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A Guide to Opioid Detox

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Clinically Reviewed by:
Lindsey Rae Ackerman, LMFT

Written by:
Alex Salman, MPH on February 23, 2024

Opioid addiction is an epidemic in America. A SAMHSA study found that in 2015, 38% of the adult American population used prescription painkillers; over one-third of the entire US population. Americans consume 80% of the world’s opiate supply. The number of individuals who died from an overdose in 2021 was a record high of 106,699. In contrast, there were about 22,900 homicides that year.

Fortunately, most painkiller addicts do not overdose. If you or a loved one are struggling with opioid use disorder and want to learn more about the detoxification process, addiction rehab, and other forms of substance abuse medical treatment, we developed this article to help answer any questions about opioid detox.

Understanding Opioid Addiction

Opioids are a class of drugs that interact with certain proteins in the brain called opioid receptors. Opioid receptors are very important because they are responsible for managing sensations of pain and pleasure. They help our bodies understand which things are good for us and which things are bad for us. When a person consumes an opioid drug, whether it’s a prescription painkiller or heroin off the streets, the substance enters the bloodstream and floods the brain with a sudden rush of dopamine. Depending on the amount and potency of the substance consumed, the rush of dopamine results in the brain can result in a ‘high’.

While prescription opioids serve a critical role in acute and chronic pain management, their highly addictive nature can lead to misuse and dependence. What might start as a legitimate medical prescription can evolve into misuse, as individuals chase the pleasurable feelings that opioids provide. As such, users often find themselves taking more doses or increasing their intake just so that they can maintain these effects. Tolerance will continue to develop, leading to even larger dosages and, often, transitioning to more potent opioids. Eventually, the individual becomes trapped in a cycle of dependence, where the absence of opioids results in distressing withdrawal symptoms, reinforcing the need for continuous use as dosages continue to rise to dangerous levels.

Opioid addiction is not solely a result of personal choices; it’s a complex interplay of biological, environmental, and psychological factors. Genetic predisposition, a history of trauma, mental health disorders, and even the accessibility of opioids all contribute to an individual’s vulnerability to addiction.

Opioids include but are not limited to:

Prescription Opioids

  • Tramadol: Ultram, ConZip, Rybix ODT
  • Buprenorphine: Suboxone, Subutex, Butrans
  • Methadone: Dolophine, Methadose
  • Codeine: Tylenol with Codeine, Fiorinal with Codeine
  • Hydrocodone: Norco, Vicodin, Lortab
  • Hydromorphone: Dilaudid, Exalgo
  • Oxycodone: OxyContin, Percocet, Roxicodone
  • Oxymorphone: Opana, Opana ER
  • Morphine: MS Contin, Kadian, Avinza
  • Fentanyl: Duragesic, Sublimaze

Illicit Opioids

  • Kratom: A plant-based substance that has opioid-like effects and is sometimes used recreationally, though its safety and legality are debated.
  • Lean: Commonly referenced in modern pop music, lean is a street name for Codeine mixed with other medications like promethazine and soda.
  • Opium: A natural substance derived from poppy plants, from which morphine and other opioids like heroin are derived, though sometimes consumed by itself.
  • Heroin: An illegal opioid derived from morphine that is highly addictive and often laced with other substances. Today, real heroin is exceedingly rare, replaced mostly by fentanyl.
  • Fentanyl: Although sometimes used in hospital settings, illicit fentanyl is also manufactured and distributed on the street. Fentanyl is 50 times more potent than heroin.

These are not the only opioids that exist. There are many more obscure and more powerful opioids on the streets, and more are likely being developed right now. Additionally, it’s unfortunately common for drug dealers to “lace” or adulterate other drugs with inexpensive opioids such as fentanyl. This dangerous practice can significantly amplify the risk of overdose and unintended consequences, as users can ingest high doses of opioids without even knowing it.

Opioid Withdrawal

When someone uses or abuses opioids on a regular basis, their body becomes more accustomed to the drug. Eventually, depending on dosage and potency, the person’s body will produce less dopamine on its own, because it can rely on the dopamine resulting from the drug use. The longer an individual engages in the misuse of opioids, the more their body adapts to the drug. Consequently, a decrease in dosage or cessation of the drug will upset the body’s delicate balance, leading to a cascade of physiological and psychological responses. In other words, when an individual who has been using opioids on a regular basis suddenly reduces or stops their intake, they will likely experience uncomfortable withdrawal symptoms. This is called opioid withdrawal syndrome.

Opioid withdrawal symptoms are usually commensurate with the duration, dose, and potency of the opioid being abused. The most severe withdrawal symptoms come from abuse of strong opioids like oxycodone, heroin, or fentanyl. Opioids possess both psychological and physical addictive properties, so opioid-dependent patients are subject to both psychological symptoms of withdrawal and physical symptoms of withdrawal.

Opioid Withdrawal Symptoms

Opiate withdrawal is intense and often overwhelming, but its the first and most important step in addiction recovery. Opiate withdrawal is a highly individualized experience, influenced by factors such as the type and dosage of opiates used, the duration of use, and an individual’s unique physiological and psychological makeup. This variability makes predicting the course and severity of withdrawal symptoms a complex task.

Physical symptoms often include

  • Muscle Aches and Pains: Intense discomfort in muscles and joints is often reported, creating a feeling akin to the flu.
  • Gastrointestinal Distress: Nausea, vomiting, diarrhea, and abdominal cramps are frequent companions during opiate withdrawal.
  • Fluctuations in Body Temperature: Sweating, chills, and fever-like sensations contribute to the overall physical unease.
  • Elevated Heart Rate and Blood Pressure: The body’s stress response is heightened, leading to increased heart rate and blood pressure.
  • Sleep Disturbances: Insomnia, restless sleep, and vivid dreams are common, further adding to the physical and mental strain.

Psychological symptoms can be equally or more challenging and can include

  • Anxiety and Restlessness: Feelings of anxiety and restlessness can be overwhelming, leading to a persistent sense of unease.
  • Irritability and Mood Swings: Extreme irritability, mood swings, and emotional volatility are often experienced, creating challenges in interpersonal interactions.
  • Depression and Apathy: A sense of profound sadness, hopelessness, and emotional detachment can take hold.
  • Cravings and Obsessive Thoughts: The relentless desire for the drug, coupled with obsessive thoughts about obtaining and using opiates, can be mentally consuming.

The Clinical Opiate Withdrawal Scale

The Clinical Opiate Withdrawal Scale (COWS) is a valuable tool for addiction psychiatrists to assess and quantify the severity of opiate withdrawal symptoms. It was developed to provide a standardized measure of withdrawal intensity which can help healthcare professionals determine the most appropriate course of action and treat withdrawal symptoms effectively.

The COWS evaluates a range of physiological and psychological factors to gauge the overall severity of opiate withdrawal. This comprehensive assessment covers:

  • Resting Pulse Rate and Sweating: The degree of elevated heart rate and sweating is indicative of the physiological stress response triggered by withdrawal.
  • Gastrointestinal Symptoms: The presence and intensity of symptoms like nausea, vomiting, and diarrhea contribute to the overall score.
  • Restlessness and Pupil Size: Restlessness, an inability to sit still, and pupil dilation are assessed to gauge the impact of withdrawal on the central nervous system.
  • Bone and Joint Aches: The degree of discomfort in bones and joints is measured, providing insights into physical distress.
  • Runny Nose or Tearing: The presence of runny nose and tearing, often observed during opiate withdrawal, contributes to the overall assessment.
  • Yawning and Sweating: Yawning, a common symptom during withdrawal, and the level of sweating are evaluated.
  • Anxiety or Irritability: Psychological symptoms like anxiety and irritability are assessed to understand the emotional toll of withdrawal.
  • Goosebumps: The presence of goosebumps is an indicator of the body’s response to withdrawal.

Opioid Withdrawal Timeline

Opiate withdrawal symptoms typically begin within hours of the last opiate use and peak within a few days. The intensity and duration of symptoms can vary, with acute withdrawal often subsiding after a week or so. However, lingering psychological symptoms and cravings can persist for weeks or even months, requiring ongoing support and coping strategies.

Is Opioid Withdrawal Management Necessary to Overcome Opioid Addiction?

To recap, opioid withdrawal occurs when someone’s body becomes so dependent on opioids that when they stop taking the drug, they experience withdrawal symptoms. While opioid withdrawal itself isn’t fatal, certain symptoms can be severe enough to cause life-threatening complications. Issues such as vomiting, diarrhea, fast heart rate, or high blood pressure can become severe enough to induce seizures or cause death.

Opioid withdrawal is one of the most uncomfortable experiences that a person can have and attempting to navigate opiate withdrawal alone can be overwhelming and risky. For most opioid users, it can feel nearly impossible to manage symptoms of opioid withdrawal without medical treatment. Seeking professional help from addiction treatment centers or healthcare providers with expertise in addiction medicine is essential. Medical supervision can ensure a safer detoxification process and the administration of medications to alleviate withdrawal symptoms.

Opioid Detox Treatment

The best way to navigate opioid detoxification is by seeking out a medical detox center. At a professional detox center, various options are available to help individuals overcome their drug abuse. Medical detox facilities offer around-the-clock medical supervision and support to manage opioid addiction, ensuring the comfort and safety of individuals throughout the detoxification process. These centers provide all-encompassing care that not only addresses but also attends to the psychological and emotional dimensions of fentanyl detox and recovery from fentanyl addiction.

What is Opioid Detox Like?

Throughout the process of opioid detoxification, medical and mental health professionals work to alleviate withdrawal symptoms and manage drug cravings. Medications may be administered to ease withdrawal discomfort, stabilize vital signs, and minimize the risk of complications. Furthermore, behavioral therapies and counseling play a pivotal role in addressing the root causes of opioid use disorder and developing coping mechanisms for sustained recovery and sobriety.

The duration of detoxification from opioids can vary significantly and is influenced by several factors, most notably the severity, and duration of drug use. While some individuals might experience a relatively shorter detox period lasting a few days, others with more prolonged or intense opioid use may require a longer period, potentially spanning several weeks. The individual’s physical health, metabolism, and the specific opioids used also play a role in determining the length of the detox process. Medical professionals assess these factors to create a personalized detox plan that ensures the individual’s safety, comfort, and successful transition to subsequent stages of addiction treatment.

How Long Will Fentanyl Withdrawal Symptoms Last?

The duration of opioid withdrawal symptoms can vary for each individual, but generally, the most intense withdrawal symptoms tend to arise within 12 to 48 hours after the last opioid dose and typically ease off within a span of 5 to 10 days.

Even as the acute withdrawal symptoms wane, other complexities might emerge. This phenomenon is known as Post-Acute Withdrawal Syndrome (PAWS), characterized by:

  • Feelings of depression, anxiety, or restlessness
  • Heightened vulnerability to overdose due to reduced drug tolerance
  • Lingering discomfort and diminished well-being post-detox
  • Intense cravings for the drug while abstinent
  • Elevated risk of relapse and continued substance misuse

These symptoms can persist for several months beyond the peak of opioid withdrawal and the duration of medically supervised detox. While there isn’t a fixed timeline for PAWS related to opioids, it is essential to maintain patience and commitment throughout the recovery journey. With time and proper support, individuals can gradually overcome these residual symptoms, steer clear of substance abuse, and regain mastery over their lives.

The Importance of Aftercare

Opioid addiction control is a multifaceted endeavor that goes beyond detoxification. Upon completing detox, individuals are encouraged to participate in ongoing treatment programs, such as residential or outpatient rehab, to further tackle the psychological and social factors contributing to addiction. These programs provide a nurturing environment and equip individuals with the tools needed to uphold sobriety and avert relapse.

It’s important for patients to acknowledge that opioid detox and recovery are highly personalized processes. The gravity of the addiction, physical health, mental well-being, and individual circumstances must all be considered when formulating the most suitable treatment plan. This tailored approach ensures that individuals receive the essential support to conquer their addiction and reclaim command over their lives.


Opioid withdrawal is a formidable challenge, but it’s a crucial step toward regaining control over one’s life.

At Clear Behavioral Health, we understand how difficult opioid detox and opioid withdrawal can be. We understand how important it is to ensure a safe and comfortable withdrawal experience for you or your loved one.

Our dedicated medical detox centers provide comprehensive withdrawal management for all opioids including fentanyl, and our inpatient rehab facilities can help you maintain sobriety and address underlying mental health conditions. Get in touch today to learn more about how our continuum of care can guide you toward a healthier, clearer life.

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