It’s not enough to say that opiate withdrawal will be different for everyone who has become tolerant to opiates after regular use. The stages of opiate withdrawal are unpredictable in symptom logy, severity, duration, intensity, and complications based on a complex integration of factors that causes one person to be more vulnerable than others along with protective factors that are unique to some individuals while excluded in others.

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Individual Factors that Influence How the Stages of Opiate Withdrawal Work

Withdrawal may start with just headaches and muscle aches.

Age, genetics, and other biological factors contribute to how the stages of opiate withdrawal work. The negative state of withdrawals is further enhanced by decreases in the functioning of the reward circuits and increases in brain stress systems. Physical, psychological, emotional, and spiritual health are often consequential compromises throughout the course of opiate dependency and most health related care comes only on an episodic or crisis-oriented basis.

Increasing the complexity of how the stages of opiate withdrawal work are the environmental, social, and contextual factors that support abstinence or invoke motivations to use again. According to the NCBI, ” Multivariate analyses indicated nonmedical users of prescription opioids who used for motives other than to relieve pain, obtained these drugs from non-parental sources, or used these drugs via non-oral routes of administration were significantly more likely to experience substance use related problems.”

Opiate dependents who have a safe, drug-free environment with access to relief from the withdrawal symptoms and consequential cravings for at least 3 – 6 months are likely to be more successful in their progress through the stages of opiate withdrawal than those in a stressful environment surrounded by others abusing opiate drugs.

Drug Factors that Influence How the Stages of Opiate Withdrawal Work

The opiate drugs, themselves, have a major impact on how the stages of opiate withdrawal work with different potencies, bioavailability, half-lives, and potentials to be abused through alternative routes of administration. According to the NIDA,” The consequences of activating opioid receptors with externally administered opioids such as heroin (versus naturally occurring chemicals within our bodies) depend on a variety of factors: how much is used, where in the brain or body it binds, how strongly it binds and for how long, how quickly it gets there, and what happens afterward.”

Opiates with a shorter half-life including heroin and many opioid painkillers have a high abuse potential increasing tolerance and dependence. The withdrawal symptoms from these drugs emerge quickly, usually in 4-6 hours based on the amount of neuro-adaptations and changes in physiological functioning that have taken place from the continuous needs to increase dosages and administration frequencies. Opiates with extended release formulas or long-half lives such as methadone and buprenorphine, when taken orally and as intended, can remain in bodily systems longer with the emergence of symptoms occurring in around 24 – 36 hours.

Abusing opiate via rapid-delivery methods such as snorting, smoking, or injecting them allows the opiate molecules to reach the brain more quickly than oral routes of administration adding to severity and complexities of the stages of opiate withdrawal. Some opiate drugs contain unknown, toxic, or variant chemicals with deviations in manufacturing processes that can cause significant damages to the brain and nerve cells. Heroin is a primary example. According to the NIDA,” Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations.”

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The Early Stage

The early stage of opiate withdrawal is marked by cravings, dilated pupils, loss of appetite, restlessness, runny nose, sweating, chills, teary eyes, uncontrollable yawning, and anxiety that continues to become more intense and discomforting as the opioids are metabolized and eliminated from the body. The symptoms are likened to flu-like infections and referred to as “dope-sickness“.

The Acute Stage

Over the next several hours the early stage symptoms are accompanied by increasing pain, stress, and stimulated autonomic nervous system activities that can lead to other complications that may become serious. According to the SAMHSA “Naturally occurring opioid withdrawal is almost never life threatening, but it can produce discomfort severe enough to warrant urgent intervention.” Persistent nausea, vomiting, diarrhea, and fever can lead to dehydration which can affect vital organs and the functioning of other bodily systems. Tachycardia and breathing fluctuations can exacerbate underlying medical issues or cause other health impairments.

Muscle aches, insomnia, abdominal cramps, mood swings, dysphoria, and heightened sensitivities to aversive stimuli usually last a couple more days and peak at around days 3-4. As the physical symptoms begin to subside in the acute phase of opiate withdrawal, the emotional and psychological problems may continue to manifest and intensify.

The Post-Acute Stage

Co-occurring health disorders are exacerbated during the abstinence period and stress is a primary “trigger” for relapse in those with unattended issues. According to the National Center for Biotechnology Information (NCBI), “Growing evidence suggests that neuroadaptive changes outlast physical withdrawal and detoxification.” Conditioned cues and reminders of use can evoke motivations to relapse and cravings can emerge out of nowhere for years to come.

Mental health disorders evolve out frequent intoxication and withdrawals and the consequential disparities opiate abusers face in their family and social relationships, finances, employment, legal, medical, or environmental circumstances. If the person can remain abstinent for several weeks or months, some of their problems can be resolved over time and healing will gradually take place, but, without making crucial changes in one’s lifestyle, the vulnerabilities to both internal and external influences remain high.

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