawal scale (COWS). J Psychoactive Drugs. 2003;35(2):253-9. doi:10.1080/02791072.2003.10400007
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Writer Bio
Heather Gloria began writing professionally in 1990. Her work has appeared in several professional and peer-reviewed publications including "Nutrition in Clinical Practice." Gloria earned both a Bachelor of Science in food science and human nutrition from the University of Illinois. She also maintains the "registered dietitian" credential and her professional interests include therapeutic nutrition, preventive medicine and women's health.