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Opiates – Withdrawal Symptoms, Addiction and Detox Treatment

Opiate addiction can be complicated to understand for both patients and their families. Use this resource page to find general information. Additionally, learn what opiate addiction is, the withdrawal symptoms, and the best available treatment options. You can also find a current list of opiate drugs and how to find addiction help.

National Institute on Drug Abuse presented insights into the growing crisis of prescription pain killersheroin abuse, and synthetic opioids, such as fentanyl. Some of the essential points were that abuse and addiction to opioids, such as heroin, continue to grow. Other main topics were how this global crisis affects all societies’ health, social, and economic welfare.

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What are Opiates?

Opiates are potent analgesic (pain-relieving) drugs often prescribed to alleviate acute or chronic pain. They are also an ingredient on medications to suppress persistent cough and diarrhea. There are several categories of opiates and opioids. For example:

  • Semi-synthetic
  • Fully-synthetic
  • Endogenous opioid peptides

Opiates are alkaloids that come from the poppy plant and include morphine and codeine. People use this type of drug for both recreational and medicinal purposes.  At some point, most of those using opiates will end up taking a semi-synthetic or synthetic opiate. There are various opiate drugs available, from prescription painkillers to illegal ones, such as heroin.

Some of the most common opiates available are:

  • Morphine- Brand Names: MS Contin, Oramorph SR, Avinza, and Arymo ER – A narcotic analgesic for acute and chronic pain management, and also very useful in providing sedation effects before a surgical procedure. It comes in liquid, tablet, and suppository preparations.
  • Codeine – A drug with antitussive properties, commonly used to treat coughs and moderate pain. It is usually available in syrup and pill form (Tylenol 1 through 4).
  • Heroin – Heroin comes from morphine and is an incredibly addictive semi-synthetic opiate.  Its abuse has become a growing crisis in the U.S.  People use the drug by injecting, snorting, or smoking. Heroin addiction can cause health conditions, including a weak immune system, infectious diseases that include HIV/AIDS and hepatitis, and even death by overdose.
  • Fentanyl – Brand Names: Duragesic, Subsys, Ionsys – Potent synthetic opiate (opioid) analgesic for severe pain associated with childbirth and often during or after major surgery. It is 50 to 100 times stronger than morphine. It is also commonly found in illicit drugs, because it’s easy to manufacture in labs and sell on the streets.

What is the Difference between Opioids vs. Opiates?

Finding differences between opioids and opiates can be quite daunting. Although the two terms do have distinctions, they are often interchangeable. Opium, found in poppy plants, is used to make natural opiates. Morphine, codeine, and opium are a few examples of natural opiates.

Opiates can also be found naturally in the human body in the form of endogenous opioid peptides. These include endorphins and dynorphins.

Opioids are synthetic or partly synthetic. They are manufactured through chemical synthesis rather than derived from the poppy plant. Semi-synthetic opioids include buprenorphinehydrocodoneoxycodone, hydromorphone, and oxymorphone. Finally, fully synthetic opiates include Fentanyl, Tramadol, and Methadone.

Both natural opiates and their synthetic counterparts act similarly in the human body by binding to specific opioid receptors in the central nervous system and other tissues.

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How do Opiates Work?

Opiates work by altering the perception of pain rather than eliminating it. First, it attaches to the molecules that protrude from specific nerve cells, called receptor sites. Consequently, the individual feels less pain. Throughout history, opiate drugs are often indicated as an anesthetic remedy for nervous disorders, migraines, and other painful conditions.

Natural opiates come directly from the poppy plant, unlike synthetic ones produced in laboratories and mostly for pain management purposes. Some of the synthetic opiates include DilaudidDemerol, Oxycodone, Vicodin, Fentanyl, and Methadone.

Opiate Effects in the Body

Opiate painkillers are potent drugs, and they could be very dangerous. When improperly used, these prescription medications can have the same risks as heroin sold on the streets. Reports show that in 2012, four times more people struggled with painkillers’ abuse than they did with heroin.
Regardless of what opiate we refer to, it is essential to know that opiate addiction, whether painkillers or heroin, can severely impact your health. In addition to the risks of abusing narcotics, sharing needles or injecting crushed pills poses additional harm. This form of drug use can lead to permanent health issues as well as organ damage. For example, some of these adverse effects include:

  • Collapsed veins
  • Infected heart lining
  • Respiratory depression
  • Digestive system disorders
  • Hepatitis
  • Hyperalgesia
  • Lower immune system response

Repeated opiate use can change how someone’s brain chemistry works, which leads to physical and emotional dependence. The body may not feel well anymore without the drug’s interaction. Additionally, withdrawal symptoms often start when a user stops taking the opiate.

Opiates Side Effects

Common side-effects include:

  • Severe constipation
  • Weakness
  • Insomnia
  • Nausea
  • Vomiting
  • Loss of appetite
  • Tingling or redness of the skin
  • Blurred vision

Signs of an allergic reaction include:

  • Rash
  • Wheezing
  • Difficulty breathing
  • The closing of the throat
  • Hives or swelling of the lips, face, tongue or throat

Opiate (Opioid) Withdrawal Symptoms

Depending on the level of dependency, opiate (opioid) withdrawal symptoms can range from mild to severe. Opiate dependency can vary by the length of time taking the drug, dosage, which formulation, the presence of a mental health issue, and individual biological factors. Often, symptoms start within 4-12 hours for short-acting opiates, and within 24 hours for the longer-acting ones. The most common withdrawal symptoms include:
  • Muscle aches
  • Anxiety or agitation
  • Sleeplessness
  • Excessive yawning
  • A runny nose
  • Sweats
  • Rapid heartbeat
  • Hypertension
  • Nausea and vomiting
  • Diarrhea
  • Stomach cramps
  • Depression
  • Intense cravings
Some of the psychological withdrawal symptoms and cravings for opiate drugs may continue for weeks or months. Moreover, emotional issues or untreated chemical imbalances are major contributing factors for extended cravings. Adequate pharmacological support and psychological therapy can decrease these symptoms and maximize recovery outcomes. Withdrawal symptoms are physically very similar to the flu with the addition of emotional side effects.

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Signs of Opiate Addiction

Opioid addiction is a highly treatable condition. For this reason, it is essential to recognize the signs so early intervention can occur. It is not one sign or another, but a combination of atypical behaviors. There are several things to look for:
  • Mood swings with no apparent reason
  • Erratic sleep patterns
  • Changes in appetite and weight
  • Slurred speech
  • Uncoordinated movements
  • Unusual deep sleep
  • Pinpoint pupils
  • Droopy eyes
  • Itching
  • Many medication bottles
  • Presence of drug paraphernalia
  • Withdrawal from loved ones or everyday activities
  • Increased secrecy
  • Lack of interest
  • Financial issues
  • Early prescription refills
  • Multiple doctors
  • Lack of motivation
  • Difficulties concentrating
  • A decline in hygiene and appearance

Warning and Risks

Opiates are also part of a successful pain management plan, but specific risks are involved. These can include addiction, withdrawal upon cessation of use, and overdose. Opioids are controlled substances in the United States that contain heroin and some prescription painkillers such as Actiq, Dilaudid, Vicodin, OxyContin, and Percocet.

Opiates can affect response and reaction times. As a result, patients should avoid operating heavy machinery or driving until they know how to respond to the medication. Women who become pregnant may be encouraged to prevent prescription painkillers because of possible complications.

Dangerous side effects can develop for patients who combine opiates with alcohol, other narcotics, tranquilizers, or some sleeping medications. Patients need to check their food and beverage labels to make sure alcohol is not an ingredient. Opiates are central nervous system depressants. Therefore, taking them with other substances can cause serious, even fatal consequences.

Opiates also act directly on the respiratory center in the brainstem, causing a slowdown in pulmonary function. This condition can result in a decrease in breathing rate. Excessive amounts of opiates, like heroin, can cause the respiratory centers to shut down breathing altogether. When someone overdoses on heroin, it is heroin in the brain stem respiratory centers that can cause the person to stop breathing and die.

Painkiller Opioids

Feelings of pain occur when specialized nerves are activated by trauma, either through injury or illness. You can find these specialized nerves throughout the body, and they carry the pain message into the spinal cord. The pain message passes to other neurons, which also results in brain response.

Opiates help to relieve pain by acting in both the spinal cord and brain. At the spinal cord, opioids interfere with transmitting the pain messages between neurons and prevent them from reaching the brain. This process is known as analgesia.

Opiates also act in the brain to help relieve pain. There are several areas involved in interpreting and responding to pain messages. They allow a person to know he or she is experiencing pain and that it is unpleasant. Opiates working in these regions don’t block the pain messages; Instead, they change the pain’s subjective experience. As a result, patients might feel full relief for their discomfort.

How Do You Build a Tolerance to Opioids?

A person who takes opiates for a long enough period will likely develop a tolerance. The body adapts to the drug’s presence, resulting in a decrease in its effectiveness over time.

Tolerance is a desensitization of the opioid receptors leading to increased pain and a higher dose. Another cause of tolerance is when the opiate receptors have been internalized by the cell itself; this is called endocytosis, a condition marked by a decrease in opioid binding sites available to provide pain relief.

Long-term opiate use can be dangerous because it can lead to dependence, addiction, and overdose. Opiate-induced tolerance can underlie all of these issues because as tolerance develops, patients need increasingly higher doses of the drug to achieve analgesia. A person who is suffering from chronic pain just wants relief. They may not think about the effects of long-term opioid use and potential risks.

Another condition that may overlap with tolerance is opioid-induced hyperalgesia. Prolonged use of the drug leads to a paradoxical increase in pain despite increases in drug dosage.

Increased pain sensitivity can happen to anyone taking any dosage of an opioid. It’s crucial that patients not increase their dosage without talking to a doctor.

Symptoms of Addiction and Overdose

Opioids are unrivaled when it comes to pain management, but they come with many risks. These narcotic drugs can be habit-forming and may lead to physical and psychological dependence. Professionals diagnose these conditions as Opioid Use Disorder.

Opioid Use Disorder

There are a number of factors that constitute an opioid use disorder. In most cases, it starts with abuse. For example, the compulsive use of opiates for any purpose outside the label’s instructions. This can be taking more than prescribed. Other forms of abuse include breaking, crushing, or otherwise disturbing the medication to cause its rapid release. Abuse can damage your health, ability to function in everyday life while ruining careers, and relationships. On the contrary, most people don’t set out to become addicted to their medication. Most people become “accidental addicts” after taking prescription medication for a legitimate condition.

Oxycodone, Percocet, and Fentanyl are among the most prescribed drugs and also among the most abused. Once the regular use has caused a tolerance, the drug becomes ineffective at producing the intended effects. At this point, many people decide to escalate their use. Therefore, leading to a more severe opioid use disorder.

Through the process of abusing opioid drugs, one can develop addiction, which is a more severe form of opioid use disorder.

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What is an Opioid Addiction?

Opioid addiction is a central nervous system disorder caused by continuous opiate intake. They elicit their powerful effects by activating opiate receptors throughout the brain and body. Two significant results produced by opioids are the pleasure (or reward) effects and pain relief. The rush of pleasure and/or relief from pain is so strong and powerful that it can lead to opiate abuse and addiction.

The brain itself produces endorphins (the body’s natural painkiller) that activate the opiate receptors. They are involved in respiration, nausea, vomiting, pain modulation, and hormonal regulation.  After prolonged opiate use, the brain’s nerve cells, which would otherwise produce these endogenous opiates, cease to function normally. Next, the body stops producing endorphins because it is receiving opiates instead. Finally, the degeneration of these nerve cells causes a physical dependency on an external supply of opiates. Abrupt or sudden abstinence from opiates induces yet another traumatic disorder – withdrawal syndrome.

How do Opioids and Opiates Affect your Brain?

Findings from animal research indicate that, like cocaine and other abused drugs, opiates can also activate the brain’s reward system. When a person injects, sniffs, or orally ingests heroin (or morphine), the drug travels quickly to the brain through the bloodstream.

Because of its chemical structure, heroin penetrates the brain more quickly than other opiates on the list, which is probably why many prefer heroin.

Once in the brain, the heroin is rapidly converted to morphine, which activates opiate receptors located in the VTA, nucleus accumbens, and cerebral cortex. Once the pleasure circuit is activated, great amounts of dopamine are released within the nucleus accumbens. This phenomenon causes an intense euphoria, or rush, that lasts only briefly while relaxation and contented states can last longer. Furthermore, the excessive release of dopamine and the reward system’s stimulation can lead to opiate abuse and addiction.

Opioid Addiction vs. Dependence

Although sometimes used interchangeably, the terms “addiction” and “dependency” describe two separate things. Opiate dependence does not always entail opiate addiction.

Compiling the research from The National Institute of Health, The American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine, one can create a general definition for each:

Addiction:

Addiction is a primary, chronic, neurobiological disease. Genetic, psychosocial, and environmental factors influence its development and manifestations. Opiate addiction is characterized by behaviors that include: impaired control over drug use, compulsive use, craving, and continued use despite adverse and dangerous consequences.

Physical dependence:

Physical dependence is a state of adaptation that is manifested by withdrawal syndrome. Withdrawal occurs by abrupt cessation, rapid dose reduction, decreasing the blood level of the drug, and/or the sudden administration of an antagonist. Physical drug dependence means a person needs the substance to function and can have intense cravings.

Opiate addiction is a disorder often caused by an untreated condition. It is known to have a strong potential for relapse because if the real issue does not receive adequate treatment, a person may fall back into old patterns of drug use and abuse. Opiates are extremely potent drugs with a particularly high relapse rate. Strong cravings and withdrawal symptoms can trigger relapse when not well managed, even after a period of abstinence.

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Symptoms of an Opioid Overdose

One should always be cautious when using prescription medications. Warnings and precautions are available on the label or through your pharmacist. Labels often spell out risks, including overdose, and give guidelines for avoiding further risks. Opiate overdose can be fatal, so it’s important to take these medications exactly as prescribed. Patients who overdose on opiates almost always do so accidentally after one escalates use due to tolerance to the drug.

However, overdose can also be intentional for those using it recreationally to achieve a state of euphoria. The risk of fatal overdose is high among this group, especially those who combine opioids with other substances to heighten effects.

Opioids are central nervous system depressants. They slow respiration, leading to serious health complications, including cardiac arrest, coma, and death. All users must be aware of overdose symptoms and how to obtain emergency medical assistance.

For example, symptoms of overdose can include:

  • Dizziness
  • Faintness
  • Nausea
  • Vomiting
  • Feeling cold
  • Clammy skin
  • Slowed heart rate
  • Difficulty breathing

 

If the overdose is recent, doctors may induce vomiting, pump the stomach, or use activated charcoal, so the body doesn’t absorb the drug. An antidote, called naloxone, may also be given to counteract the effects of an opioid overdose.

Opioid Withdrawal Symptoms and Risks

One of the most challenging aspects of recovery from opiate addiction is the withdrawal process. Many of our patients want to know what to expect from the opiate withdrawal process. However, no two people have the same withdrawal experience. The timeline for opiate withdrawal depends on a variety of factors and differs between individuals. As a result, effective treatments for opiate addiction cannot take a “one size fits all” approach. Understanding the typical symptoms of opiate withdrawal can help you make informed decisions about your treatment.

Drug addiction does not develop overnight. Opiates — whether heroin or prescription painkillers — exert their effects by crossing the blood-brain barrier and acting on specific brain areas. The opiate molecules bind to particular receptors in the brain’s limbic system responsible for processing rewards and emotional information. When these receptors are activated, they trigger the “rush” or euphoric sensations experienced by opiate users.

Over time, however, the brain becomes numb to the effects of opiates, and tolerance is built. It takes more and more of the drug to achieve the same effect. When the drug is no longer present, and the body does not get its usual dose, the result is a collection of physical and psychological symptoms.

Opiate withdrawal symptoms typically start within a few hours of the drug leaving the bloodstream. Withdrawal from short-acting opiates usually happens between 5 and 10 days. The severity and duration of opiate withdrawal depend on the length of use, dosage, metabolism, the drug of choice, and other factors.

After a few weeks, most people have no residual symptoms, although some people have reported experiencing a post-acute withdrawal syndrome (PAWS) that lasts up to a few months. Many individuals in the recovery community have commonly described PAWS. However, the Diagnostic and Statistical Manual of Mental Health Disorders, or any other significant medical association, does not recognize it.

Going “cold turkey” can be dangerous for some opiate users. Patients run the risk of severe dehydration or elevated blood pressure. Furthermore, opiate withdrawal can cause heart irregularities that may be dangerous for patients with certain chronic medical conditions. Professional medical attention is the best way to keep one safe during an opiate withdrawal. For example, medical detox protocols help remove opiates from your system and safely manage withdrawal symptoms.

Perhaps one of the most prominent disadvantages of going “cold turkey” is the high likelihood of relapse. Due to the extreme discomfort of withdrawal, some might not even complete the process. Hence, professional medical detox is more likely to result in a positive, safe, and effective way to obtain an opiate-free life. The Waismann Method ® located exclusively in Southern California has successfully treated thousands of patients and medically assisted them in overcoming opiate withdrawal symptoms.

Drug Abuse and Treatment Options

An effective Opiate abuse treatment must address the physiological changes. Withdrawal symptoms may be severe and can include pain, diarrhea, nausea, vomiting, hypertension, and tachycardia. No one should have to suffer without professional care. Therefore, inpatient medical treatment can make the detoxification stage more comfortable, safer, and successful. Easing the physical symptoms can often prevent a relapse episode. However, medical detox is just the first step in an effective opiate addiction treatment. Non-addictive medications such as Naltrexone (Depade, Revia, Vivitrol) to control cravings, emotional assessment, and professional support are essential components to achieve full and long-lasting recovery.

A person who has developed a physical and/or psychological dependence on a (narcotic) medication will need a professional detox to recover safely. Examples of these opioids include Oxycodone, Hydrocodone, Fentanyl, Methadone, Morphine, Suboxone, and heroin.

Opioid addiction has become a tremendous problem in the U.S. due to several factors, including the high number of prescriptions available. Besides, opioids have become increasingly easier to obtain, both among patients seeking pain relief and recreational users. Detox is the first step in any responsible recovery program and much more successful when professionals medically manage it.

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Waismann Method® of Rapid Detox and Opioid Medical Detoxification

Opiate abuse often leads to tolerance and dependence, which requires a specialized detox. The Waismann Method offers different protocols to achieve complete detoxification, including detox under anesthesia. The idea is that all patients should receive treatment with the utmost respect, professionalism, and compassion. Above all, a successful opioid detox can help patients overcome physical dependence within days.

Our detox methods, including rapid detox, provide medical support to overcome the withdrawal symptoms without replacement opiate drugs. After detox, patients also take advantage of our exclusive recovery center, Domus Retreat, for a few days. Waismann Treatment™ is unique and thorough and is design for those who seek the best and most advanced form of medical opiate detox available. Patients have options of 5, 7, 10, or 14 day programs and it is all-inclusive. Around the clock care is available starting from the extensive pre-treatment assessment, throughout the detoxification with our multi-board certified anesthesiologist, and finally, at our private recovery center.

List of Opioids and Opiates

Click on a drug from the list below for more information.

Source –  National Institute on Drug Abuse

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