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.

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.

Peak

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.

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. ').