Opioid use disorder (OUD) substantially affects a person’s quality of life. It’s an epidemic in the U.S. Individuals who use opioids persistently should receive an official diagnosis from a healthcare professional and be treated promptly.¹ OUD causes clinically substantial impairment and distress. It impacts more than 16 million individuals worldwide, and over 2.1 million individuals in the U.S. Opioids also contribute to over 120,000 deaths across the globe.
Like other types of substance use disorders, opioid use disorder is a chronic brain disease where individuals continue using opioids despite the complications their use can cause.
OUD consists of the following:
OUD includes addiction and dependence, with addiction representing the disorder’s most severe form.
Fortunately, progress is being made to help individuals affected by opioid addiction or opioid use disorder overcome it. OUD can cause substantial impairment, like any other chronic disease, without adequate care. However, highly effective treatment is available that improves individuals’ quality of life and saves them.‘
Opioids are a class of manufactured chemicals (opioids) and naturally occurring chemicals (opiates) that doctors often prescribe to help ease pain. They’re generally prescribed after severe injury or surgery as long-term pain management caused by conditions such as cancer. In some cases, they’re used to alleviate diarrhea or as cough suppressants.
As opioids enter a person’s body, they interact with their brain’s opioid receptors. This produces various physiological responses, which include pain relief. But they also stimulate the brain’s reward pathway, causing a feeling of happiness and well-being known as euphoria.
This reward pathway activation makes opioids highly addictive for some individuals. When individuals continue using the drugs, it leads to changes in their brains that produce tolerance. This means that they’ll require larger doses of opioids to get the same euphoric high or level of pain relief.
Over time, individuals who use opioids, whether it’s for pain, getting high, or other reasons, end up developing a physical dependence on them, which means if they suddenly stop taking them, they’ll begin experiencing symptoms of withdrawal. At this point, some individuals may take opioids, not for the high or pain relief but to help end the withdrawal symptoms.
An opioid use disorder diagnosis is made based on the DSM-5 Criteria and when an individual who is using opioids regularly experiences a minimum of the two following signs within the past 12 months²:
The individual develops a tolerance to opioids, which means they require larger quantities of opioids to experience the drug’s desired effects. If they stop using opioids, they experience withdrawal symptoms or use opioids to ease withdrawal symptoms.
The individual takes opioids for longer than planned or in more significant quantities. They cannot reduce their use or quit using opioids despite wanting to do so. They devote a great deal of time to using, acquiring, or recovering from opioids. They feel urges to use opioids.
An individual’s use of opioids often interferes with their ability to complete duties at work, home, or school. They continue using opioids even when their use is causing issues interacting with other people. They often skip important events and occasions at school, work, or in their personal life.
They repeatedly take opioids in situations that may cause them physical harm (i.e., driving under the influence of opioids). They continue to use opioids despite the drugs causing or exacerbating physical or mental issues.
The more of the symptoms mentioned above that an individual experiences, the more severe their opioid use disorder is.
Opioids can be classified into five categories.³ These are natural opioids (naturally occurring in opium), semi-synthetic opioids (synthesized from opium substances), synthetic opioids (synthesized from substances that aren’t found in opium, or endogenous opioids (synthesized in the body).
Common types include:
Prescription opioids are often prescribed and used to treat moderate-to-severe pain. They’re also frequently prescribed by doctors after injury or surgery or for medical conditions like cancer. Recently, there’s been a drastic increase in prescription opioids being accepted and used to treat non-cancer, chronic pain like osteoarthritis or back pain, despite serious risks or there is a lack of evidence about their long-term effectiveness.⁴
Morphine is a non-synthetic narcotic that has high abuse potential and comes from opium. It’s used to treat pain.⁵
Pharmaceutical fentanyl is approved for treating severe pain, such as advanced cancer pain. It’s a synthetic opioid that is 50 to 100 times stronger than morphine.⁶ Doctors prescribe it in the form of lozenges or transdermal patches, and it is often diverted for abuse and misuse in the U.S.
Most cases of fentanyl-related overdose, harm, or death in the United States are associated with illegally-made fentanyl. It’s sold and found in illegal drug markets because of its heroin-like effects. It’s frequently combined with cocaine and heroin as a combination product, with or without the user’s knowledge, to increase the euphoric effects.
Heroin is an illegal opioid. Every day, 36 individuals die from heroin-related overdose in the U.S.⁷ Heroin is usually injected, but individuals can also snort or smoke it. When individuals inject heroin, they put themselves at risk of long-term, severe viral infections such as hepatitis B or C, and HIV, as well as bacterial infections of the bloodstream, skin, and heart.
Opiates are a type of opioid found naturally in the poppy plant. They are used to create semi-synthetic opioids and are mimicked in lab experiments to produce fully synthetic opioids.
Opioid withdrawal symptoms range from mild to severe. Those who suffer from lengthy drug addiction or abuse tend to experience intense symptoms. Other factors could play a role in the various types of withdrawal symptoms an individual experiences. These factors include:
There are four stages of opiate withdrawal:
Depending on what type of addiction the individual is experiencing, acute withdrawal generally occurs within several hours of an individual’s last dose. The individual will typically experience flu-like symptoms that are linked with painkiller withdrawal. Once the acute withdrawal is over, they’ll begin experiencing the protracted abstinence period, which often lasts up to six months. This is the period when individuals in recovery are the most susceptible to triggers that result in relapse.
Individuals go through a withdrawal timeline while going through the four stages of detox.
This is around three to four hours after the individual’s last dose. This stage is characterized by increased fear or anxiety related to oncoming withdrawal symptoms. It’s also marked by drug-seeking behavior and cravings.
This is around eight to 10 hours after the individual’s last dose. Restlessness and anxiety start to increase within this period. The individual will generally experience flu-like symptoms such as:
Individuals will also continue to experience drug-seeking behavior and cravings.
This stage begins around one to three days after the individual takes their last dose. Their symptoms will have reached their peak by this point. They’ll typically start experiencing:
During this period, their cravings will be at their strongest.
Individuals typically experience this stage up to 24 months after they take their last dose. They will no longer experience acute symptoms. But, they may experience:
An individual is still highly vulnerable to environmental triggers that could promote relapse.
Opioid overdoses are life-threatening and require emergency attention immediately. Being able to recognize the signs of opioid overdose is essential to saving lives. Overdose death can be common in cases where an overdose or opioid misuse goes untreated.
Individuals may experience signs that include:
Anyone who notices an individual exhibiting any of these above symptoms should call 911 right away. Overdose prevention is essential for combating the opioid crisis. People who are struggling with opioid abuse should consult with a professional about treatment.
Naltrexone is an FDA-approved medicine to treat opioid use disorder as a Medication-Assisted Treatment (MAT) solution. Doctors prescribe and administer naltrexone in extended-release intramuscular injectable or pill form for OUD.
Individuals can take the pill form daily (generally for alcohol use disorder), but the injectable form is approved for OUD treatment and is administered monthly by a doctor.
Naltrexone is just one element of a comprehensive treatment plan, which includes different behavioral health therapies and counseling to offer patients a whole-person treatment approach. Naltrexone isn’t recommended as a medication-assisted treatment option for people who are younger than 18 years old or for people who experience other medical conditions.⁸
Naltrexone isn’t addictive. It’s not an opioid and doesn’t cause withdrawal symptoms when the individual stops using it. It blocks the sedative and euphoric effects of opioids like morphine, heroin, and codeine.
It blocks and binds opioid receptors and suppresses and reduces opioid cravings. There’s no diversion and abuse potential with naltrexone.
For certain individuals with OUD, detoxification is the start of treatment.⁹ Detox is the medically supervised and controlled withdrawal from a substance. Detox isn’t a solution all by itself since most individuals with OUD resume taking opioids unless they receive further treatment.
While withdrawal symptoms aren’t life-threatening, they can become very uncomfortable. The dose and speed of withdrawal will determine the intensity of the reaction. For instance, heroin is a short-acting opiate, often producing briefer but more intense symptoms.
There isn’t one approach to detox that is guaranteed to work for everyone. Healthcare professionals will often switch regular heroin users to methadone (a synthetic opiate and longer-acting drug) that they can take by injection or orally. The healthcare professional will gradually reduce the dose over some time — typically a week. They may sometimes add in a drug called clonidine (which lowers blood pressure) which helps to shorten the patient’s withdrawal time and ease their physical symptoms.
Alcohol and opioids are both addictive substances that can cause significant harm to individuals and society. Alcohol is a central nervous system depressant that can lead to addiction, liver damage, and accidents. Opioids, such as heroin, fentanyl, and prescription painkillers, can lead to physical dependence, overdose and a range of negative consequences like loss of employment, financial problems, and legal issues. Both substances are highly dangerous and it is important to raise awareness about their risks.
A person who is dealing with a substance use disorder may wonder what it’s like to detox. The initial step in treatment for opioid dependence is typically the detox phase. This is the process where an individual clears their system of alcohol or drugs and stays sober. When it comes to drug abuse, the detoxification phase is the period it takes for the body to process or metabolize any drugs that are present in its system.
At a Riverside County rehab center like Inland Detox, healthcare professionals understand that each patient has their own reasons why they wish to detox from substances. Some individuals only want to detox and rid their bodies of harmful substances. Others want to enter a drug treatment center that doesn’t offer detox. Regardless, it’s the same goal for most healthcare professionals in this field: to ensure they serve each and every one of their patients while making them as comfortable and supported as possible while making positive life choices.
Drug detox can be an extremely uncomfortable process, and each person will experience different reactions depending on what type of drug they were using and for how long. Certain drugs can cause physical discomfort, while others cause mental distress.
For instance, meth detox can lead to intense psychological withdrawals, managing intense cravings and anxiety. On the other hand, detoxing from alcohol can cause dangerous physical withdrawals, with individuals experiencing seizures in more severe cases.
Benzodiazepines and alcohol are the most dangerous substances to detox from and frequently require medication. Opioids, particularly heroin, are considered the most uncomfortable drugs to detox. Each drug will present its own detox side effects.
Healthcare professionals frequently practice medication-assisted treatment during the detoxification process for harm reduction. These medications are designed to treat long-term opiate withdrawal problems, like drug cravings. Doctors will slowly taper the medication dosage down over time until the individual recovers from acute withdrawal symptoms. Healthcare professionals may continue to prescribe opioid medication during a patient’s stay in an inpatient rehab center.
Some types of medications used in opioid detoxification include:
Healthcare professionals frequently prescribe clonidine to suppress withdrawal symptoms and treat high blood pressure. It’s beneficial in decreasing symptoms of stress and anxiety. It comes in patch form that the individual wears on their skin or oral tablet form.
Clonidine doesn’t produce euphoric effects commonly linked with opioids. Because of this, it has little potential for physical dependence or abuse. Medication treatment makes it simpler to stop using after the individual’s withdrawal symptoms have subsided.
This drug, also called Subutex or Suboxone, is often used to treat alcoholism, but this medicine is also very effective for opiate addiction treatment. It’s a partial agonist, meaning it doesn’t mimic the full effects of a more potent opiate like hydrocodone. Buprenorphine helps to reduce withdrawal symptoms and opioid cravings, assisting individuals in maintaining motivation in treatment.
Methadone was the prescription opioid medication of choice in the past in detox settings, but lately, it’s been largely replaced by buprenorphine. It’s generally prescribed to help individuals ease off the substance they were initially dependent on. Methadone is a long-acting opioid, so it works more effectively as a long-term substance abuse disorder treatment approach for individuals who struggle with chronic opioid addiction.
There’s no precise timeframe for one person to detox from a certain substance. Many factors come into play to determine the length of time that a drug will clear entirely from an individual’s system. It can take hours or even days, depending on the type of drug.
Some factors that can determine the detox length of time include:
The highly experienced and skilled staff members of Inland Detox help individuals obtain the most comfortable and successful treatment results possible. Health statistics show many individuals in long-term rehab facilities for drug abuse require a dual-diagnosis treatment approach since they struggle with physical and psychological dependence problems. Also, many individuals suffer from a co-occurring medical condition that could hugely affect their addiction.
Not all opioid treatment programs with detox treatment offer these services and only manage their client’s physical symptoms through detoxification and then pass the other treatment responsibility on to others.
Inland Detox believes a dual-diagnosis treatment approach is the absolute best treatment model in opioid treatment programs. Because of this, individuals can feel confident that they’ll receive the best care possible to tackle not only their physical addiction to opioids but also any underlying medical or psychological issue they may have that triggers their addiction. They’ll receive round-the-clock care and support in a safe and comfortable environment.