Opioid Detox: How to Do It & When

Opioid abuse often begins innocuously. The cluster of drugs that encompasses OxyContin and Percocet are frequently prescribed to help patients manage acute pain—after a major surgery, for example, or if they’ve been injured in a traumatic car accident.¹

But opioids’ innately addictive nature can give rise to Opioid Use Disorder (OUD), a chronic medical condition that affects an estimated 2.7 million people in the United States.² Due to the impact these drugs have on opioid receptors—biological structures, located throughout the body, that influence sensations like pain and euphoria—they may lead to abuse and dependence, just as they can progress into the use of other, more hazardous opiates such as heroin and fentanyl.³

Opioid Use Disorder is deemed one of the biggest public health crises of our modern era, so much so it’s characterized as an epidemic by the National Institutes of Health.⁴ Fortunately, Opioid Use Disorder is treatable—and the road to recovery begins with safe detox.

Whether you or your loved one have taken the brave and life-saving step to seek opioid treatment, here is the information you need to understand what happens during opioid detox.

What Are Opioids?

Opioids are a class of drugs either derived from the opium poppy plant⁵—a flowering annual endemic to Turkey—or created in a laboratory.⁶ The difference between opioids vs. opiates is the former is made synthetically. As noted above, opioids work by affecting opioid receptors within the brain, spinal cord, and more, helping patients:⁷

• Mitigate pain
• Deliver feelings of elation
• Encourage mental relaxation
• Treat coughing and diarrhea

In medical settings, opioids are considered a safe and effective method for tolerating moderate and chronic pain, whether it’s from a complicated dental surgery, an injury from a car accident, or cancer—if they are taken as prescribed and used only temporarily. 

That said, not only can prescription opioids lead to misuse, abuse, dependence, tolerance, and addiction (largely because of the rush of dopamine and the sense of euphoria they produce), but illegal opioids are also a rampant street drug. Some of the physical signs of opioid addiction include Nearly three-quarters of US residents who develop OUD report that their addiction began with prescription opioids—a fact that underscores how tremendously addictive this drug can be.⁸ 

Altogether, these legal and illegal drugs contributed to approximately 75% of the 91,799 drug overdoses that occurred in 2020 alone.⁹

What Are the Most Common Opioids?

A handful of the most common opioids include:

• OxyContin
• Oxymorphone
• Hydromorphone
• Percocet
• Hydrocodone (Vicodin)
• Methadone
• Codeine
• Tramadol
• Oxycodone
• Demerol
• Morphine
• Heroin
• Fentanyl

Whether used chronically to handle persistent pain or for the high feelings they deliver—or misused in a single, isolated moment—addiction to opioids can lead to grave, even fatal consequences. 

Despite these ramifications, quitting opioids cold turkey can have equally dangerous symptoms and complications. This necessitates opioid users tapering off from these drugs with the assistance of a healthcare practitioner or undergoing medical opioid detox.

What is Opioid Withdrawal?

Whether a person experiences opioid dependence vs. addiction, they are bound to experience withdrawal. Opioid withdrawal refers to a set of symptoms that surface with the significant reduction or complete cessation of opioids. Acute cases of withdrawal from opioid dependence are classified as Opiate Withdrawal Syndrome (OWS), which is defined as a life-threatening medical condition.¹⁰

However, not all cases of opioid withdrawal are severe; some, for example, characterize it as experiencing a bad flu. Your (or your loved one’s) experience with opioid withdrawal is generally contingent upon:

• Frequency of use
• Duration of use
• Severity of opioid dependence
• Overall health

Withdrawal Symptoms

Symptoms of withdrawal may range from mild to moderate to severe and may include:¹¹

• Anxiety
• Intense, difficult-to-manage opioid cravings
• Muscle and bone pain
• Nausea, vomiting, and diarrhea
• Sleep disturbances such as insomnia 
• Light sensitivity
• Cold flashes
• Goosebumps
• Lacrimation (or tearing eyes)
• Uncontrollable movements in the legs
• Runny nose
• Pupil dilation
• Hyperthermia (or hot flashes)
• Excessive sweating
• Fever

For some, these symptoms can be unpleasant and enormously challenging to manage on one’s own—and may lead to using again. In other cases, complications from severe vomiting and diarrhea, such as heart failure and aspiration, may result in death.

Timeline of Withdrawal

How long does opioid withdrawal last, and how long do opioids stay in your system after the last dose? Opioid withdrawal symptoms can set in as early as a few hours after stopping use. The factors outlined above, like your overall health, have a hand in how withdrawal unfolds, but the typical timeline is as follows:

• Long-acting opioids – Withdrawal from long-acting opioids may begin within 6 to 12 hours after your last dose, peak at 72 hours after cessation, and diminish up to 10 days after your last dose.

• Short-acting opioids – Withdrawal from short-acting opioids, such as heroin, reaches its pinnacle 2 to 3 days after your last dose.

If an opioid withdrawal is conducted under clinical care, medical teams may use what’s known as the Clinical Opioid Withdrawal Scale (COWS) to assess and determine the severity of withdrawal—and to establish the steps and precautions they’ll take.

What is Opioid Detox?

Performed with the goal of diminishing your or your loved one’s physical and psychological reliance on opioids, an opioid detox aims to:

• Monitor and diminish the symptoms of opioid withdrawal
• Manage cravings to prevent a relapse
• Provide support for long-term recovery
• Identify, and address, any underlying medical issues

When to Detox from Opioids 

If you’ve taken opioids for less than two weeks, you should be able to taper off of them under medical supervision. If this sounds like your circumstances, it’s important to discuss this with your physician.

That said, opioid addictions may go on for weeks, months, or years. The sooner you jumpstart treatment with detox, the higher your success of overcoming OUD—and the less painful your symptoms might be.

How to Detox from Opioids

An addiction is not about willpower or the internal strength you can muster. If a physical dependence on opioids has developed, it’s crucial to receive the support you need to ensure your withdrawal symptoms don’t pose a serious and possibly even lethal threat to your well-being. Similarly, the desire to use again, and the anxiety associated with quitting opioids, can be incredibly overwhelming without pharmacological and counseling help.

To this end, experts across the board usually recommend medically-supervised opioid detoxes in one of two settings: inpatient or outpatient.¹²

Inpatient

Inpatient opioid detox is an excellent option for those who may need to extract themselves from their living situation to conquer the desire to use, or who may face significant withdrawal symptoms. In an inpatient environment, you will:

• Live at a treatment center, which will provide you with ongoing medical care and counseling throughout the detoxification process.

• Be provided with education on substance abuse, lifestyle choices, and coping methods that can nourish you throughout recovery (should you choose, or be placed, in a long-term inpatient care facility).

While costlier than outpatient programs, an inpatient program can help ensure your safety during detoxification, prevent the possibility of relapse during acute withdrawal, and offer more intensive psychological support. Inpatient programs may also help accelerate the opiate detox process and return you to your life, and wellness, faster than an outpatient program.

Outpatient

In an outpatient opioid detox setting, you will: 

• Continue to live at home or in a safe environment you’ve selected—for example, with a close friend or a family member.

• Receive medications, medical treatment, and counseling at a treatment center.

• Attend support group meetings on a daily basis (depending on the outpatient program you’ve chosen for yourself or a loved one).

Outpatient programs are often chosen when one cannot break away from their daily obligations, or for financial reasons. The detoxification process may be slower in some cases, but it can also give a patient a chance to learn to deal with triggers that are inherent in life without relapsing after treatment concludes.

Common Medications Used in an Opioid Detox

Opioid detox is oftentimes managed with pharmacological help—to mitigate immediate withdrawal symptoms and foster long-term recovery.

The most common medications used in long-term opioid detox include:

• Methadone – Methadone is an FDA-approved opioid drug that’s frequently used in medically assisted treatment detox—and in both inpatient and outpatient settings—to mitigate cravings, curtail withdrawal symptoms, and inhibit the effects of opioids.¹³ It operates as an opioid “replacement” and is administered either orally or through an IV. Typically, patients with OUD start off with 10mg and “descend” from there. On the third day, a chemical analysis known as titration is conducted to ascertain the methadone needed for maintenance and to prevent relapse.

• Buprenorphine – As a viable alternative for those who do not have access to methadone clinics, buprenorphine works in a similar way to methadone, namely by reducing cravings and curbing the physical dependence on opioids.¹⁴

For withdrawal symptoms, such as bone and muscle pain and intense cravings, drugs such as lofexidine may be prescribed. 

The Next Steps After Opioid Detoxification

How to detox from opioids may seem to focus almost entirely on receiving assistance with the distressing and potentially dangerous withdrawal symptoms that arrive. But opioid treatment extends well beyond managing physical and psychological withdrawal. It’s estimated that 90% of people with OUD will relapse within a few months of completing opioid detoxification. 

To counter this, a comprehensive, long-term treatment plan is recommended. Generally, this includes:

• Pharmacological assistance, such as the use of methadone, under a physician’s supervision
• Behavioral therapy
• Group therapy
• 12-step programs
• Psychoeducation
• Support with developing new habits to manage cravings

Finding Safe Opioid Detox—and Recovery—with Elevate Rehab

The opioid abuse epidemic underlines the drug’s exceptionally addictive nature—just as it emphasizes the need to address OUD as soon as possible. Rediscovering your happiness and meaning in the absence of opioids is possible, especially if you partner with a team of compassionate healthcare providers who have extensive experience in addiction recovery. 

This is precisely what you will find with Elevate Rehab. With deeply restorative treatment centers in Lake Tahoe and Santa Barbara, we equip you with medical, pharmacological, and psychological support to help ease you into sobriety. And as a holistic rehab center, we help address not just the addiction that may have robbed you of your well-being but all of you.

Learn more about our opioid treatment program today.

Sources: 

1. Mayo Clinic. Tapering off opioids: when and how. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/tapering-off-opioids-when-and-how/art-20386036
2. CDC. Opioid use disorder. https://www.cdc.gov/dotw/opioid-use-disorder/index.html
3. National Library of Medicine. Physiology, opioid receptor. https://www.ncbi.nlm.nih.gov/books/NBK546642/
4. National Institutes of Health. Opioid addiction. https://www.nih.gov/about-nih/what-we-do/nih-turning-discovery-into-health/opioid-addiction
5. Britannica. Poppy / Description, major species, uses & facts. https://www.britannica.com/plant/poppy
6. Mayo Clinic. What are opioids and why are they dangerous? https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/expert-answers/what-are-opioids/faq-20381270
7. National Institute on Drug Abuse. Prescription opioids drugfacts. https://nida.nih.gov/publications/drugfacts/prescription-opioids
8. John Hopkins Medicine. Opioids. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/opioids
9. CDC. Understanding the opioid overdose epidemic. https://www.cdc.gov/opioids/basics/epidemic.html
10. National Library of Medicine. Opioid withdrawal. https://www.ncbi.nlm.nih.gov/books/NBK526012/
11. Addiction. Yes, people can die from opiate withdrawal. https://onlinelibrary.wiley.com/doi/full/10.1111/add.13512
12. PCSS. Medically supervised withdrawal (detoxification) opioids). https://pcssnow.org/resource/detoxification-from-opioids/
13.  SAMHSA. What is methadone? https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone
14. SAMHSA. What is buprenorphine? https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine