Opioid withdrawal is a complex subject and can be a worrying topic.
Opioid Basics
Opioid withdrawal refers to reducing your usage of opioids until you can stop taking the medication completely. You might also hear this referred to as detoxification. Before we get started with your opioid withdrawal options, we’ll cover some basic information.
What Are Opioids?
Opioids are very strong painkillers that are commonly prescribed for short-term, acute pain, such as recovering from surgery or when you’ve had a serious injury. In some rare cases where chronic pain is severe, patients may be prescribed opioids in the longer term. This should only happen if all other treatments have been ineffective.
This 2019 article explains that opioids include, “opiates (drugs derived from the opium poppy, including morphine, codeine, heroin, and opium) and synthetic opioids like hydrocodone, oxycodone, and methadone”
We have opioid receptors in specific areas of our body and brain. The body makes its opioids which attach to these receptors: these natural opioids regulate and reduce pain among other functions. The number of opioids produced naturally is low, isn’t dangerous, and simply helps our body and mind to function properly. When we introduce medical opioids into our system, they mimic the opioids which naturally occur and attach to the existing opioid receptors to provide pain relief.
Why Do People Choose To Stop Taking Opioids?
Although opioids can be very effective in providing short-term pain relief, in the long term they have many negative effects and risks. Opioids can have many side effects including:
- Nausea
- Drowsiness and fatigue
- Mental ‘fog’ and confusion
- Slowed breathing
- Constipation
- Excess sweating
- Difficulty passing urine
- Itchy skin
- Hormone changes that can affect sexual performance
- Decreased immune function
- Increased risk of falls and fractures
- Dry mouth (often leading to dental problems)
Long-term use of opioids can increase the risk of hypoxia, a condition caused by slowed breathing: this results in not enough oxygen reaching the brain. This can have serious long-term consequences including, “psychological and neurological effects, including coma, permanent brain damage, or death.”
Over time opioids become less effective as your body and mind become accustomed to having them in your system. This means that you need to keep increasing your dose to get the same pain relief results you once had. This is a dangerous cycle.
When opioids are taken in the long term it can lead to opioid-induced hyperalgesia, meaning you become more sensitive to pain! This study explains that “The condition is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could become more sensitive to certain painful stimuli.”
Opioids are a high-risk drug for dependency and addiction. Dependence refers to needing the drug and feeling withdrawal symptoms if you don’t take it. Addiction refers to actively seeking out the drug and misusing the medication. We will use the term ‘relapse’ regarding both dependence and addiction, which simply means starting to take opioids again after withdrawal.
Why Is Opioid Withdrawal Difficult?
When you are taking opioids for a long period, your brain and body become used to having them in your system. Your system adjusts to accommodate the additional opioids. Over time the opioids create a sense of well-being and even euphoria, which is a welcome side effect for most. A chemical messenger in the brain called dopamine is released in high levels in reaction to opioids. Dopamine creates a ‘reward’ reaction, essentially making the association between an action (taking the opioid) and pleasure (the euphoric feeling).
When you begin to withdraw from these opioids, your brain, and body have to readjust to being without them. This can be tough, particularly if you’ve been taking opioids for a long time. During the withdrawal process, this sense of euphoria is of course decreased and eventually disappears: in the short term this stark contrast in mood can leave you feeling lethargic, low, and depressed.
The side effects of withdrawing from opioids can be significant, and this can be a scary prospect. It’s important to be informed about what might occur during withdrawal, but at the same time, this can be off-putting. It’s vital to remember that with the right support and an appropriate withdrawal plan, these side effects can be managed. It’s also important to remember why you are choosing to withdraw from your medication and to focus on your end goal.
Even if you are not addicted to your opioids, you can come to depend on them to reduce your pain and to help improve your quality of life. The thought of being without this help can be worrying. You might fear that you’ll be stuck in bed, in lots of pain. You may worry about what the future will hold without this pain relief. No one wants to be in pain, so this is completely understandable! This alone can make opioid withdrawal difficult.
However, with the right withdrawal treatment, you should receive support to find other proven, effective methods of chronic pain relief to replace your opioids. You might like to review our detailed post on pain management techniques to understand just how many options are out there for you.
What Are The Symptoms Of Opioid Withdrawal?
There are a wide range of symptoms that you could experience during opioid withdrawal. Which symptoms are experienced and how severe they are depending on the individual, the type of opioid you were taking, how high your dose was, and how long you’ve been taking the medication. Opioid withdrawal treatment aims to try to reduce the side effects you might experience.
Some of the more commonly experienced side effects of withdrawal include:
- Nausea and vomiting
- Stomach cramps
- Muscle and joint pain
- Diarrhea or constipation
- Chills or sweating
- Restlessness, anxiety, and irritability
- High emotions and mood disturbances (this can be severe and can include suicidal thoughts)
- Tremors, muscle twitching, or other abnormal movements
- Runny nose and watery eyes
- Yawning
- Rapid heart rate
- Changes in blood pressure
- Problems sleeping
- Goosebumps on the skin
- Yawning
- Hallucinations
- Seizures
How Long Does Opioid Withdrawal Take?
The amount of time it takes to withdraw will depend on many factors and will vary for each individual. The dose will be gradually reduced at a rate that suits your individual health needs and circumstances. The withdrawal symptoms are typically at their worst within the first few days and can last up to two weeks or more.
Risks Vs Benefits
The risks of withdrawal are of course going through the withdrawal symptoms we’ve discussed. It’s fundamentally not a pleasant experience and can be physically and emotionally taxing. There can also be complications arising from side effects.
The benefits of withdrawing from opioids in the long term tend to greatly outweigh the risks. Benefits of withdrawal include being free from addiction/dependence, being free of opioid side effects, and finding effective ways to treat chronic pain rather than mask it.
Where Do You Start With Getting Help?
Deciding When It’s Time
Deciding to withdraw from opioids is a big decision and it can feel worrying. Knowing when it’s time should primarily depend on physical factors such as if you’re experiencing serious side effects which you are struggling to cope with. You might be concerned or have been told by doctors that these side effects have the potential to cause long-term damage.
If you are finding that the dose you are taking is not giving you the same relief it once used to, this means that you have built up a tolerance. From then on, you would have to continue increasing your dose to be able to get the same pain relief effects you once had. This is a good indication that it’s time to stop taking opioids.
If you feel you are addicted to your medication or you have been misusing your medication (taking too high of a dose or seeking out medication that has not been prescribed to you), it’s time to reach out for help.
Other factors can play a part in your decision such as feeling that you are at a place in your life where you are ready to explore other chronic pain management options; having enough support around you or access to professional support; and feeling emotionally ready to start the withdrawal process. It’s important to note that it’s rare to feel completely emotionally ready, it’s natural to be nervous and this shouldn’t put you off withdrawing from your medication.
Reaching Out For Help
It is vital that when you’re ready to stop your medication, you reach out for help. Do not stop taking opioids suddenly or on your own. This article from Mayo Clinic aptly states, “Don’t try to go cold turkey on your own. Opioid withdrawal can be dangerous, and symptoms can be severe.” This isn’t to scare you, but rather to ensure you get the help you need to start the process safely. Speak to your doctor or specialist about your options. They will help you to taper off your medication safely, with the support that is right for you.
Tapering Off Your Medication
Your doctor will put together what is known as an opioid taper schedule, to help you gradually reduce your dose in small increments to make it more manageable. The length of time it takes to taper off your medication completely will vary depending on your individual needs and medical situation. Likewise, the increments in your dose that are reduced will depend on the individual. The taper schedule will be detailed, including exactly when and how you should take your medication. The tapering schedule must be followed exactly.
Care Plan
A care plan should be formed with your doctor or health team. This will include assessing your opioid use and your risk of relapse. It should detail which withdrawal treatments are best for you, along with where you should withdraw (outpatient or inpatient for example). The care plan should set out your tapering schedule, what support you will need, how regularly you will be monitored, replacement treatments for your chronic pain, and any additional help you will need going forward.
The plan should account for any additional addiction issues and other physical and mental health concerns. The goal of a care plan is to ensure you have the support you need to give you the best chance of success. This should all be discussed fully with your doctor so you understand the choices they are making and the plan set out for you. If you have any questions, be sure to speak up.
Monitoring
When you are tapering off your medication, you need to be monitored to ensure you are safe and to minimize any risks. Monitoring should include:
- Monitoring your vitals to ensure you are safe and handling the withdrawal physically. This might include checking your pulse, temperature, blood pressure, and general demeanor.
- Taking urine or blood samples to check the levels of your medication left in your system.
- Talking to you about how you are coping and providing further advice and support.
- Talking to you about your pain level and helping you to manage this as your dose decreases.
- Potentially prescribing other medications to help control withdrawal symptoms and make things more comfortable for you.
- Signposting you to therapy and support options to help you through your withdrawal.
There are several ways you may be monitored during the withdrawal process. Which setting is used depends on your own needs, local health service budget, and protocols, and how much support you have at home.
Outpatient Monitoring
If your withdrawal symptoms are likely to be mild, you don’t have additional health issues and you have good support, you will likely withdraw from opioids at home. This will involve being in regular contact with your doctor or health team who will monitor you closely. You may visit your doctor regularly for tests, or you may see a specialized clinic on an outpatient basis.
Going through with the withdrawal process at home can be difficult because you don’t have access to professional help 24 hours a day, and must continue to push forward of your own accord. Temptation can creep up to relapse if withdrawal symptoms become intense. However, if you have good support from your loved ones and stick to all of the guidance your doctor provides, it is possible to complete the withdrawal process at home.
Inpatient Withdrawal Treatment
Inpatient treatment involves staying at a hospital or clinic during the withdrawal process. The staff are trained to help you through the withdrawal process: they will closely monitor you to keep you safe and provide appropriate support. This might involve administering medications to minimize withdrawal symptoms, providing therapy sessions, and assisting with social needs to prepare for discharge.
Inpatient treatment is proven to be more effective for opioid withdrawal, primarily because of the amount of support, constant monitoring, and the avoidance of temptations. However, inpatient treatment is typically only used in severe cases or if the patient has other physical or mental illnesses.
Residential Treatment
Residential treatment will typically involve going to stay in a house, rehabilitation center, or clinic designed specifically to support those going through opioid withdrawal. You might also hear this referred to as a ‘rehabilitation program’. You may have your room or flat and may be free to come and go (depending on your progress), so it’s more independent than an inpatient setting. However, you will still have access to staff 24 hours a day and close monitoring to guide you through the withdrawal process.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens, and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888 or (516) 419-4480 for the Long Island office to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.
