What are the symptoms of opioid withdrawal?
Are there any risks and can it be deadly?
Opioid withdrawal can be a daunting task that most chronic opioid abusers have gone through more than once. First comes a reason to stop using- the supply runs out, legal problems, family demands, or an inner desire to become free of the daily addiction routine. Then comes the problem of actually being able to stop.
Opioid withdrawal refers to the range of symptoms that occur after stopping or dramatically decreasing opioid drugs after habitual use.
Opioid drugs include morphine, codeine, Oxycontin, MS Contin, Dilaudid, Percocet, oxycodone, Vicodin, hydrocodone, fentanyl, methadone, heroin, and others.
Common Symptoms Of Opioid Withdrawal:
- Abdominal cramping
- Agitation
- Anxiety
- Diarrhea
- Dilated pupils
- Goose bumps
- Insomnia (difficulty sleeping)
- Nausea
- Runny nose
- Severe muscle aches
- Suicidal thoughts
- Sweating
- Vomiting
- Watery eyes
- Yawning
When an opioid user stops using their drugs, the body rapidly begins to experience the opposite effects of the drug they had been using, causing an agonizing withdrawal syndrome that can last from days to weeks. Opioid drugs (like prescription painkillers and heroin) cause relaxation, sleepiness, decreased pain sensation, and feelings of euphoria. Stopping use throws the body into a contrary experience characterized by agitation, restlessness, extreme pain sensitivity and a general horrible feeling.
Most commonly accepted lists of opioid withdrawal symptoms do not include the risk of death. Although death is an uncommon complication of withdrawal, it can and does happen.
Ways That Opioid Withdrawal Can Result In Death:
- Severe Dehydration
- Relapse and overdose
- Withdrawal from Opioids and Benzodiazepines
- Suicidal thoughts brought on by withdrawal
- Dehydration, from diarrhea and vomiting, that is not addressed during acute withdrawal can cause death. Dehydration is preventable and treatable, with appropriate medical care. Most cases of dehydration causing death occur in confinement settings, like jails and prisons. The dehydration is prolonged, and during that time the opportunity to help the person in withdrawal is missed. Jails process more drug withdrawals than any other type of institution, but often do not have medical resources to properly manage severe withdrawal. With the current opioid epidemic, opioid users make up a significant proportion of prison populations. Since jails are the entry point into the correctional system, they are certain to be faced with acute withdrawal among their opioid-dependent inmates. Opioid withdrawal needs to be recognized as potentially life-threatening and managed accordingly.
- Relapse and overdose deaths often occur in people who have just withdrawn or detoxed. People who regularly use opioid drugs develop a tolerance for it. This means they require larger and larger doses to get the same effects. Tolerance can quickly fade, even after a brief period of abstinence. This can occur any time a habitual user stops using, such as in detox, rehab or prison. After going through withdrawal, tolerance to the drug is reduced, therefore an overdose can occur with a much smaller than usual dose. If a user goes back to the same dose they used prior to stopping, they are at high risk of fatal overdose. Medication Assisted Treatment (MAT), such as Buprenorphine (Suboxone), has been shown to reduce the risk of relapse, and therefore decrease the risk of subsequent overdose deaths.
- Withdrawal from Alcohol and Benzo’s can be very dangerous and needs to be taken seriously. Many opioid users also take benzodiazepines (benzos) like Xanax (alprazolam), Valium (diazepam), Klonopin (clonazepam), and Ativan (lorazepam). Benzodiazepines are known for enhancing the effects of opioids like painkillers, heroin, and methadone. Withdrawal from combined opioids and benzodiazepines can be very dangerous and possibly lethal. Stopping a benzo “cold turkey” without professional medical assistance is not recommended. It is critical that anyone undergoing withdrawal from benzos seeks medically supervised detox.
- Suicidal thoughts can accompany the extremely uncomfortable opioid withdrawal syndrome. The pain, restlessness, and agitation, can easily trigger morbid thinking. Remember that the dope sickness (withdrawal syndrome) will end, and better times await. Professional help including Addiction Counseling is recommended. If that is not possible, call a crisis hotline, and/or a friend or family member. Ideally, a person going through withdrawal will not be left alone.
Opioid withdrawal syndrome (dope sickness) includes both physical withdrawal symptoms AND psychological effects. It is recommended to prepare for both of these aspects of withdrawal to increase the chances of a successful recovery. The best outcomes result from treatment programs that combine addiction counseling (with an addiction counselor or psychotherapist), and Medication Assisted Treatment such as Buprenorphine (Suboxone) or methadone.
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References
Fiscella K., Pless N., Meldrum S., Fiscella P. Alcohol and opiate withdrawal in US jails. Am J Public Health 2004; 94: 1522–4.
Darke S, Larney S, Farrell M. Yes, people can die from opiate withdrawal. Addiction 2016.
Bardsley CH. Opioids. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap.162.
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