The United States has the highest rate of opioid use per capita in the world. As a nation, we consume 80% of the world’s opioid supply.1 In 2014, the National Survey on Drug Use and Health found that 1.9 million people aged 12 or older had a past-year opioid use disorder, contributing to over $72 billion in medical costs.3,5
Opioids are the world’s oldest known drugs and use of the opium poppy dates back millennia. These drugs act on opioids receptors in the body which are associated with the brain’s system of reward.
It is well known that long-term use of opioids leads to physical dependence. However, the side of opiate addiction that we don’t hear about is the intense withdrawal period. It is important to start a conversation about what it feels like to come off of opiates as withdrawal has been shown to contribute to high rates of relapse and overdose.
Fact: The length of withdrawal varies from person to person.
The length of opiate withdrawal depends on several factors. Withdrawal will be affected by the half life of the drug, how heavily the individual abused the drug, and how long they used opioids.
For drugs like heroin, which have a shorter half-life, and are shorter-acting, withdrawal symptoms can begin 6-12 hours after the last dose. With longer acting drugs such as methadone, LAAM, or buprenorphine, symptoms may take anywhere from 1-2 days to present.27
Withdrawal symptoms for short acting opioids usually peak within 1-3 days and taper off over the course of a week. Chronic symptoms such as anxiety, insomnia, and dysphoria may last for weeks or months following withdrawal.4
Fact: Medications can help ease withdrawal symptoms.
Medication, along with behavioral therapy to treat addiction is called medication-assisted treatment (MAT). MAT can play an important role in managing withdrawal.
The 3 main types of active ingredients in FDA approved medications to treat opioid dependency are methadone, buprenorphine, and naltrexone.20 Studies have shown that MAT helps reduce the risk of overdose and increase retention rates of patients in treatment.28 Despite this, and due to various factors including social stigma and limited availability, these medications are often underused during withdrawal.
In 2012, only 1 million people received MATs. That may sound like a large number, but take into account that 2.5 million people were dependent on opioids in 2012—meaning that less than half received this treatment.24 One study found that MATs were incorporated into less than half of private treatment programs and of the programs that adopted MATs, only 34% of patients received them.22
Fact: Many prisons don’t have the systems in place to handle opiate withdrawal.
The U.S. has the largest prison population in the world, with nearly 1 in 100 adults in jail.10 The war on drugs led to mass incarceration and a large number of people are sent to jail because of illicit drugs, including opiates.11 So what happens if you are physically dependent on opiates, get arrested, and then you’re sent to jail?
One survey found that out of 500 prisons nationwide, 12% allowed methadone users to continue maintenance therapy during their incarceration.12 The study found that in prisons that don’t provide methadone, no standard protocol was in place to help wean individuals off of methadone or other opiates. This means that a large number of newly incarcerated individuals are experiencing extremely uncomfortable periods of withdrawal as they enter prison.
Fact: Babies with neonatal abstinence syndrome (NAS) may experience withdrawal after birth.
Newborns who are exposed to opioids in-utero have a 55-94% chance of developing neonatal abstinence syndrome (NAS). NAS is a short-term syndrome that can have long lasting effects.
Due to the prevalence of opioids, the incidence rate of NAS is rising. The number of babies born with NAS in the past decade has increased by 5 times and it is estimated that every 25 minutes a baby is born suffering from opiate withdrawal in the U.S.7
The onset of withdrawal symptoms for the newborn depends on the half-life of the drug, how long the mother took opioids, and the timing of the mother’s last dose. Depending on the type of drug taken, symptoms of NAS can present within 24 hours of birth for short half-life drugs such as heroin, or be delayed for 7 days or longer for long half-life drugs such as methadone or buprenorphine.13
Non-medical strategies such as swaddling, placing the infant skin to skin with the parent, rocking, and breastfeeding have all been shown to help reduce severe withdrawal symptoms.14
Fact: Researchers are developing new forms of medication to better meet the needs of patients.
A new drug called Probuphine was approved by the FDA in January 2016.26 The drug comes in the form of a tiny rod, containing buprenorphine.
As opposed to oral medications which are taken daily, or injectable versions that are taken weekly or monthly, Probuphine is a long-lasting implant. The drug is changed every 6 months, making it a more convenient option for some individuals.
Fact: Relapse after withdrawal is common.
When a person has a dependence to opioids their brain undergoes a series of changes and the body becomes used to the drug being in the system in order to function properly.
Studies have found that it can be extremely difficult for people to stop using opioids without also going through treatment.30 The brain has a similar response to all opioids, so whether a person is withdrawing from heroin or a pain reliever like oxycodone they will experience comparable symptoms.
Opioid withdrawal can include:32
Goosebumps and fever are signs of a more severe withdrawal. The rates of relapse among people who go through detoxification alone is roughly 95%.29,30 This highlights the importance of treating not only the presence of drugs in the body but the underlying motivations for addiction and drug abuse.
- Casati A, Sedefov R, Pfeiffer-Gerschel T. (2012). Misuse of medicines in the European Union: A systematic review of the literature. Eur Addict Res, (18), 228–45.
- Coalition Against Insurance Fraud. (2007). Prescription for peril: how insurance fraud finances theft and abuse of addictive prescription drugs.
- Jones CM. (2015). Unpublished analysis of the 2014 National Survey on Drug Use and Health Public Use File.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.
- Department of Health and Human Services (HHS). (2016). Medication Assisted Treatment for Opioid Use Disorders.
- National Institute on Drug Abuse (NIDA). (2014). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.
- National Institute on Drug Abuse (NIDA). (2015). DrugFacts: Prescription and Over-the-Counter Medications.
- Brownstein, M. J. (1993). A brief history of opiates, opioid peptides, and opioid receptors. Proceedings of the National Academy of Sciences, 90(12), 5391-5393.
- Stein, C., Millan, M. J., Shippenberg, T. S., Peter, K. L. A. U. S., & Herz, A. L. B. E. R. T. (1989). Peripheral opioid receptors mediating antinociception in inflammation. Evidence for involvement of mu, delta and kappa receptors. Journal of Pharmacology and Experimental Therapeutics, 248(3), 1269-1275.
- Travis, J., Western, B., & Redburn, F. S. (2014). The growth of incarceration in the United States: Exploring causes and consequences.
- Milloy, M. J., & Wood, E. (2015). Withdrawal from methadone in US prisons: cruel and unusual?. The Lancet, 386(9991), 316-318.
- Fiscella K, Moore A, Engerman J, Meldrum S. Jail management of arrestees/ inmates enrolled in community methadone maintenance programs. J Urban Health 2004; 81: 645–54.
- Meyer, L., & NAS, N. A. S. (2015). Neonatal Abstinence Syndrome.
- Jansson, L. M., Velez, M., & Harrow, C. (2004). Methadone maintenance and lactation: a review of the literature and current management guidelines. Journal of Human Lactation, 20(1), 62-71.
- Patrick, S. W., Davis, M. M., Lehmann, C. U., & Cooper, W. O. (2015). Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. Journal of Perinatology, 35(8), 650-655.
- Fodor, A., Tímár, J., & Zelena, D. (2014). Behavioral effects of perinatal opioid exposure. Life sciences, 104(1), 1-8.
- Fischer B, Argento E: Prescription opioid related misuse, harms, diversion and interventions in Canada: A review. Pain Physician 2012; 15(3 suppl):ES191–203.
- American Society of Addiction Medicine. (2016). Opioid Addiction 2016 Facts and Figures.
- American Society of Addiction Medicine. (2013). Opioid Use Disorder Diagnostic Criteria.
- Office of National Drug Control Policy. (2012). Healthcare Brief: Medication-Assisted Treatment for Opioid Addiction.
- Substance Abuse and Mental Health Services Administration (SAMHSA). (2011). Medication-Assisted Treatment for Opioid Addiction. Facts for Families and Friends.
- Knudsen HK, Abraham AJ, Oser CB. Barriers to the implementation of medication-assisted treatment for substance use disorders: the importance of funding policies and medical infrastructure. Eval Program Plann 2011a;34:375–381.
- Knudsen HK, Abraham AJ, Roman PM. Adoption and implementation of medications in addiction treatment programs. J Addict Med 2011b;5:21– 27.
- Volkow, N.D., Frieden, T.R., Hyde, P.S., & Cha, S.S. (2014). Medication-assisted therapies—tackling the opioid-overdose epidemic. New England Journal of Medicine, 370 (22):2063-6.
- Department of Health and Human Services (HHS). (2016). Medication Assisted Treatment for Opioid Use Disorders.
- Food and Drug Administration (FDA). (2016). Meeting of the Psychopharmacologic Drugs Advisory Committee. Probuphine for maintenance treatment of opioid dependence.
- Kleber, H. D. (2007). Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues in Clinical Neuroscience, 9(4), 455-470.
- National Institute on Drug Abuse (NIDA). (2015). Patients Addicted to Opioid Painkillers Achieve Good Results With Outpatient Detoxification.
- Ling, W., Amass, L., Shoptaw, S., Annon, J.J., Hillhouse, M., Babcock, D., Brigham, G., Harrer, J., Reid, M., Muir, J., Buchan, B., Orr, D., Woody, G., Krejci, J., Ziedonis, D., Group, the B.S.P. (2005). A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid detoxification: findings from the National Institute on Drug Abuse Clinical Trials Network. Addiction (Abingdon, England), 100(8), 1090-1100.
- Weiss, R.D., Potter, J.S., Fiellin, D.A., Byrne, M., Connery, H.S., Dickinson, W., Gardin, J., Griffin, L.M., Gourevitch, N.M., Haller, D., Hasson, A., Huang, Z., Jacobs, P., Kosinski, S.A., Lindblad, R., McCance-Katz, F.E., Provost, E.S., Selzer, J., Somoza, C.E., Sonne, C.S., Ling, W. (2011). Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence: A 2-Phase Randomized Controlled Trial. Archives of General Psychiatry, 68(12), 1238-1246.
- Price RK, Risk NK, Spitznagel EL: Remission from drug abuse over a 25-year period: patterns of remission and treatment use. Am J Public Health 91(7):1107–1113, 2001
- Kleber, H. D. (2007). Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues in clinical neuroscience, 9(4), 455.
- Wesson, D. R., & Ling, W. (2003). The clinical opiate withdrawal scale (COWS). Journal of psychoactive drugs, 35(2), 253-259.
- Centers for Disease Control and Prevention. (2015). Opioid painkillers widely prescribed among reproductive age women.