The opioid drug class includes the illicit drug, heroin, and prescription opioids such as codeine, hydrocodone, hydromorphone, oxycodone, morphine, and methadone. Today, opioid abuse has become an epidemic; in 2014, an estimated 4.3 million Americans reported nonmedical opioid use and 435,000 Americans used heroin.1
Chronic opioid use can lead to the development of dependence, which is the body’s adaptation to the presence of a substance. When a person develops opioid dependence, they will experience withdrawal symptoms when attempting to abstain from using.1
Although, by nature, opioid withdrawal is not life-threatening, it can be extremely unpleasant.1,2 As a result, many treatment professionals recommend that patients attempting to withdraw from opioids seek medical assistance and detox treatment.3 At-home detox, while possible, presents numerous dangers, potential medical complications, and relapse risks.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines several diagnostic criteria used by physicians and other treating professionals to make a diagnosis of opioid use disorder or addiction. Among these criteria are the following signs, symptoms, and changes in behavior:2
Additionally, you may be addicted to opioids if you experience withdrawal symptoms when use is dramatically reduced or abruptly discontinued or if you use opioids to alleviate or avoid withdrawal symptoms.2
The DSM-5 indicates that withdrawal symptoms typically emerge after prolonged and heavy opioid abuse (over the course of several weeks or longer). People who abruptly quit or significantly decrease use may experience some of the following signs and symptoms:2,3
Many of these withdrawal symptoms can be extremely distressing. Detoxing on your own at home could prove exquisitely difficult because of this unpleasant, potentially painful experience.
Every patient’s detox timeline varies depending on several factors, such as individual physiology, age, frequency and amount of use, typical mode of administration (e.g. injecting or snorting), as well as the specific opioid they are attempting to detox from. For example, the acute withdrawal syndrome associated with heroin and many of the opioid painkillers typically begins between 6–12 hours after the last heroin dose, with symptoms peaking within 1-3 days and subsiding within 5–7 days.2
The withdrawal timeline may be somewhat delayed for long-acting opioids, such as methadone. Withdrawal symptoms for methadone may emerge 2-4 days after the last dose and typically dissipate within several weeks.2,3
While some people with opioid dependence can successfully detox at home, the support, medications, and monitoring provided in a formal detox program make the process much smoother and more comfortable.
As mentioned, though the experience is often highly uncomfortable, opioid withdrawal is rarely immediately life-threatening. However, certain complications that may require medical attention could arise. These possible complications include:1,3
Relapse remains the most concerning risk associated with opioid withdrawal, as most overdose deaths occur in people who recently detoxed from opioids.1 Any period of abstinence to occur during detox will result in a natural reduction of one’s opioid tolerance. Should an individual whose tolerance has decreased in this manner relapse with an opiate dose on par with what they were previously taking, they will be at increased risk of an overdose.1
Even if overdose is avoided, the relapsing user will have reentered their previous destructive cycle of opioid abuse and will again be at risk of experiencing the adverse medical and psychosocial consequences of their now-reinforced compulsive opioid use.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), comprehensive detoxification efforts must consist of 3 components:3
In the evaluation stage, toxicology screening takes place to detect any substances having been used. Treatment professionals will additionally assess for concurrent psychological and physical disorders. This stage includes a biopsychosocial assessment and creates the initial basis for appropriate treatment planning.3
The stabilization stage involves interventions that help guide a person through intoxication and withdrawal to get to a drug-free state. The detoxing patient may be administered select medications used to alleviate unpleasant withdrawal effects. Treatment professionals review treatment expectations with the patient and may work collaboratively with their family members, physician, or employer.3
The third stage of promoting additional, post-detox recovery efforts involves providing education about addiction treatment and emphasizing its importance on the continuum of substance abuse care. This means encouraging admittance into a treatment program to offset the risk of relapse after detox completion. Professionals may create a contract with the client to commit to a stable aftercare plan.3
Detox can occur in many locations, and the setting in which detoxification occurs should be appropriate for the individual patient. These settings are as follows:3
To alleviate or reduce some of the opioid withdrawal symptoms, patients may receive medication during their detox processes. Such medications are:3