A guest blog provided by Mark Pirner, M.D., Ph.D.
If you are in recovery, you’ve probably been through opioid withdrawal at least once and probably more. Some people compare opioid withdrawal to ‘the worst flu in your life’ but I’m not sure that accurately captures the agony, depression, hopelessness, pain and despair. Opioid Withdrawal Syndrome (OWS) is a term to describe the combination of symptoms that occur during opioid withdrawal. They can include anxiety, yawning, sweating, eyes tearing, goosebumps, runny nose, hot/cold flashes, nausea, vomiting, diarrhea, restlessness, muscle and bone pain, and so on. Specific symptoms and severity differ for everyone. But, OWS and fear of OWS is definitely one reason why some people continue to use opioids despite wanting to stop.
Learn more about SMART Recovery’s approach to overcoming opioid addiction.
Why Does Opioid Withdrawal Occur?
What many people don’t know is that the root cause of most of the physical OWS symptoms originate in our brain stem. The brain stem is just like it sounds, the stem at the base of your brain going down and connecting to your spinal cord. It is part of our ‘primitive brain’, that regulates basic functions like breathing, awareness, ‘fight or flight’ responsiveness and so on. Not very sexy, but critical for survival. And just like it sounds, we don’t have much mental control over our brain stem. Luckily, since it would be distracting to constantly remember to breath or stay awake, for example.
Opioids suppress brain stem function, and this is why opioid overdose results in loss of consciousness and depressed breathing. But, when people take opioids long enough, (typically a week or longer but depends on the individual), the brainstem cells try to overcome the suppression by increasing output. In other words, it’s like revving the accelerator to get the same speed when brakes are being applied.
Now imagine taking your foot off the brake (abruptly discontinuing opioids) with the accelerator still revving (brain stem adapted to opioid suppression). There is a massive ‘fight or flight’ output from the brainstem, and this is what causes symptoms of OWS. It takes a couple of days for the brainstem to adjust back down, and why OWS is most severe 2-3 days after stopping short acting opioids like heroin and oxycodone. It’s also why physical OWS symptoms tend to lessen after 3-4 days. OWS symptoms are longer and sometimes less severe for people who stop buprenorphine or methadone because these take longer to ‘wash out’. Cravings and other brain changes also occur that are separate from brainstem activity, and take much longer to return to more normal.
How is OWS Treated?
Mostly by managing the symptoms as they occur, for example hydration, and trying to get and stay as comfortable as possible. Some health care providers prescribe different medications to ease OWS. These can include replacement opioids like buprenorphine and methadone, as well as non-opioid alternatives.
Learn more about medication-assisted treatment (MAT).
How to treat opioid withdrawal is an individual decision, but there is no debate that ‘getting through’ withdrawal is a critical first step to recovery.
About the author: Mark Pirner, MD, PhD is a senior medical director at US WorldMeds (www.usworldmeds.com), where he leads their medical affairs opioid withdrawal treatment portfolio. Mark attended medical school at the University of Minnesota, completed internal medicine residency at Duke University Medical Center, and endocrinology fellowship at the National Institutes of Health. US WorldMeds is a wholly-owned specialty pharmaceutical company based in Louisville, Kentucky, committed to raising awareness of opioid withdrawal syndrome and its treatment.
The good news is that while opiate withdrawal can be unplesant detoxing under medial
supervision at home is highly doable and I doubt leads to death. I fell very strongly that as a society’s we need to encourage the message that life without depencey on opiates while challenging is absolutely doable
We need to emphasize individuals CAN recover. I think too much emhases is placed on the horrors of opiate addiction. Let us as a nation shift and put focus to the victory our focus on recovery!
I am going through withdrawal. I am still have cold sweats, chills, pajamas are soaking wet, stomach pain.
I would like to think I am in the last stage of physical withdrawal.
Lisa, I feel your discomfort. I’m not sure where I’m at with my withdrawal. I’m up having another restless night of pain and no sleep. But I continue to hope that tomorrow will be better.
Stay strong
Great to see us focusing on a very misunderstood component of the negative reinforcement thing ‘…I just want to NOT feel so lousy’, that drives continued use DESPITE!
I support a county correctional population and we find it very helpful to get some of the biological detail behind what drives craving etc, etc.
Good Work
I was taking 45 mgs up to 90 mgs of oxycoden for 5+ years. The main reason I didn’t stop using sooner was that I was terrified of the withdrawal. I found Smart Recovery on line (SROL) while looking for an alternative to the 12 step model. I spend a good year exploring the site. Smart helped me recognize and then decide I could break free of this gripping addiction. I read if I change my thinking I could change my life.
I made the decision to break free and work my recovery 1st by asking my pain management Doctor to design a tapper plan. I set my start date and every morning I check in on the opiate check in thread at SROL. Every morning my posts we’re replied to by an awesome and kind volunteer Her daily presence helped me to keep on keeping on
I have been free of the ball and chain of oxycoden for almost 6 years. I also have a loving compassionate aunt also in recovery who listened to me in kindness and love.
In SROL I learned to see my addition as 1 of
the multitude attributes that make me and I was not defined as a person based on 1 behavior. The Smart approach of not labeling a person an addict or alcoholic helped me develop a true sense of unconditional self acceptance. Which is an essential component of my recovery.
It is time for me to step outside of SROL and bring a Smart Recovery Meeting to my community here in NEPA.
We begin this Monday May 6 at the local library from 7-8:30pm.
I have a strong belief I will receive much more than I am giving as a facilitator. Freedom from addictions is absolutely doable!
I am in poconos
I realize this form is for “opioid addiction & recovery” but what about us chronic pain people. I mean those of us that have very real pain, like a ligament stuck in a nerve, that the surgeon couldn’t get out and severe spinal stenosis of the foraminal openings (pinched sciatic nerves) that surgery can’t fix, and no doctor will touch. I hate taking oxy and have been taking it longer than many have been alive. I’m sick every day and still in pain, cause of all the new regs. the CDC (center to destroy a community). Which community? Those of us who aren’t robots and have very real pain issues, and have tried all the Spinal cord stims. and pain pumps, and nerve burning and freezing. Just take the pain meds they say. Really, which ones? Neurontin that made my kidneys bleed? We are really in a minority! I doubt any of us wouldn’t give anything to be healthy, and not take opioids, cause it’s a life of no sleep, anxiety, and tons of regulations that can change at the drop of a hat. We don’t get “high” from taking opioids, just semi-free from pain for a brief period. I’d like someone to tell us what to do, except smoke dope, like I did 40 years ago!
Here here!
Your description of the CDC is right on!! My heart went out to all of the veterans who suffered from absolutely horrific withdrawal because the CDC took their opioids away, and especially for those who killed themselves because of it for their study. Every time a doctor shames me for taking opioids, I tell them to try to live in my body for just one day – they couldn’t handle the pain!
Anyone who says opiate withdrawals are merely “unpleasant” has clearly never detoxed from a real addiction…the pain is indescribable.
I’m detoxing right now and being a single mom (husband travels for work) it’s Hell but my kids still need me. Every day is a victory. It’s been 4 days so far, so many more to go. I hate the addiction, I will be in pain regardless so….. I guess I will just keep up with my injections and see. I see a new Dr next month
So proud of you-i am into my 3rd week of oxy free existence-( 3 back surgery’s last year) lack of any energy is my.major complaint -and I mean not wanting to crawl out of bed. I have a career that allows me to the time to get started with appts-I read this maY last 2 months…
I am also in my third week of rehabilitation from Prescribed Oxy.
It makes me sad that I have to point out I was using opiates legally for pain and just because the medication is gone doesn’t mean the pain is gone.
I’m in your same situation did you make it through detox and if so do you feel normal yet like energy to go back to being a active mom with your child I’m on day 4 hoping for light at the end
The single mothers, or any mothers are the ones I worry about. I know I’m going through hell. I am 57 years old and detoxing from 12 years of prescribed opiates. I’ve been lucky that my husband has been on vacation for a whole month of December. I do not know how mothers with children can do this. You have my sympathy and my prayers.
How are you now, a year later in November 2020
Where is the help for the patient with truly intractable pain, who has tried all pain management modalities to no avail, and only opioids work to suppress the pain?
I have discovered that oxy makes the pain or makes it worse. Following 3 back surgery’s in 2018 I thought is was still in pain-til I detoxed and discovered that the medication tells you you are in pain-and now I take tumeric &excedrin
I didn’t realize that OWS is mostly present during the first few days after you stop using opioids. When my uncle had knee surgery, he was given some pain pills in order to help relieve the pain, but he has been using them so much that he throws up if he doesn’t have them regularly. It may be best for him to speak to a professional about dealing with withdrawals.
I’m new. I’ve been going through some stuff the past few years. Most recently it’s been my girlfriend of almost a decade fighting cancer. It’s taken a toll on me and though I do have legitimate pain in my back (construction worker all my life) I’m sick of worrying where I will get what from who And when Since doctors refuse to help. I may post more details about me at a later time but as of now… today, I am going 10 days clean from pills. Percocet, Norco, morphine, etc.
Right now my struggle is with the hot and cold flashes. It’s the only thing chirping in the back of my head to get more. Just buy one. It will be ok. Nope no no no …. trying to stay focused.
Anyone heard of anything to help with the chills and hot flashes??
The hot and cold and the chills and the jitters and the restless legs have been my demon.
Don’t fight insomnia, sleep when you can. Drink plenty of water.
I’m only in my third week of healing. I have a lot of questions myself, and a lot of anger.
Good luck to you.
I’ve been trying to get off Oxys. The withdrawals are extreme. Th muscle and bone aches, hot and cold sweats are the worst. I want to just die. I Can’t seem to get the agony. So I take a little just for the break. Anything I can take that would help with the body aches? I think that is the worst part for me. Want to detox at home if possible. I’m so embarrassed 😞
I had been taking 30mg of OxyContin 3 x a day for 12 years. On December 12 I called my pain management doctors for a refill as I had done for 12 years. The medication did not get filled and their office would not give me an answer. On December 13 I was forced to go off of the Oxy cold turkey. My primary care doctor prescribed me gabapentin and Requip for restless Leg syndrome and pain.
I have so many questions and concerns I don’t even know where to start. Other than my husband I have been alone. This is a small town with no support group. And even now the pain management doctors refused to give me answers. They would not even move my appointment up, I see them on January 21.
I am 57 years old. I am not an addict or an abuser. I have cysts in my back and arthritis.
I am partly glad to get off the opiates but managing the symptoms and the pain has been devastating. There have even been a few nights of suicidal thoughts.
Never, ever let someone diminish what we’ve been through.
Hi Deb,
Have you looked into our online community? You can attend online meetings and use the message boards since there are no support groups in your area. Please visit http://www.smartrecovery.org/community to find the online community.
Thought I’d share my withdrawal experience from prescribed medication. I was prescribed medication for arthritis pain. Was on them for 10 years. I never took more than prescribed. My doctor suggested a taper off gradually. I tried that for 2 weeks and then flushed what I had left and went cold turkey. It is 5 months on March 8, 2020. Up until the third week of February I had so many different symptoms. Insomnia was the worst symptom but has since disappeared. I hope someone can find this helpful. Cheers.
Hey how did you handle the anxiety?
Hi David, first off sorry for not replying sooner. When I would get anxiety I would just remind myself it is only temporary like all the other symptoms. After stopping drugs on October 8, 2019, I know now it is 100% true that the paws is your brain rewiring and your body removing all the crap from your system. I am not sure where you are in your detox, but I can speak to the point it does get better each passing day. Early in going cold Turkey I would read stories that it gets better and have many doubts but I experienced it and it does get better. When I look back over the past year, it was towards the end of February 2020 (was about 5 months in) that I noticed how much better I was. I started to laugh more often and all around felt better. One thing I remember through all this is it was around day 3 or 4 of stopping and was sitting in my living room and remember watching the clock as each minute would pass and think one more minute to freedom. Just stay positive during this and you can doing it. One thing that helped me was watching others talk about their success of stopping and how it does get better over time. Let me know how you are doing. Take care and remember no one in here will judge you. I never pictured myself using prescription drugs for pain which eventually become part of my daily life. I proved I don’t need the junk and so can you!!
I fell in 7/2020, followed by 2 wrist surgeries. I was prescribed medicine which I took following the first surgery. then I had a second surgery on my wrist after which I was prescribed a different medicine, which I was taking according to the directions. I fell 9/3/2020 and completely dislocated my ankle had surgery and was prescribed oxycodone. Now I’m done with meds and feeling awful. How long does it take to feel better ????
10 days of hell then few more weeks mentally. I hope you’re doing well and read my comment for pure help.
Today is my 15th day of detox at home by myself. I am not getting any better and I’m scared. I can barely walk, barely move, insomnia, hot/cold sweating drenched in the bed, my muscles feel like there are no muscles in my body. I have to work and I have to take care of my daughter and I can’t. I leave my house every day loaded up with vitamins and I can’t function. Is it typical for all the symptoms to last more than two weeks?
Yes, it can take longer than 2 weeks for sure. My friend got scared after 2 weeks because he didn’t get any better. I told him it would, and made him stop scaring himself, it would pass, 100%. After another week he started to feel better. Totally normal, don’t be scared okay? Give it another week at least. I promise you it will get better!
I come from a family with bad backs. It is genetic. I’ve had four back surgeries, which helped, but the pain only changed. I was to a point I couldn’t sit to work so I went on opioids – 22 years ago. I’ve had to replace my knees, have crippling scoliosis, fractured discs in my back, along with a very rare auto-immune disorder that causes joint pain, and I have osteoarthritis along with severe non-surgical spinal stenosis. If I didn’t have opioids or Buprenorphine type meds I would kill myself. I understand about mu receptors and how they increase over time in your body. I also understand my crippling issues (I am in a wheelchair now as my back has taken away my ability to walk). I will never stop taking opioids and am tired of people shaming others who really need them. I have done every type of exercise, physical therapy, massage, etc., until I couldn’t anymore. I will continue to fight to live, but I need pain medication to do it.
I’m on day… 3, i think. I made myself taper off of my prescription. A lot of days I took more than what I was actually prescribed. I had weight loss surgery in 2003, so my issue is my lower back (l5/s1); stenosis causing sciatica, but my weight loss surgery comes into play because it means i can’t take any NSAIDS for pain. But that means if Tylenol won’t help, i need something stronger. My birthday is new year’s eve & I have another prescription waiting. I never want to get it filled, but I always do — I tell myself it’s for my back pain & I need it to function. I feel so bad even after tapering off. My body hurts. I’ve sneezed nonstop, the anxiety is SO BAD, my chest hurts, my fight/flight response is in overdrive. I can’t cook or clean. I’m barely taking care of myself. I’m not taking care of my daughter. We planned a trip to the snow for Christmas & i dreaded every second of it knowing i would feel bad, so i was happy when the air bnb fell through. I guess I’m writing this because I want to & know I need to stop. I’ve never admitted that to anyone I don’t know. I’ve never really thought of stopping seriously. I kinda want to, I kinda don’t… that’s where I’m at so I know I’ll fill the Rx on the 31st. I hate feeling like this. I feel so guilty all the time.
Hi Sarah, I stopped pain meds cold turkey on Oct. 8, 2019 and also had the thoughts you have. I knew the day I could pick up a refill and always said to myself I need these but want to stop. It has been over two years since stopping and I am so happy I did. For about 4 months I would have periods of depression (looking back I’m thinking it was from the paws). I hope you are doing ok. Write back anytime.
Why do the hot flashes only occur at night? Does anyone know? Get through the whole day with barely any symptoms minus some anxiety and mild depressive mood and then tired at night maybe sleep for one hour wake up so hot, can’t get comfortable, so restless and can’t sleep rest of night until maybe 5-6 am for another hour or two then wake up feeling normal again?
How many days did the worst stuff last?
Kerry, I’m the same. Day 10 of no pain pills. Daytime, besides the tiredness and lack of energy, pretty much fine. But nighttime, totally different story. So tired, I want to fall asleep so badly, but get restless legs and arms. I cant get comfortable and sweat from head to toe. I get so frustrated and angry I cant fall asleep. I’m sure I make it worse. So, I’d like to know that same thing, when will I ever be able to sleep again?
Question I took drugs for a very long time. The most was from 2012 until 2017. I went through some heavy withdrawals like sweating and very bad stomach aches. Last year I started getting very bad stomach aches and, at same time, hot flashes, that continue even today. These hot flashes seemed like when I stopped using drugs and was wondering if it could be paws all these years later. I went threw every test known, but my doctor is out of answers. I did notice, before I stopped using, my hands started to shack and this never went away. I was wondering if anyone had any of these symptoms years later later. Thanks and good luck to you all.
Is there anyone that previously wrote a message about their withdrawal experience have any updates to provide? As I mentioned above in an earlier post, I been off codeine (prescribed for arthritis) since October 8, 2019. Two months ago I was prescribed an antidepressant (Lexapro) in order to help with anxiety and depression. I hesitated for a long time to see my doctor for this, thinking I was strong enough to push through without any meds, but realized I needed help. If you are in a similar boat, please seek medical help. These symptoms can be the result of opiate use. Thought I’d share in hopes to help others.