Table of Contents
- 1 Video Transcript
- 2 Difference Between Opiates and Opioids
- 3 How Opioid Drugs Work in the Body
- 4 The Science of Tolerance
- 5 The Science of Dependence
- 6 The Opioid Withdrawal Syndrome
- 7 Opioid Withdrawal Symptoms
- 8 The Synergy of Mental and Physical Symptoms
- 9 Acute Opioid Withdrawal Timeline
- 10 Tapering Can Prevent Acute Withdrawal
- 11 Opioid Withdrawal Remedies Can Prevent Acute Withdrawal
- 12 Post-Acute Withdrawal Syndrome
- 13 Please Like & Subscribe
[Start of Audio] [00:00]
Hey, welcome to this brand new training video on the opiate withdrawal timeline and symptoms. We’re going to cover a lot of stuff in this video. We’re going to cover the science of opioid dependence and what that’s like in the body and then we’re also going to talk about the science of the opioid withdrawal syndrome and how that comes to happen and what’s going on in your brain and body.
I’m going to cover acute withdrawal symptoms and also the acute withdrawal timeline, but I’m going to go really in depth to that because depending on whether you’re taking certain short-acting opioids or long-acting opioids and depending on whether you’re going through a cold-turkey withdrawal, or if you’ve been tapering, there’s going to be a lot of different timeline variability’s.
And so then I’m also going to talk about something called Post-Acute Withdrawal Syndrome and how long that timeline is and also what the symptoms of that are.
So this is going to give you a really good overview on this whole entire process.
So first let’s start with the “Science of Opioid Dependence.”
Difference Between Opiates and Opioids
So opiates are actually any type of drug that is derived from the opium poppy plant, that certain plant, and all of a sudden lots of scientists can actually make drugs like hydrocodone and oxycodone and morphine. Those all come from opiates.
They’re just synthetic or semi-synthetic versions of the opium poppy plant. Opioids are any type of drug, whether it’s natural or man-made that bind to your mu opioid receptors in your brain, in your intestines, spinal cord, in other areas of your body.
So again, like certain opiates would be things like hydrocodone, oxycodone, heroin, and morphine. And then opioids would be things like, for instance, a natural opioid is Kratom or some people pronounce it Kratom or in Thailand, it’s pronounced Kratom.
And then some synthetic opioids would be things like tramadol, methadone, buprenorphine.
How Opioid Drugs Work in the Body
So how do opioids work? Well, what happens is we already have mu opioid receptors in our brain and when we exercise or eat certain foods or do other activities that stimulates the natural production of endorphins, which are natural painkillers.
When you take any type of opiate or opioid drug, what happens is the drug binds to the mu opioid receptors in your brain and body, and then the receptors turn on and they activate the release of a whole lot of endorphins.
So that’s why they’re so good at painkilling.
You get a massive endorphin release.
Some other effects of opioids are pain relief, euphoria, decreased central nervous system, so it’s repressing of the breathing and all that kind of stuff and they can be constipating.
And so now let’s talk about tolerance and dependence.
The Science of Tolerance
So opioid drugs work really good at the beginning, but what happens is if someone has been taking them daily for a prolonged period of time, maybe a short is just three to four weeks, all of a sudden you start to get a really big tolerance and tolerance means you need more and more of the drug to get the same desire to effects.
And so what eventually happens, not too long after taking these opioid drugs, is there’s no way to ever feel as good as you did at the beginning when you’re taking these.
The thing that really sucks about opioids is compared to all the other drugs on the planet, you get a tolerance to these things lightning fast, and then for some people it just keeps going up and up.
So it’s a really pain in the butt, big pain in the butt.
And then dependence.
The Science of Dependence
Physiological dependence is when your neurons in your brain have become adapted to the presence of the drug. So again, opioids are a central nervous system depressant.
They depress the CNS.
So when you start to take these things daily for three to four weeks and especially longer, now all of a sudden, just to feel normal, not a, not CNS depression, but just for your central nervous system, just to feel normal and balanced, you have to have a certain blood opioid concentration that your neurons have adapted to.
So your body basically becomes totally addicted to opioids and you need it just to feel normal.
All right, so now let’s talk about what happens during the opioid withdrawal syndrome.
The Opioid Withdrawal Syndrome
So again, the only way to go through withdrawal is if somebody is physiologically dependent on opioids, which we just talked about. So during opioid withdrawal, what happens is, let’s say for instance someone has been taking 80 milligrams of hydrocodone daily for the last two years and then all of a sudden, and they’re getting it prescribed by a doctor and all of a sudden their tolerance has gone up so much that to not go through withdrawal, they’ve had to take 100 milligrams daily.
So what happens is their prescription runs out early on.
All of a sudden they’re going to have to go through a cold-turkey withdrawal.
So they use it, let’s say their last dosage at night.
They wake up in the morning and they don’t have any pills left, so within an hour to two hours of waking up maybe a little bit longer, depending on when they last took it and how fast their opioid metabolism this.
Pretty soon they’re going to.
Their blood opioid concentration is going to fall low enough to where the brain starts to freak out.
So blood opioid concentration plummets.
It falls and decreases to levels below your dependence level, so now the central nervous system is no longer getting that opioid depressed feeling, but instead of it just going back to baseline, when you come off opioids, cold-turkey, what happens is it goes through something called a “rebound effect.”
CNS Rebound Effect
So you’ve been depressing. You’ve been depressing your CNS, depressing it for all this time, and then you come off of it and you’ve been dependent on.
It’s where you need it just to feel normal.
So when you get off, instead of feeling normal, it goes, it rebounds in the opposite direction.
So now your CNS is going crazy.
It is completely activated.
This part of your brain called the locus coeruleus activates the fight or flight response.
So your central nervous system goes into total hyperdrive, short circuits.
Then there’s a cascade of stress hormones like cortisol and epinephrine and norepinephrine, also known as adrenaline and noradrenaline.
So back in the day, so let’s say you were a caveman or cavewoman and you saw sabertooth tiger, all of a sudden you would go… your body would activate the fight or flight response instantly when you saw that because that would make you not have an appetite, not have to go to the bathroom and it would flood you with all those, um, hormones and chemicals that make you be able to concentrate more and make you be able to run away.
And it just gives you tons and tons of energy with your legs and if you need to fight back.
But after about 10 to 15 minutes after they made it to safety… a caveman or cavewoman… all of a sudden their parasympathetic nervous system would take over and that’s the “rest and digest” part of the autonomic nervous system.
So then you start to relax.
Well, that doesn’t happen during acute opioid withdrawal.
This cascade of stress hormones keeps going and keeps going because you’ve been dependent on these opioids.
Your brain is now addicted to it and your body’s addicted to it.
So when you go through a cold-turkey withdrawal, it just wreaked so much havoc on your brain and body.
And then there’s also… along with the CNS depressing effects of opioids… they also have a constipating effect as well.
Constipation Rebound Effect
So when someone first starts taking opioids, they may feel constipated, but then what typically happens is people will adjust to that. Once they’re dependent on it, then they won’t be constipated anymore.
Now a lot of people still get constipated from opioids, no matter how long they’ve been taking it.
And that really happens, especially with methadone and certain other types of opioids, certain opioids, and if you’re taking high dosages, a lot of people never really feel normal they’re always constipated.
So, but so when you come off cold-turkey withdrawal, again, the constipating effect does not return to baseline.
Instead, there’s also a rebound effect with that function.
And so it goes in the opposite direction and instead of constipating or baseline, the person going through withdrawal has diarrhea and stomach cramping and nausea and stomach pain.
And those are just some of the opioid withdrawal symptoms that come from the syndrome.
Opioid Withdrawal Symptoms
So there’s two classes of symptoms when you’re going through acute withdrawal. One is the mental symptoms. So that’s things like extreme anxiety, total depression and fear.
The inability to focus, and then there are the physical symptoms.
So again, I was just talking about the diarrhea and the stomach cramping and pain.
People also can vomit during withdrawal and lot of people get restless legs and restless arms and just overall a really restless body.
One time, the worst withdrawal I went through was when I was coming off a gram of heroin a day and I tell you, I was laying down and I thought my leg was going to kick me all the way down the street.
My legs were just kicking, my body was moving around. I was just flopping around. It’s sucked. I went to the hospital because I couldn’t get any withdrawal remedies.
So I went there and they gave me some tramadol and Librium. So yeah, those helped a lot.
But anyways, you also can get sweating and hot and cold flashes in that, that gross gooseflesh feeling.
And then there’s even more.
These are just some of the most common symptoms.
And the thing that really sucks about opioid withdrawal is the mental symptoms.
The Synergy of Mental and Physical Symptoms
So if it was just the physical symptoms, if you just had all those ones below, yeah, that would suck. That would really feel horrible. But if you had a balanced mood, you were feeling okay mentally, emotionally, it wouldn’t be one 10th is bad, it wouldn’t be.
I mean, it would just be so much better.
The reason why opioid withdrawal is, in my opinion, the most horrific experience from drugs and drug use is because you have the synergy of the mental or psychological symptoms combined with the physical symptoms.
So those two together make it the most feared thing.
Like everyone that’s dependent on opioids, their greatest fear is getting this sickness, getting these symptoms when they come off and you know, Gosh, we will do so much to keep the dependence going so we don’t have to experience this.
So now let’s talk about the acute withdrawal timeline.
Acute Opioid Withdrawal Timeline
So again, I was saying in the overview video that they can defer a pretty, a lot. They can differ between months depending on what type of opioids you’re coming off. So if you’re taking a short-acting opioid like hydrocodone, oxycodone, heroin, morphine, or any other short-acting opioids, it’s typically four days.
And here’s how it goes…
Short-Acting Opioid Acute Withdrawal Timeline
The first day does not feel good whatsoever.
The second day gets a whole lot worse.
Maybe it doubles and intensity and severity.
And then days three to four are the peak of the opioid withdrawal symptom severity. So again, it’s about four days long.
On the fifth day you wake up and it’s a lot better.
I mean, it still feels really shitty, still feels really bad.
Excuse my language, but it gets a lot better.
So again, the first day sucks the second day’s way worse, and days three and four are hell on earth.
But then on day five, you’re technically over with it usually.
For some people, the short-acting opioid withdrawal timeline can last up to seven days.
That kind of has to do with how fast or slow people’s opioid drug metabolisms are.
Depending on the short-acting opioid and that person’s individual biochemistry, maybe how long they’ve been taking it for rarely, it lasts up to seven days for the acute withdrawal, technically, typically it’s usually days one through four and then it starts to get better a little bit very slowly.
Long-Acting Opioid Acute Withdrawal Timeline
And then the long-acting opioid withdrawal timeline is different since it, since these long-acting opioids such as buprenorphine and methadone, since they bind to your receptors so strong and they take so long to come out of your opioid receptors.
The withdrawal timeline typically is about seven to 14 days and the severity is a little bit different too.
So let’s say for instance, you’ve been taking eight milligrams of buprenorphine for the last two years.
Well, you can go the first one or two days typically and not really feel bad at all. Maybe you have a little bit less energy.
Your mood is not as good, but it takes so long for both buprenorphine and methadone to come out of your receptors after you’ve been taking it for some time that you typically don’t start to feel pretty bad until either day three or day four.
Some people can make it two days feeling good.
Some people can make it even three or four days feeling good. Some people can even make it longer, but typically between about three to seven days, I’m detoxing from a long-acting opioid.
That’s when your symptoms, you know, the mild to moderate symptoms will start to increase.
And so yeah, it’s about a seven to 14-day process for the acute withdrawal timeline. But in some circumstances like when people have been on buprenorphine long term and then have like high dosages and they come off cold-turkey or if someone’s been on methadone long term and they just detox cold-turkey.
I’ve seen a lot of cases where the acute withdraw lasts about one to three months.
I used to be a counselor at an Opiate Treatment Program and they prescribed Suboxone, Subutex, methadone, and Vivitrol.
And I had, you know, 85 to 90, sometimes 100 patients on my caseload, so I counseled a lot of people and I did intakes for a lot of people and so since I had this gigantic group of this population, I heard lots of stories.
Severe Cases of Long-Acting Opioid Acute Withdrawal Timeline
So some of the patients that I had, they’d be on like maybe a hundred milligrams of methadone. For instance, this one guy had, he was like 19 years old. He was on a hundred and 20 milligrams of methadone and he had been on it for, I dunno, probably around eight or nine months.
He got arrested.
He was doing heroin on the side, got arrested for having heroin, went to jail for six weeks and that whole entire six weeks, he said he was in acute withdrawal.
He had diarrhea.
He said he did not sleep a wink for the first four weeks and imagined being in jail and you cannot sleep when you’re going through acute cold-turkey methadone withdrawal.
Oh my gosh.
It made all of my previous withdrawals seemed like nothing because I always did it at my own house and even though it was bad, I never came off a huge amount of methadone cold-turkey, in jail.
So yeah, it can last up to one I’ve never heard of anything longer than three months.
That’s pretty much the most severe I’ve heard, but you know, do not come off high levels of methadone or buprenorphine cold-turkey because the withdrawal will last forever.
Tapering Can Prevent Acute Withdrawal
And then look at this note at the bottom. So tapering is when you systematically reduce your dosage over a period of time that can actually, if you do that right, if you taper the right way, that can prevent the acute withdrawal syndrome.
So typically the longer you draw out a taper, the less withdrawal symptoms you have.
I’ve had a lot of coaching clients that have opted to do the taper route and they said that they did not have an acute withdrawal.
They did not feel great.
They didn’t feel their total best when they came off, but they didn’t feel too bad, you know, and they were also taking supplements and many of them were exercising and at least focusing a little bit on nutrition so all that stuff can help and that’s how to avoid the acute withdrawal.
Opioid Withdrawal Remedies Can Prevent Acute Withdrawal
Also, the way you can avoid the acute withdrawal is by taking certain either prescription medications over-the-counter medicines, natural drugs or a combination thereof and other opioid withdrawal remedies.
But if you check out some of my other videos, I’ve got a ton of different videos on all those different withdrawal remedies.
So now once somebody makes it past the acute withdrawal, then the battle is not over and really it’s just beginning because then comes the Post-Acute Withdrawal Syndrome, also known as PAWS.
Post-Acute Withdrawal Syndrome
So PAWS is a biopsychosocial syndrome and it results from the damage that drugs have done to the brain and it’s a combination of that, plus having to live life and cope with stress without the drugs that you’ve been so accustomed to using to help you cope with life and help give you whatever benefits they were giving you.
So PAWS, again, it’s a biopsychosocial syndrome and it’s also got its own set of symptoms and a lot of them are the same symptoms as the acute withdrawal only.
They’re not as bad they’re to a lesser degree.
Post-Acute Withdrawal Symptoms
So things like anxiety, insomnia, fatigue or extreme exhaustion… feels like your battery pack is unplugged. You just have no juice in your batteries. Depression and hopelessness, also known as an “anhedonia,” which is the inability to feel pleasure, basically, pleasure deafness.
Weakness, and then increased sensitivity to both physical and emotional pain.
Attention deficit problems and much more too.
So yeah, there can be a lot of different mental and post-acute withdrawal symptoms.
But again, they’re not typically as bad as the acute withdrawal, but the thing that really sucks about these is they last a lot longer.
Post-Acute Withdrawal Symptoms Timeline
These symptoms can linger on a minimum of about two to three weeks. Now, if somebody does a real good job tapering or if somebody does a really good job with medications and supplements and other things for the acute withdrawal, and then they really get into a good PAWS recovery program, then they can have a pretty darn easy time with this.
I’ve seen it happen time and time again, especially with a lot of my coaching clients.
A lot of them can get back to feeling 100 percent of energy and mood and even better than they felt before opioids.
Then at the, at the very minimum, that takes about two to three weeks.
I don’t think I’ve ever seen it faster than two weeks, is the very fastest, more typically about three to six weeks to get back to 100 percent.
Now you can feel decent during that time if you do the right stuff, but a lot of people do not know how to heal from post-acute withdrawal syndrome effectively in fast.
So what often happens is people experience these pause symptoms for about one to three months and that’s the most common.
Less often some people will experience for three to six months, but it does happen quite a bit and then in severe cases, the symptoms can still last at least to some degree for six to 12 months or longer if the person does not address the biochemical imbalances that opioid dependence either caused or exacerbated.
So that’s post-acute withdrawal.
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So again, this is Matt Finch, Founder of Opiate Addiction Support.
I will see you on the next training video. Thank you for watching til the end, and take care.
[End of Audio] [21:38]