Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN
Written By: Phillippe Greenough
Article Updated: 01/24/2021
Number of References: 20 Sources
The withdrawal symptoms of oxycodone are extremely unpleasant and are often the reason someone struggling with addiction continues to use it. Since it is more potent than morphine, oxycodone withdrawal symptoms cause widespread physical and psychological instabilities and can take time to resolve. Some symptoms of oxycodone withdrawal include deep depression, severe anxiety, diarrhea, insomnia, and aches which may all last for at least a week. Here, we will examine the causes and contributing factors of withdrawal, as well as the effects of oxycodone withdrawal on the mind and body.
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Oxycodone withdrawal symptoms are extremely uncomfortable and are similar to heroin withdrawal in intensity. This, of course, assumes all other factors are equal including amounts used, duration of use, and route of use. Symptoms will become so severe as to make someone almost bedridden due to the physical aspects, and the psychological experience is similarly painful. This combination of intense physical and mental pain is often enough to drive someone to relapse just to get relief from the symptoms.
The withdrawal timeline for oxycodone can vary somewhat between people, but these differences are quite small. For the most part, the acute withdrawal timeline is fairly standard, lasting about a week. The post-acute phase is where there can be significant differences, for some people it may last weeks, while for others it may take many months to fully resolve.
The acute phase will begin very soon after the last time someone used oxycodone. This drug has a very short elimination half-life of ~3 hours, so withdrawal symptoms will appear and escalate quickly. An elimination half-life is a measure of how quickly the levels of the drug in the blood will go from their maximum level to half of that value. Oxycodone withdrawal symptoms will not begin in earnest until a substantial portion of the drug has been cleared from the blood. Symptoms can begin to appear around 6 to 8 hours after the last time someone used oxycodone.
The first few days will see the appearance and drastic escalation of oxycodone withdrawal symptoms. Someone may experience sweating, chills, and anxiety within hours and by the end of the first day without the drug, they will be well on their way into withdrawal. While someone may sleep a little the first night, the second day often exhibits muscle, bone, and joint pains along with diarrhea and vomiting. Tremors will begin around this time as well with an increase in irritability and a total lack of energy or motivation for anything. The second night will often exhibit severe restlessness and insomnia, with someone tossing and turning in bed all night. These symptoms will worsen over the first few days, usually plateauing about three or four days into withdrawal. After this plateau, the physical symptoms may begin a slow dissipation which is often complete by around the end of the seventh day after symptoms appear.
Some symptoms that may be experienced during the first week of oxycodone withdrawal can include:
This phase is an extremely uncomfortable, and even painful experience both physically and mentally. The severity of these symptoms will peak within days, and it can make a week seem like several months. Insomnia, dehydration, and lack of food will worsen the subjective experience of the other symptoms and can lead to potentially dangerous complications; especially if someone has an underlying health condition. It is highly recommended to enter a detox program for oxycodone withdrawal, as it can be a horrible experience without the help of medical monitoring and medications to reduce the symptoms.
The second week will be characterized by intense depression, severe anxiety, strong cravings, total fatigue, and profound lethargy. Without the physical symptoms to distract from the psychological, someone may become mentally distraught as they can more fully experience the psychological stresses of withdrawal once the physical symptoms dissipate. This can leave someone feeling completely drained with a total lack of motivation to do anything but lay in bed. While the rest of the physical issues are normally much improved by this time, insomnia is often still present as well as some stomach discomfort, although these usually resolve towards the beginning of the second week. Additionally, the cravings for oxycodone may become severe throughout the second week, and continuing care is extremely important. The end of the second week may mark a mild reduction in the intensity of these symptoms, but they should be expected to continue for a while.
Some symptoms of oxycodone withdrawal that may be expected to persist into the second week may include:
Week three may mark a slight lifting of the depression, fatigue, and lethargy although they are commonly still present in some capacity. Insomnia may be almost totally resolved by now and a more healthy sleep cycle may help the rest of the symptoms slightly. Cravings may have seen a reduction as well, although anxiety is still most likely very high. Social anxiety seems to be especially intense, and the thought of going out in public can seem overwhelming. This will fade with time but usually remains high throughout the third week. The beginning of the fourth week of oxycodone withdrawal should be significantly better. While cravings, depression, and anxiety are typically still present, the rest of the symptoms are usually totally resolved by now, or very close to it.
The changes made to the brain due to chronic oxycodone use will take time to fully resolve. This can take several more weeks or even months. It depends upon the person and their unique circumstances. Medications and further treatment can help, but some difficulty is to be expected.
The symptoms of post-acute withdrawal will begin after the acute phase and are much longer-lived, commonly lasting several months. These are psychological in nature and can be very uncomfortable.
Some of the most commonly experienced symptoms of post-acute withdrawal syndrome include:
These symptoms will be most intense in the weeks immediately after acute withdrawal and will slowly fade as time passes. Cravings, depression, and anxiety may be the most intense symptoms and can often make it feel like a life without oxycodone is not worth living. Depression in particular may potentially be dangerous, as suicidal thoughts are not unheard of during oxycodone withdrawal. This is a manifestation of the mental pain they are experiencing and with psychiatric help, these symptoms can be minimized. The brain will take time to heal and return to normal functions, but this takes time, and someone may be in a great deal of discomfort while this takes place.
There are a number of factors that can influence the intensity of oxycodone withdrawal symptoms. Some of these are related to the choices someone makes regarding their drug use, while others are totally out of their hands. The intensity of withdrawal also directly affects the duration of withdrawal as worse symptoms result in a longer withdrawal process.
Some factors which are the greatest contributors to oxycodone withdrawal intensity include:
The length and amounts of oxycodone use are probably the biggest contributors to withdrawal intensity. The amounts used will directly influence the amount of downregulation the brain undergoes, therefore the more oxycodone someone uses, the greater the neurological changes that take place. Similarly, the length of time that someone used will influence the “permanence” of these changes, or the degree to which they become set and ingrained. This can affect the intensity, but more often influences the duration of withdrawal, as the longer these changes are in effect, the slower the brain is to reverse them once oxycodone is removed.
Pre-existing or co-occurring mental health issues can also influence withdrawal intensity but in a more indirect manner. The psychological symptoms arise from downregulation and neurological changes that emerge from oxycodone use. If someone were to already suffer from a mood disorder then the depressive symptoms of oxycodone withdrawal would be more severe. The same goes for anxiety disorders, bipolar, and a wide range of other mental health issues. The symptoms of withdrawal can worsen and amplify any underlying conditions, leading to a more intense and uncomfortable withdrawal experience.
A family history of addiction is also an indirect contributor, although it may still play a role. There is a marked trend for addiction to run in families and it is known that there are genetic components to drug or alcohol addiction. If someone has a genetic predisposition to addictive behavior, it is likely that they would begin using much more oxycodone at a much sooner time than someone with no such genetic history. This may mean that someone with a genetic predisposition may become psychologically and physically dependent on a drug sooner, and after using the same amounts, than would someone with no genetic predisposition for addiction. What is known is that a higher incidence of close family members having substance use issues can negatively impact someone’s chances of long term recovery.
For a better idea of the experience of oxycodone withdrawal, it is useful to know more about the mechanisms that produce it. Oxycodone, when taken orally, is about 1½-2 times as potent as morphine and it similarly acts as an agonist at all 3 major opioid receptors, the μ (Mu), δ (Delta), and κ (Kappa) receptors, with a preference for the μ opioid receptors. These opioid receptors are the major moderators of the natural pain management system of the brain, known as the endogenous opioid system, and strong stimulation can produce an array of secondary effects throughout the brain and body. Oxycodone use produces powerful effects, both immediate and downstream, in the brain and nervous system. The most immediate effect is an intense euphoria, relaxation, and pain reduction (analgesia).
Repeated overstimulation of the opioid system by oxycodone can produce tolerance, and eventually dependence. This is due to a process called “downregulation” that the brain undergoes in an attempt to maintain balance. Through repetitive, strong opioid stimulation the brain will turn down the sensitivity of these opioid receptors. This has the effect of requiring more opioid drugs to produce the same effects. Eventually, through continued use, downregulation will occur to such a degree that the natural opioid peptides that normally stimulate this system will be too weak to have any significant effect. These receptors will have been downregulated so much that they require extremely strong opioid drugs to become stimulated. Once someone reaches this point, oxycodone withdrawal symptoms will begin when they do not use the drug on a regular basis.
Withdrawal produces a wide range of symptoms, but these can be divided into two distinct categories: acute symptoms and post-acute symptoms. The acute symptoms include both physical and psychological and are the symptoms immediately experienced upon ceasing oxycodone use. The post-acute symptoms are strictly psychological and may last for a very long time. Let’s take a look at these different symptom sets in detail:
The symptoms of oxycodone withdrawal can be extremely uncomfortable and sometimes even dangerous. If someone wants the best possible chance to go through the withdrawal process in the safest and most comfortable way possible, then it is highly recommended that they enter an oxycodone detox center. These facilities have trained medical professionals, medications, and therapies to give someone the resources they need to overcome oxycodone withdrawal and begin a new life in recovery.
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