Opiate detox can be an extremely uncomfortable and sometimes painful process, and medical help is almost always recommended. In an average healthy person, there are minimal risks of dangerous complications, although if someone had underlying or pre-existing medical conditions, they may be at increased risk of serious complications or even death. Likewise, if someone has had a drug or opiate problem and tried to quit on their own but failed, then an opiate detox center is highly recommended.
Some specific situations where entering an opiate detox center would be especially recommended may include:
Due to the cardiovascular disruptions that commonly occur during opiate detox, if someone has a heart condition then they should absolutely seek medical help during detox. The increases in heart rate can put a great strain on their heart, and also increase the risk of hemorrhagic stroke due to sharp spikes in blood pressure. In most cases, this does not pose a serious threat, but if someone already had poor cardiovascular health, they may be at increased risk for these issues. With the medical expertise of doctors and medications provided by opiate detox centers, these risks can be minimized and managed.
Another effect of detox is wild fluctuations in blood sugar. This results from the increase in norepinephrine and adrenaline, which can greatly increase blood sugar levels and cause stored glucose to be released in very large amounts. This is extremely dangerous to a diabetic and can lead to hyper- or hypoglycemia which may result in seizures, coma, or death if it is left unmonitored and untreated. Medical monitoring and supplemental therapies may be able to reduce these risks and help someone make it through opiate detox in one piece.
People who are experiencing severe symptoms from opiate detox are highly encouraged to seek a medical detox center. These symptoms, while not only being extremely uncomfortable, can reduce the chances someone has of completing detox. The worse the detox symptoms are, the more likely someone is to get relief the fastest way they know how; do more opiates.
If someone was an IV opiate user this is especially the case, as IV opiate use produces much more severe detox symptoms much sooner. Because the drug enters the brain and body so fast when someone injects opiates, the symptoms of detox will appear much more quickly and also escalate more quickly. Additionally, there is a wide range of health and recovery risks that come along with intravenous drug use, and an IV opiate user will stand a better chance at a safe, healthy, and successful recovery if they enter an opiate detox center.
There are many different types of opiates used today and while they are used for the same purpose, all of them have unique characteristics. There are 3 major classes of opiates which encompasses every opiate drug:
Also referred to these days as opioids, all of these drugs produce very similar effects through very similar mechanisms of action. Likewise, all of these drugs can produce addiction and withdrawal symptoms through consistent use. Depending on someone’s specific use habits and the specific opiate, symptoms can range in both intensity and duration. If someone was addicted to certain opiates, then entering a detox program may be more strongly recommended.
A general overview of some of the most addictive opiates with links to further drug-specific information includes:
Morphine is a broad spectrum opiate, interacting with every known opiate receptor in the brain and it is the gold standard by which the potency of other opiates is gauged by a “potency-to-morphine” measuring metric. While it is still used for pain relief today, it is only used short term as it rapidly produces tolerance, dependence, and subsequently withdrawal. Since it is so potent in the brain, morphine withdrawal symptoms are extremely uncomfortable. Even though morphine withdrawal is almost never fatal, it is highly recommended for someone experiencing withdrawal to attend an opiate detox center, as medications and medical supervision can give someone a higher chance of a successful recovery and help make the experience more bearable.Morphine Detox Centers
Heroin is one of the oldest and most widely abused semi-synthetic opiates. Due to its chemical structure, it can be thought of as a supercharged version of morphine. It is often injected, as this produces extreme euphoria which is almost instant. Because of the intensity with which heroin affects the brain, addiction can happen very quickly. Heroin withdrawal, while not usually fatal, is a truly agonizing experience, and it is highly recommended for someone to enter an opiate detox center if they are attempting to quit. Because of the intensity of heroin withdrawal, the chances of a successful recovery are very low unless someone gets help.Heroin Detox Centers
Suboxone is a fully synthetic opiate that has risen to great popularity recently as an opiate withdrawal treatment medication, even though it is itself an opiate. The specifics of the way buprenorphine (the active ingredient in Suboxone) works produces a phenomenon known as the ceiling effect. This means that while the euphoria is dose-dependent, it will only increase to a certain point and then cease. This is specifically in the case of opiate addicts, and those who are naive to opiates may feel a mild euphoria when taking Suboxone. The withdrawal symptoms of Suboxone are unpleasant, although not as intense, but longer-lived than other opiates like morphine or oxycodone.Suboxone Detox Centers
Codeine is a natural opiate that is used to treat mild to moderate pain and as a cough suppressant. It is similar to morphine and hydrocodone but is roughly 8 times weaker than morphine. Codeine has a similar half-life to morphine, but due to its weaker affinity for opioid receptors, the codeine withdrawal symptoms will be much less intense than with other opioids. That being said, withdrawal from codeine is still a very unpleasant experience and someone is highly encouraged to seek help if they expect to undergo withdrawal.Codeine Detox Centers
Oxycodone is an extremely powerful semi-synthetic opiate that is used pharmaceutically in the treatment of severe pain. Very similar in heroin to its effects, this drug may also be injected depending on the formulation and manufacturer. There are extended-release (Oxycontin) and instant release (Roxicodone) formulations although both of these see widespread abuse. Oxycodone withdrawal symptoms are very similar in intensity and duration to heroin, depending on the doses used of course, and entering a detox center is highly recommended when someone is trying to quit.Oxycodone Detox Centers
Fentanyl is an extremely powerful fully synthetic opiate that is commonly used to treat severe pain, such as that experienced by cancer patients. Recently, it has been used as a cutting agent by drug manufacturers or traffickers within opiates and other drugs to increase their potency, and this has resulted in thousands of overdoses and deaths. Fentanyl can be between 50 to 100 times more potent than morphine per unit weight depending on the route of intake someone chooses, and it is between 30 to 50 times more potent than heroin. There are also fentanyl analogs that can be 1,000 to 10,000 times more potent than morphine, such as sufentanil and carfentanil, respectively. Withdrawal symptoms from fentanyl can be horrible and can be very similar to heroin withdrawal. If someone is attempting to quit using fentanyl, it is very highly recommended that they enter a fentanyl detox center.Fentanyl Detox Centers
Hydrocodone is a fairly common and relatively weak opiate when compared with the others on this list. Although it produces similar analgesic effects as oxycodone, the euphoria experienced can be much less intense. That being said, hydrocodone addiction and withdrawal are very real, and often painful, experiences. Hydrocodone has a fairly long half-life, so the symptoms of hydrocodone withdrawal may be less intense than oxycodone withdrawal but will last longer. It is usually recommended to enter a hydrocodone detox center when trying to quit using the drug, as these centers can reduce the discomfort as well as increase someone’s chances of successful recovery through support and continuing care.Hydrocodone Detox Centers
Vicodin and Lortab are prescription painkillers that both contain a combination of hydrocodone and acetaminophen. They produce effective pain relief but lack the intense euphoria associated with many other opiates unless taken in large doses. Due to the inclusion of acetaminophen these large, euphoria-producing doses are extremely toxic to the liver since a common ratio of hydrocodone-to-acetaminophen is 5:500mg. These levels of acetaminophen toxicity common in Vicodin or Lortab abuse result in extreme liver damage and reduced function. The sooner someone quits abusing these prescription drugs, the better off they will be as liver damage can be fatal. Entering a Vicodin detox center can provide help and support with the withdrawal process, and may also help anyone find effective care for any potential liver damage they may have suffered through Vicodin or Lortab use.Vicodin Detox Centers
Dilaudid is a very powerful semi-synthetic opiate painkiller that is used to treat both acute and chronic pain. It can be either short or long-acting depending on the formulation. Hydromorphone (the active opiate in Dilaudid) is around 4 to 7 times as potent as morphine per unit weight and it has a similar half-life. Due to this, Dilaudid withdrawal symptoms will be quite severe and may resemble heroin withdrawal in both intensity and duration. If someone is trying to quit using Dilaudid, it is very highly recommended that they enter a Dilaudid detox center.Dilaudid Detox Centers
Opana is a semi-synthetic opiate that is about three times as potent as morphine and roughly twice as potent as oxycodone as a painkiller. Oxymorphone (the active ingredient in Opana) is an outlier as it does not have any cough suppressant effects, as almost every other opiate does. Commonly used for pain relief, including obstetric pain, in 2006 there was an extended-release formulation released which quickly proved to be liable for abuse. Due to the very short half-life of Opana, the withdrawal symptoms of oxymorphone can be quite severe; both duration and intensity are comparable to heroin. If someone is trying to quit using Opana, it is very highly recommended that they enter an Opana detox center.Opana Detox Centers
One of the first fully synthetic opiates which saw widespread use, methadone originally entered the pharmacopeia as a heroin withdrawal medication. It is unique among opiates as it exhibits both opiate and non-opiate characteristics as its main mechanism(s) of action. As far as potency goes, methadone exhibits what is known as “therapeutic inequivalence” as there is no direct equivalence in potency between methadone and other opiates. While the potency may vary, methadone has an extremely long half-life, which means that methadone withdrawal symptoms will persist for much longer than withdrawal symptoms from other opiates. While the symptoms may not be quite as severe, the prolonged withdrawal period may be overwhelming for many people. If someone is attempting to quit methadone, it is very highly recommended that they enter a methadone detox center.Methadone Detox Centers
Tramadol is a unique opiate in the sense that it works on both the opioid system and serotonin and norepinephrine systems in the brain. The fact that it affects these other, nonopioid systems increases its effectiveness at pain management through avenues different from other opiates. It has fairly weak opiate interactions, with potencies ranging from 1/5th to 1/10th the potency of morphine depending on the route of intake. That being said, the symptoms of tramadol withdrawal are very unpleasant and may include more intense psychological symptoms than other opiates due to tramadol’s other interactions. If someone is trying to quit using tramadol, it is recommended that they enter a tramadol detox center.Tramadol Detox Centers
The physical symptoms are certainly the most severe and prominent feature of opiate detox. The opioid system imbalances produced through chronic opiate use will result in profound disruptions in a variety of physical processes and systems. This is caused, indirectly, by the downregulation of opioid receptors in the brain and body.
The opioid system is known to slow and reduce nerve signals in other systems, and downregulation results in the opioid system having a greatly reduced effect on these other systems. During opiate withdrawal, since the body is less sensitive to endogenous opioids the opioid system is unable to exert its calming effects on dependent systems. Subsequently, many systems that are neurologically “downstream” of the opioid system will enter a hyper-excited state during opiate detox.
Some of the systems that are heavily affected in this way include:
The gastrointestinal tract is home to a very large number of opioid receptors, including μ-opioid receptors which are a common target of opiate drugs. In the digestive tract, these receptors act to slow and moderate the stomach emptying into the intestines, intestinal muscle contractions, and control of the sphincter muscles. Due to the hyper-excited state of these systems during opiate detox, this entire system enters a hyperexcited state
The most noticeable effect of opiate withdrawal on digestion is the prevalence of diarrhea. This is intense and frequent in the first week or so of detox and is very unpleasant. Additionally, appetite is greatly reduced or absent entirely, stomach cramps are frequent, and nausea is a constant companion. These symptoms will resolve with time, but the body must first restore balance to the opioid receptors in the enteric nervous system and this is a slow process.
The cardiovascular system is also impacted by the detox process. There are direct effects that are produced through opiate detox, while the psychological effects of detox may contribute as well. There is still some mystery as to the exact nature and mechanisms that opioids can interact with the cardiovascular system. While their exact cardiovascular functions are currently unclear, it is known for sure that the μ and κ opioid receptors play some role in heart function and regulation, and detox can subsequently affect the function of these receptors.
Due to the downregulation of opioid receptors, and the subsequent lack of stimulation resulting from detox, these receptors are unable to slow and moderate cardiac nerve impulses. Additionally, extreme anxiety and other neurological hyperactive states will result in an increase in adrenaline which will absolutely increase heart rate and blood pressure. This is not dangerous to an otherwise healthy person, but if someone were to have a pre-existing heart condition, this could potentially lead to very dangerous complications, although this is rare.
There are a number of disparate systems that do not fit neatly into a single physical system which are affected by detox. These may include systems involving voluntary muscles, skin and mucous membranes, and sensory systems. While the sensory effects may technically be psychological or neurological in nature, we will include them here since they alter the perception of the physical aspects of the body.
Some of the peripheral effects of opiate detox which result from an increase in adrenaline or glutamate levels may include:
Some sensory effects of opiate detox may include:
These effects are very unpleasant and will take time to subside naturally. As the body readjusts to the absence of opiates and subsequently undergoes upregulation (the opposite of downregulation), these symptoms will begin to resolve. This is a slow process and can take time, but the physical effects of opiate detox are always the first to resolve.
There is some variability in the psychological effects between individuals during opiate detox, but for the most part, everyone will experience certain symptoms to a greater or lesser degree. These effects are likewise caused by the disruption of the endogenous opioid system, and the cascade effect this produces in “downstream” neurological processes.
Some of the most common psychological effects of opiate detox can include:
The most common symptom of opiate detox by far is the presence of very powerful and persistent cravings. These cravings are produced through very complex mechanisms that aren’t fully understood but certainly involve dopamine and parts of the limbic system, also referred to as the “reward center” of the brain. The chronic use of opiates and the way this affects opioid receptors, particularly at the κ opioid receptors, can produce long term disruptions to key areas of the limbic system such as the ventral tegmental area and the nucleus accumbens. These areas are known to be heavily involved in learned behavior, memory formation linked to behavior, and feelings of reward and euphoria.
Through chronic opiate use, someone may temporarily eliminate their ability to feel good unless they use opiates. The result of this is very strong and very long-lived cravings for opiates. This is due to the prolonged overstimulation of the opioid system and the very high levels of dopamine this produces. After chronic opiate use, the normal sensations of pleasure can barely be perceived, as they have been outshone for so long by the opiate-induced dopamine surges. The inability to feel good will combine with the strong sense memory of pleasure and opiates, which will make someone want to do opiates. This can be so severe in some cases as to manifest as a preoccupation or an outright obsession with thinking about opiates and opiate use. This will reduce with time, but has been known to persist for years in some cases.
Depression is an extremely common effect of opiate detox and can often last for many months. While the causes are not clearly understood, there are some factors that certainly contribute to the severity of depression during detox. This may be due to both neurotransmitter disruptions as well as the loss of such a powerful, although unhealthy, coping mechanism as provided by opiates. Similar to cravings, the severe downregulation and subsequent structural changes that occur to the limbic system during opiate addiction can take time to reverse and repair. Disruptions to the limbic system can have downstream effects on the neurotransmitters dopamine, serotonin, and GABA and all of these neurotransmitters contribute to someone’s mood and state of mind. Serotonin is probably the greatest contributor, being heavily responsible for mood elevation and regulation.
This results in a state of mind and outlook on the world which may best be characterized by the words hopeless, pointless, unmotivated, and unrewarded. People who are early in the detox process often feel hollow and cold with a sense that they will always feel this way, and nothing is going to change that. This is not the case, and only extended periods of abstinence will give their brain time to heal these changes. Once the brain can regain some sort of neurotransmitter balance, someone’s outlook will begin to lighten, becoming less bleak, hopeless, and depressed.
Anxiety is another very common symptom of opiate detox, usually beginning as generalized anxiety and tending more towards social anxiety as the weeks pass. This can be a minor or major symptom depending on the person with some people experiencing a great deal of anxiety, while others experience very little. While this is always most intense during the weeks immediately after opiate use has ceased, anxious symptoms may persist for several months in some form. This is due to imbalances in dopamine, serotonin, and norepinephrine along with structural changes the brain has undergone in response to neurotransmitter imbalances and downregulation.
Norepinephrine is both a neurotransmitter in the brain and a hormone when it is present in the blood. It is responsible for stimulating the release of adrenaline, so increased levels of norepinephrine will lead to a heightened state of awareness, often to an uncomfortable degree. Adrenaline is a major component of the fight-or-flight response, so the anxiety experienced during detox is akin to a panicked state of fear. This symptom will resolve with time, but continued abstinence is the only permanent solution.
The first steps toward finding an opiate detox center will be to search for one which is closeby, accepts your insurance, offers scholarships, or is reasonably priced for self-pay clients. Once a few candidate centers have been chosen, someone can move on to the details of insurance coverage or out-of-pocket cost to refine their options. A good place to start would be right here and right now…
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