Let’s say you are planning to take a trip to Yosemite National Park; it makes sense for you to learn something about Half Dome and Yosemite Falls. Similarly, before undergoing opioid detox, it helps to know something about opioid withdrawal.
The Details of Withdrawal
Withdrawal happens in stages; how bad it feels will depend on several different factors, some of which have nothing to do with drugs. One way or the other, whether you detox all at once or drag the process out, you will experience a certain and finite amount of suffering. But the suffering is temporary and it will come to an end.
A few hours after his last fix, but before the drugs completely leave the body, the addict begins to worry about his next fix. This brings on the first symptoms of withdrawal: anxiety, restlessness, and craving. Known as anticipatory withdrawal, the addict begins to look for and seek out more drugs.
To many addicts, the anticipatory withdrawal phase – thinking about what’s to come – is worse than the physical phase of withdrawal. Yes, the fear of withdrawal can be, and often is, worse than the actual withdrawal itself. It is commonly believed that craving happens because drugs are not available. However, it’s actually quite the opposite. Craving happens only when drugs are potentially obtainable. Many addicts in a lock-up facility stop craving drugs when they discover that no one is smuggling illegal substances into the facility, meaning drugs are simply unavailable.
After a while, they stop thinking about drugs and the sickness subsides. At some point, they are released from the facility (perhaps early due to good behavior) and get on the bus feeling perfectly fine. As the bus gets closer to home – and closer to those old drug using neighborhoods – their nose starts running and their eyes start watering; they know a dealer is just around the corner and they know it’s possible to get drugs again.
This is not a made up story; it’s a scenario that happens over and over again. You crave drugs, not because you can’t have them, but because you can. Let’s get back to opioid withdrawal…
Opiate Detox and Withdrawal
The process of physical withdrawal begins 8-10 hours after the last fix, give or take a few hours. Internal symptoms include feelings of anxiety, restlessness, nasal stuffiness, and the urge to find/use drugs. The outward symptoms are yawning, sweating, runny nose, tearing, nausea, abdominal cramps, dilated pupils, rapid pulse and hypertension.
Opioids are unique in that the emotional effects are felt most powerfully while using – the feeling that nothing bothers or even matters – but in withdrawal, physical effects dominate.-Walter LingWithout relief, the withdrawal symptoms become full-blown over the next two or three days. Anxiety and restlessness worsen, craving and drug seeking intensify, and elevated heart rate and blood pressure are accompanied by fever and chills. Nausea turns into vomiting and diarrhea.
Opioids are unique in that the emotional effects are felt most powerfully while using – the feeling that nothing bothers or even matters – but in withdrawal, physical effects dominate. You suffer aches and pains, nausea, vomiting, cramps, diarrhea, chills and goose bumps. Your legs jerk; you’re literally kicking the habit.
The manifestation of opiate withdrawal symptoms is very much subject to outside influences. The most obvious influences include the amount and regularity of drug use, the rate of withdrawal, and the physical and psychological condition of the patient. Less obvious influences include surroundings, treatment settings, and the treating physician’s attitude and confidence.
Addicts in jail often show very few withdrawal symptoms simply from the fear of being found out. An anxious physician is likely to have anxious patients, while a calm and confident doctor is likely to have patients that do well. While helpful, medications often play only a very minor role.
To old timers, the opiate withdrawal process resembles a severe bout of the stomach flu. In fact, it is described as such in medical literature. But by the accounts of every addict I know, withdrawal is actually much worse.
The Silver Lining
Going cold turkey is rarely, if ever, suggested. Most detox treatment facilities prescribe short-term medications to ease the discomfort of the withdrawal process. The silver lining here, as promised, is that there is an end to all this. As I said, a finite amount of suffering is to be expected. That suffering, however, is time limited and you can get over it.
While the acute symptoms and signs of withdrawal may subside over several days, the body does not return to a physiological state of normalcy for weeks, sometimes even months. Sleep is disturbed and heart rate and blood pressure remain unstable. There’s a lingering loss of appetite, lack of energy and strong cue-induced cravings for drugs. This is known as protracted withdrawal, a period during which relapse is common without intervention. But that, strictly speaking, belongs to the next step of recovery, which is something that detox should prepare you for.
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