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What to Expect During Opioid Detox

The withdrawal symptoms that come with opioid detox are often a deterrent for those who want to enter recovery. But for many, the fear is larger than the experience itself.

While it can be a tough process, there are a number of ways to manage opioid detox, so it is not as disruptive as it might have been five years ago.  

What Is Opioid Detox Like?

Opioid detox is defined by intense physical withdrawal symptoms that are often compared to the flu times 10. The physical issues alone can be overwhelming. Almost everyone finds it impossible to think about or do anything else for the 10 to 14 days that these symptoms continue.

During the first couple of weeks of opioid detox and beyond, psychological issues are arguably just as disruptive to the process of getting sober. It can be difficult to fight the urge to relapse. Without supervised medical care and support, most people will not make it through the process of detox, not because they cannot withstand the physical symptoms but because the cravings are too much to bear without help.

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Is There a Difference Between Prescription Painkiller Detox and Heroin Detox? 

Not necessarily. Prescription painkillers like OxyContin and Percocet bind to the opioid receptors in the brain, just as heroin does. Many people living with an opioid addiction use these drugs interchangeably to stave off withdrawal symptoms during active addiction and stay “well.” 

The factors that cause detox have more to do with daily dose than what opioid the person takes to hit that threshold, though there are exceptions for those who take short-acting opioids such as Percocet or heroin as opposed to long-acting opioids like extended-release painkillers. Dependence on only short-acting opioids generally means that symptoms of detox will begin more quickly after the last dose, while those who are addicted to long-acting opioids primarily may have a few more hours before withdrawal symptoms begin.

What Does a Detox Timeline Look Like?

In most cases, physical withdrawal symptoms begin within the first few hours after the last dose, especially in the case of heroin addiction. Within 12 hours, even those who are primarily dependent on extended-release painkillers and other long-acting opioids will begin to experience withdrawal symptoms like fever, sweating, increased blood pressure and heart rate, anxiety, and agitation.

The symptoms will continue over the next three days and become worse. Stomach cramps, nausea, diarrhea, and vomiting — often, all at the same time — begin. During this time, intense cravings for opioids and depression can begin as well.

Once these symptoms peak after three days or so, they plateau and linger at this level. This can be difficult to get through, as it feels like they will last forever without the drug of choice. 
After about 10 days, withdrawal symptoms slowly begin to dissipate. The psychological issues of depression and drug cravings may be the last to go. They may continue for weeks, if not months.  

What Factors Might Change the Detox Timeline for Opioids? 

Some of the factors that may impact how opioid detox is experienced, the duration of the detox process, and the severity of withdrawal symptoms throughout include:

Is It Possible to Prepare in Advance to Make Detox Easier?  

It is not easy to prepare for anything proactively when you are in the midst of active addiction, but there are some things you can do to ease the transition into treatment.

  • Learn as much as possible about the options available to you in terms of medical care and support before you begin.
  • Choose the opioid detox program that has the resources you need to help you get through safely.
  • Surround yourself with people who are supportive of this process and cut out those who might try to talk you out of it, get you high, or get high around you.
  • Work on your mental mindset. Come up with reasons why you want to get sober and what you would like to accomplish when you are no longer shackled by addiction. Put signs of your motivational goals, like pictures of places you would like to visit or inspiring quotes, around where you will be during the opioid detox process.
  • Identify in advance an opioid addiction treatment program that will help you to stay sober for the long term. Enroll prior to starting detox.

What Can I Do to Make Detox Less Difficult?

If you choose the “cold turkey” method of detox, where you stop abruptly taking all substances and allow your body to respond naturally, it is hard to do anything but be present in your body and manage each symptom as best as possible. Self-care in this situation generally involves staying hydrated as much as possible, resting even if you cannot sleep, staying in a safe and drug-free location, and asking for help as needed.

Many people choose medicated detox that allows them to slowly taper off opioids in a controlled manner, replacing illicit substances or prescription drugs with controlled doses of a replacement drug such as buprenorphine or methadone.

By lowering the dose of the replacement medication slowly, the body will still respond and exhibit withdrawal symptoms at times of transition, but it will not be as overwhelming. However, it will involve a longer overall withdrawal process.

What Happens After Opioid Detox?

Usually, addiction treatment begins during opioid detox when medications are used. Addressing the mental and emotional processes that trigger cravings for substance abuse is essential to creating new habits and behavior patterns that are healthy.

Though addiction is a chronic disease that may be defined by relapse, the ultimate goal is to avoid relapse. It is always a potentially deadly risk, especially after any period of sobriety. Follow opioid detox with comprehensive addiction treatment and long-term peer support that will help you to sustain sobriety as a new way of life.

Sources

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(Mar 2019) Review article: Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment. The American Journal of Addictions. from https://onlinelibrary.wiley.com/doi/full/10.1111/ajad.12862

(March 2017) What is detoxification, or detox? National Institute on Drug Abuse (NIDA). from https://www.drugabuse.gov/about-nida/frequently-asked-questions#detox

(Feb 2014) Short-Acting and Rapid-Acting Opioid Agents. The University of Utah. from http://www.health.utah.gov/pharmacy/ptcommittee/files/Criteria%20Review%20Documents/02.14/Short-Acting%20Opioid%20Drug%20Class%20Review.pdf

Commonly Used Long-Acting Opioids Chart. National Institute on Drug Abuse (NIDA). from https://www.drugabuse.gov/sites/default/files/files/CommonlyUsedLAOpioids.pdf

(2013) Factors affecting substance abuse treatment across different treatment phases. International Journal of Psychosocial Rehabilitation. from http://www.psychosocial.com/IJPR_17/Factors_affecting_substance_misuse_Flora.html

(Sep 2016) Cumulative burden of comorbid mental disorders, substance use disorders, chronic medical conditions, and poverty on health among adults in the U.S.A. Psychology, Health, & Medicine. from https://www.tandfonline.com/doi/abs/10.1080/13548506.2016.1227855

(2019) Suboxone Treatment and Recovery Trial (STAR-T): Study Protocol for a Randomised Controlled Trial of Opioid Medication Assisted Treatment with Adjunctive Medication Management Using Therapeutic Drug Monitoring and Contingency Management. Journal of Addiction. from https://www.hindawi.com/journals/jad/2019/2491063/abs/

(Jul 2015) 18 Powerful Ways to Build Your Mental Toughness. Inc.com. from https://www.inc.com/lolly-daskal/18-powerful-ways-to-build-your-mental-strength.html

(Nov 2018) Methadone maintenance treatment among patients exposed to illicit fentanyl in Rhode Island: Safety, dose, retention, and relapse at 6 months. Drug and Alcohol Dependence. from https://www.sciencedirect.com/science/article/pii/S0376871618304721

(2018) Evaluation of Successful Rehabilitation Treatments for Opioid Addiction. Boston University. from https://search.proquest.com/openview/2ce08dc1505bc231790f8c1710815081/1?pq-origsite=gscholar&cbl=18750&diss=y

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