The Stages of Opioid Withdrawal

The symptoms of opioid withdrawal begin quickly and last for up to a year. Many describe feeling close to death as the opioids leave their system, increasing the urgency of their cravings. Although unassisted opioid detox is usually not fatal, it can easily be overwhelming.

The exact length and nature of opioid withdrawal depend on several factors, like age, length of opioid use, and the type of opioid used. However, the general course is outlined below.

‍Stage 1 – from 6-72 hours from last opioid use

‍This stage is critical and is often experienced by addicts who are not intentionally undergoing detox but simply run out of their opioid supply. Physical symptoms begin but are also accompanied by strong physical and psychological cravings. These symptoms include:

• Anxiety and panic attacks
• Sweats
• Agitation
• Depression
• Insomnia
• Loss of appetite
• “Flu-like” symptoms like muscles and joint aches, nausea, vomiting, runny nose, and diarrhea

‍Stage 2 – from 72 hours to 2 weeks from last opioid use

‍The body has rid itself of opioids and is starting to rebalance its normal neurochemical levels. Symptoms are now reaching their peak and opioid cravings are at their strongest. For many, this is the most difficult stage and includes increased physical symptoms such as:

• A rise in blood pressure, breathing rate, and pulse
• Chills alternating with fevers
• Goosebumps
• Increased agitation and nausea
• Muscle cramps and spasms
• Insomnia

‍Stage 3 – from 2 weeks to 1 year from last opioid use

‍By now, many of the acute physical symptoms of opioid withdrawal have usually greatly decreased in severity. However, cravings for opioids are still likely to be strong. This is due to the long-term, possibly even permanent, structural changes that opioid abuse causes in the brain. These changes encourage the brain to associate opioid use with euphoria. The memories of those positive feelings can last years and may never fully fade.

Other symptoms that may be encountered in stage 3 of withdrawal include:

• Insomnia
• Nausea
• Fatigue
• Memory loss

Unassisted detox carries a certain appeal for many opioid users for several reasons. First, it provides a sense of accomplishment, a feeling that any problem can be overcome through mental toughness alone. Furthermore, the use of a detox program or drug rehab service would legitimize their opioid problem. In other words, asking for help would be the same as admitting that they have a problem. It’s critical to remember that there are some issues that no one can face alone, and that there is no shame or weakness in seeking help.

Opioid use disorder is a chronic disease of the brain, and just like any other chronic disease, long-term treatment is necessary for effective management to prevent relapses. Diabetics cannot eat right for just a week and expect normal blood sugars for life. Cancer patients do not take a single dose of chemotherapy in the hopes of being cured. In the same way, opioid addicts will need help for an indefinite period of time to effectively manage their disease.

The truth is that unassisted detox rarely works. In fact, most users relapse within 90 days on their own, and the majority of those begin using again in the first 30 days. The program type with the absolute best success rate is one of continued medical, psychological, and social support with either individual or group treatment.

However, people absolutely do succeed at breaking the chains of opioid addiction, and professional treatment is usually the key. Local programs that support not only the medical needs of their patients but also offer true support for the mind, have cured thousands and continue to do so – especially in Maryland, in the midst of some of the nation’s heaviest opioid addiction.