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Opana Withdrawal & Detox

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 09/24/2020

Number of References: 21 Sources

The symptoms of Opana withdrawal, while rarely dangerous, are very unpleasant and uncomfortable. A strong opioid painkiller, this drug can produce strong physical and psychological symptoms when a chronic user suddenly ceases use. Here we will take a look at the specific causes of Opana withdrawal, the symptoms and effects themselves, the timeline involved, as well as some effective treatments to reduce the discomfort, and increase the chances of someone successfully completing withdrawal from Opana.

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Opana Pharmacology & Addiction

Opana is a very powerful opioid painkiller whose active ingredient is oxymorphone. Oxymorphone is about 3 times as potent as morphine per milligram when taken orally and it has a fairly long half-life as far as many opioids are concerned at between 7-9 hours. This half-life is dose-dependent due to the extensive metabolism that Opana undergoes, with higher doses leading to a longer total half-life. Opana is a strong agonist (activator) at the μ (Mu) opioid receptor with fairly weak interactions at both the κ (Kappa) and δ (Delta) opioid receptors.

The opioid system is a powerful neurotransmitter system in the brain and body that is, in part, responsible for the perception of pain, mood, and pleasure along with a multitude of other functions. When using Opana, the opioid system is activated much more strongly than is possible from the natural opioid peptides produced by the body. This produces euphoria, pain relief, gastrointestinal slowing, somnolence, and a general depression of neurological functions. Through chronic use, the brain and body will begin to adapt to the presence of Opana through a process called downregulation. This is the act of the body reducing the sensitivity and/or the number of opioid receptors in an attempt to main balance and effective homeostasis.

Once downregulation occurs, the normal opioid peptides will be unable to stimulate opioid receptors to the necessary degree. This will result in tolerance in the short term, where more Opana, or any opioid drug, is needed to produce the same effects they previously produced. Through continued use and further downregulation, this produces a physiological dependence on the drug, where someone will begin to feel unwell, both mentally and physically when they go too long without using opioids. Further use can deepen this dependence through a process known as neurological remodeling, which is where the brain makes structural changes to better operate in this chronically downregulated environment. Remodeling is responsible for the long-term effects of Opana withdrawal, including the prolonged psychological symptoms that can last for long periods after drug use ceases.

Opana Withdrawal Symptoms

The symptoms of Opana withdrawal can be divided into two distinct phases: acute and post-acute withdrawal. The acute phase is what most people probably picture when they think of opioid withdrawal and is characterized by sometimes intense physical symptoms along with psychological symptoms. The post-acute phase can be prolonged, although the symptoms are strictly psychological in nature.

The acute phase manifests symptoms within hours of the last time someone used Opana, and these can become quite severe in heavy users. These symptoms are rarely dangerous on their own, but if someone has a pre-existing health issue, this could lead to dangerous complications. In particular, those with heart health issues or diabetes are at an increased risk of dangerous outcomes during withdrawal.

Some of the most common symptoms of Opana withdrawal include:

  • Increased Anxiety
  • Diaphoresis (constant sweating)
  • Rhonirrhea (very runny nose)
  • Piloerection (goosebumps)
  • Chills and Hot Flashes
  • Extreme Restlessness
  • Frequent Yawning
  • Depression
  • Allodynia (inability to experience pleasure)
  • Fatigue and Lethargy
  • Cravings for Opana
  • Shaking and Tremors
  • Insomnia
  • Loss of Appetite
  • Stomach Cramps and Diarrhea
  • Nausea and Vomiting
  • Pain in the Muscles, Joints, and Bones
  • Elevated Blood Pressure
  • Increased Heart Rate

These physical symptoms can be very uncomfortable, or even painful for those who used Opana in large amounts, or for a long period. The most uncomfortable symptoms are fairly short-lived; usually dissipating within a week or so. Entering an Opana detox center can make the experience much less uncomfortable, and for those with pre-existing health conditions, it may reduce the risks as well. After these physical symptoms resolve, there are still challenges ahead, as the post-acute, psychological symptoms may persist for weeks, months, or even years in some cases.

Post-Acute Opana Withdrawal

The post-acute Opana withdrawal symptoms, while less directly unpleasant, can make continued sobriety very difficult. Being strictly psychological in nature, these symptoms can be a hurdle to meaningful interpersonal connections and continued recovery. They are usually depressive in nature, and can cause someone to be depressed, unmotivated, and exhibit a general negative affect. While not directly dangerous, the sometimes profound depression that can manifest may increase the risks of both relapse and/or suicide, so these post-acute symptoms should not be taken lightly.

Some of the most common post-acute Opana withdrawal symptoms include:

  • Depression (possibly including suicidal ideation)
  • Increased Anxiety (especially social anxiety)
  • Fatigue and Lethargy
  • Cravings for Opana
  • Increased Irritability
  • Insomnia

These symptoms may emerge alongside the physical symptoms within a day or so of the last Opana use, although they will persist much longer than the acute symptoms. While the physical symptoms are due to opioid receptor downregulation, the post-acute symptoms are due more to the neurological remodeling that occurs after prolonged opioid receptor downregulation. There is great variability between individuals regarding the duration of post-acute Opana withdrawal symptoms, with some people making a full recovery within weeks and others experiencing symptoms for many months or even years.

Opana Withdrawal Timeline

As with many drug withdrawal syndromes, the symptoms of Opana withdrawal can vary in duration between people. For the most part, the timeline of the acute phase is fairly standard, but the post-acute phase can exhibit substantial differences in length. With Opana’s intermediate half-life of ~7 to 9 hours, withdrawal symptoms can begin within 12 hours of the last use. These symptoms will begin mild and escalate over several days before stabilizing and finally resolving over the following few days. The acute symptoms of Opana withdrawal can last for around a week and are outlasted, sometimes significantly, by post-acute Opana withdrawal symptoms.

First Week

Usually, the first symptoms of Opana withdrawal to emerge are increased anxiety, sweating, and a very runny nose. These may begin within 12 hours of the last Opana use and will be joined by chills and hot flashes, which may sometimes alternate or occur simultaneously. The first night usually exhibits insomnia and severe restlessness with someone unable to get much meaningful rest. The next day, tremors and shaking often arise along with stomach issues such as cramps, diarrhea, reduced appetite, and possibly vomiting. Irritability will increase and energy levels typically plummet, leaving someone unable or unwilling to do almost anything other than move between their bed and their bathroom. In addition, aches and pains usually emerge during the second day and include muscles, joints, and even bones. Cardiovascular fluctuations can occur as well, although these are usually just a nuisance and not dangerous unless someone has underlying heart problems or diabetes. All of these symptoms will often increase over the first three or four days before plateauing and finally resolving over the next few days.

Second Week

The second week usually shows some improvement, although the beginning of the week is often very rough. The physical symptoms may be on their way to resolution, but several days of little to no sleep or food, coupled with the stress of withdrawal, can leave someone mentally and physically distraught. With the exception of mild insomnia, the physical symptoms are usually almost totally resolved by day seven or eight after the last time someone used Opana, although the psychological symptoms are often still present. The psychological effects may be more pronounced during this time as well since the physical symptoms are no longer present to distract from the mental effects. Depression and strong cravings for Opana may emerge during the second week if they haven’t already. Fatigue and lethargy are usually still pervasive, and anxiety remains high.

Third Week

By this time, the physical symptoms are usually fully resolved. While sleep may remain somewhat difficult, it is much improved since the last week. With appetite returning to normal and diarrhea subsiding, better eating habits and more effective digestion can go a long way towards improving someone’s state of mind and body. Depression, cravings, and anxiety are often still present, sometimes at high levels, and irritability and low energy levels often remain. This time, maybe surprisingly, may pose the greatest risk of relapse. Cravings can remain strong, and without the physical symptoms to remind someone how bad it is, the idea to use Opana again can often seem more attractive within the first few weeks of withdrawal.

Fourth Week and Onwards

Four weeks after the last time someone used Opana, there is often substantial improvement. Someone will be physically much healthier, although the psychological symptoms may persist. While the worst may be behind someone, there is still a long journey ahead. It is highly recommended to seek additional care after withdrawal has been completed, as the road to recovery can sometimes be difficult. Having help on the way can increase someone’s chances of long term recovery as well as making the process less difficult and stressful. Both medications and therapies can be used to reduce the severity of these symptoms until the body and mind can repair themselves, and this is often highly recommended.

The Importance Of Opana Detox

Entering an Opana detox center can provide a multitude of benefits, both short and long-term. As far as the short term, the process of Opana withdrawal and detox can be made much less unpleasant through medications, therapies, and medical supervision to reduce possible risks. In the long term, the therapies provided can help someone develop healthy coping skills and relapse prevention practices. Additionally, these centers may provide referrals to continuing care programs after detox has been completed. These centers are often the first step towards long term recovery and a new life free from Opana addiction.

Opana Detox Center Guide

Physical Effects Of Opana Withdrawal

Even though the physical effects of Opana withdrawal are rarely dangerous, they can still be extremely uncomfortable. The opioid system has effects on systems other than simply pain sensation and psychological factors. These include a heavy influence on gastrointestinal function and an unclear, although present, influence on heart function. These major body systems, along with several other effects are quite common during Opana withdrawal.

The opioid system also has downstream effects of other neurotransmitter systems. In the case of Opana withdrawal, the neurotransmitters serotonin, dopamine, and norepinephrine are affected. This is due to both downregulation and remodeling in these neurotransmitter systems that can produce a variety of effects. As far as physical symptoms are concerned, norepinephrine disruptions can contribute to some of the endocrine, exocrine, and cardiovascular effects of Opana withdrawal.

Gastrointestinal Effects

Aside from their presence in the brain, opioid receptors are also found in the gastrointestinal tract. While the 3 major receptors are found in the gut, the μ-opioid receptor is by far the most plentiful. This is also the opioid receptor that Opana binds most strongly to. In the gut, the μ-opioid receptors act to slow and moderate intestinal muscle contractions, affect the stomach emptying its contents into the intestines, and modulate sphincter muscle tone. Due to chronic Opana use, opioid receptors in the gut also undergo downregulation. This means that the normal endogenous opioids will have a reduced ability to stimulate these receptors once someone stops using Opana.

The most direct gastrointestinal effects of Opana withdrawal are general digestive hyperactivity. This includes stomach cramps, nausea, loss of appetite, and frequent diarrhea. Vomiting may also occur, although this is rarer than these other symptoms. The ability of the μ-opioid receptors to slow this activity is compromised due to downregulation, so digestion happens much more quickly than normal, producing a great deal of discomfort. In addition, this may potentially increase risks and dangers for those with underlying health issues. Diarrhea can be very frequent during Opana withdrawal, and dehydration is a real risk. These can be amplified by a decreased appetite and a decreased desire to drink, also due to the gastrointestinal issues that arise from eating and drinking. This can lead to complications when combined with other, pre-existing health conditions.

Cardiovascular Effects

The cardiovascular effects of Opana withdrawal are less intense than those on digestion, but they can still produce some discomfort. They are rarely dangerous in otherwise healthy people, but those with pre-existing heart problems or diabetes may be at increased risk for negative complications. The main physical contributor to the cardiovascular effects is disruptions to the norepinephrine neurotransmitter system. During withdrawal from Opana, both the levels of norepinephrine and the body’s sensitivity to norepinephrine are increased.

Norepinephrine is both a hormone and a neurotransmitter, depending on where it is found in the body. When found in the blood, it can increase heart rate, heart contractility, blood pressure, and blood sugar levels. It is a major moderator of the fight-or-flight response and can affect the levels of epinephrine (aka adrenaline) in the blood. In normal circumstances, levels of norepinephrine may spike for short periods in a critical survival situation, such as when facing a predator. During withdrawal, the levels are increased for an unusually long time and this can lead to prolonged periods of increased heart rate, blood pressure, and blood sugar. Those with heart problems or diabetes are at an increased risk of cardiac arrest, hyperosmolar hyperglycemic nonketotic syndrome (HHNS), or diabetic ketoacidosis.

Secondary Effects

There are a variety of other physical effects of Opana withdrawal, and while some of these may arise from the same underlying causes, they may manifest in different physical systems. For example, some of the effects listed below are caused by the same imbalances that produce the cardiovascular effects and are all technically autonomic nervous system effects of Opana withdrawal. These can be caused by increased norepinephrine as well as direct opioid system disruptions. Some of these effects have obvious and understood causes, while others remain somewhat mysterious. That being said, these effects are all quite common during Opana withdrawal.

Some of the effects on the autonomic nervous system, aside from the cardiovascular effects, include:

  • Dilated Pupils
  • Tremor or Shakes
  • Insomnia
  • Diaphoresis (constant sweating)
  • Rhinorrhea (very runny nose)
  • Body Temperature Fluctuations
  • Blood Sugar Instabilities

A very common effect with no clear cause is:

  • Frequent Yawning

Psychological Effects Of Opana Withdrawal

The psychological effects of Opana withdrawal, while less directly dangerous, can be very uncomfortable mentally and can still pose unique risks. In addition, these effects can be quite long-lasting, often persisting for weeks, months, and even years in some cases. These can manifest both as depressive symptoms and a general negative affect as well as hyperactive symptoms in the form of increased anxiety. While the duration of these symptoms can be different for everyone, they will improve with time and continued abstinence from Opana use.

Depression

One of the major secondary effects of the opioid system is on the serotonin neurotransmitter system. Serotonin is a mood elevator and regulator, and many popular antidepressants, SSRIs and SNRIs in particular, work by increasing the levels of serotonin within neurons. Through strong opioid receptor stimulation, levels of serotonin are increased, and through chronic use, this can lead to downregulation and, later, remodeling of serotonin systems. Due to both of these factors, after someone stops using Opana the serotonin system will be unable to moderate mood as it normally would since the receptors have an increased activation threshold. This can result in both mood swings and depression, two very common symptoms of Opana withdrawal.

In addition to strictly neurological causes, there may be behavioral reasons for depression as well. Opana use, as with all opioids, can become a very powerful coping mechanism, helping someone to deal with the normal stresses and challenges of life. While it is extremely unhealthy, the potency of Opana can cause someone to become emotionally dependent on it to cope with life. Once this is suddenly removed, there can be a great sense of loss and hopelessness. Coupled with all of the other symptoms of Opana withdrawal, this sense of loss can contribute to the depressive effects.

Cravings For Opana

Arising from somewhat similar causes as depression, cravings are very common effects of Opana withdrawal. From a neurological standpoint, there is a similar mechanism at work, albeit in a different neurotransmitter system. Where cravings are concerned, dopamine is often the culprit as opposed to serotonin. Dopamine is a major excitatory neurotransmitter, and when released in certain areas of the brain, such as the nucleus accumbens, amygdala, and hippocampus, it can produce feelings of reward that are strongly tied to the memories of the actions that produced this reward. After prolonged Opana use, dopamine downregulation, and later remodeling, will occur which reduces the ability of normal levels of dopamine to produce any feeling of pleasure or reward. After this has occurred it is common for any feeling of pleasure to be associated with Opana use. When someone longs to feel better during withdrawal, they will frequently think that more Opana use is their only source of relief.

In addition to these neurological causes, there are behavioral ones as well. Similarly to the symptoms of depression, the loss of a powerful coping mechanism can cause someone to crave its return. The mental and physical symptoms of Opana withdrawal can cause someone to want relief, understandably so. Oftentimes, their natural instinct at this point would be to use more Opana for relief, leading to cravings for the drug. These behavioral and neurological causes can be treated, but the most important factor is remaining clean from Opana, or any drug use for that matter, for long enough for the brain to recover from the changes produced through addiction to Opana.

Anxiety

Anxiety is another very common effect of Opana withdrawal. While anxiety may be increased in general, social anxiety can be particularly prevalent. This can have multiple causes, including neurological, behavioral, and psychological. From a neurological perspective, it is known that norepinephrine is increased during opioid withdrawal. With norepinephrine being an excitatory neurotransmitter and hormone, this results in attention being heightened, sometimes to the point of a constant state of hypervigilance.

Psychologically, the other symptoms of Opana withdrawal, both physical and psychological, can leave someone mentally drained and on edge. This can leave someone feeling overwhelmed and vulnerable, initiating a natural anxiety response. From a behavioral standpoint, the loss of such a powerful, and unhealthy, coping mechanism as Opana can also contribute to anxiety. With a sudden loss of this coping mechanism, someone may feel extremely tense and with an inability to resort to their most powerful coping tool, a constant state of dysphoria and tension is common. Similar to the rest of the psychological effects of Opana withdrawal, these will often reduce over time so long as someone remains free from Opana or other drug use.

What Factors Influence The Intensity of Opana Withdrawal?

Withdrawal from Opana is a very unpleasant experience, although the intensity of this unpleasantness can vary. There are several factors that can alter the severity of symptoms, some of which are based on choices someone makes, while others are totally out of their control. Some of these factors can influence both the intensity and the duration of Opana withdrawal symptoms.

Some factors that can influence both the duration and the intensity of Opana withdrawal include:

  • The amounts of Opana someone used
  • The amount of time someone used Opana
  • Co-occurring mental health issues
  • A genetic predisposition towards addiction

The largest contributor to the intensity of Opana withdrawal symptoms is certainly the amounts of the drug someone used. The downregulation that occurs is directly influenced by the amount of Opana someone uses; more Opana equals more downregulation. The more downregulation that occurs results in more severe withdrawal symptoms. In addition, the length of time someone used Opana can directly affect the duration of symptoms. Remodeling will also occur alongside downregulation, although the effects of remodeling will take some time to be felt. The longer someone uses Opana, the more remodeling occurs, thus the longer it takes to reverse once someone stops using the drug.

Co-occurring mental health issues can influence the intensity of withdrawal symptoms, although in a less direct manner. Since anxiety and depression are such common symptoms of Opana withdrawal, if someone had a prior issue with either of these mental health issues, they may experience worse psychological symptoms during Opana withdrawal. This may also result in the symptoms taking longer to resolve once they do quit using the drug. Finally, the risk of suicide is usually increased during withdrawal, so increased depression or anxiety could contribute to an even greater increase in the risk of suicide.

Genetics plays a role in addiction, for sure, although the exact extent of this role is unclear at present. While it may be a very tangential influence, genetics probably plays some role in the intensity of Opana withdrawal symptoms, however indirect it may be. Addiction does tend to run in families and this could influence both the age someone starts using Opana or the frequency or intensity of use once they do begin.

Opana Withdrawal Treatments

Addiction to Opana can be extremely challenging to overcome, and it often requires help. Thankfully there is a wide range of treatment approaches to helping people overcome this difficult hurdle. Medications can help treat both the physical and psychological symptoms, while therapy can help the psychological symptoms and provide healthy tools for continued sobriety. When used together, these treatments can provide a comprehensive toolkit to help someone find their way out of the dark place that people are often living in during Opana addiction.

Medications

Recently approved by the FDA, lofexidine (Lucemyra) is the first non-opioid that is approved to treat opioid withdrawal. Other than this medication, there are many that have been used to effectively treat individual Opana withdrawal symptoms as they arise. Some of these can be used to treat the immediate, physical symptoms, while others may be used for longer periods to reduce the severity of the longer-lived psychological symptoms.

Some medications commonly used to treat Opana withdrawal include:

  • Antidiarrheals
  • Sleep Aids
  • Antidepressants
  • Anti-Anxiety Medications
  • Certain Blood Pressure Medications (usually β-blockers to reduce anxiety)
  • Antihistamines

These are just a few of the broad classes of medications that are frequently used, and some of these classes have many effective medications to choose from. Everyone responds a little differently to certain medications, so finding the most effective one may take some time. Having the help provided by Opana detox centers can be invaluable in this regard. These centers have trained and experienced medical professionals that make it their life’s work to help those struggling with Opana addiction to find a way out.

Therapies

While medications can treat the symptoms, getting to the root causes that underlie some of the psychological issues is the specialty of therapy. Not only can these therapies help reduce the discomfort of some of the psychological symptoms, but it may also provide effective tools for continued recovery such as healthy coping skills, communication skills, and developing healthy boundaries. These can give someone the confidence, peace of mind, and support needed to break free of Opana addiction once and for all.

Some therapies that are commonly used to treat Opana withdrawal include:

  • Behavioral Therapies
  • Individual Counseling
  • Group Therapy
  • Coping Skills Development
  • Support Groups
  • Aftercare Planning

The importance of therapy as a foundation for long-lasting recovery cannot be overstated. Getting to the root causes of why someone began using Opana in the first place, trauma experienced during active addiction, or shame and guilt related to behaviors during addiction can be an extremely enlightening and healing process. More than that, therapy can help someone break unhealthy habits and replace them with constructive behavioral practices, both mental and physical. This can help someone avoid the pitfalls that may lead them to want to use Opana again, and further improve their chances of lasting recovery.

While the symptoms of Opana withdrawal are not usually fatal, the intense discomfort may be too intimidating for many people to overcome alone. Entering an Opana detox center is often the first step towards a new life, and the resources provided at these centers can be life-changing. Not only do these centers provide medications and therapy, but they can also act as a liaison towards further treatment and continuing care after Opana detox is complete. Recovery is possible, it only requires the courage and willingness to ask for help. This may not be easy, but with support and direction, a life free from Opana addiction can be a reality.

References For This Article

  1. 1 FDA AccessData: Opana ER (oxymorphone hydrochloride) Label
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  3. 3 Addiction Biology: Pharmacodynamic Effects of Oral Oxymorphone - Abuse Liability, Analgesic Profile and Direct Physiological Effects in Humans
  4. 4 Journal of Pharmaceutical Sciences: Oxymorphone Active Uptake at the Blood-Brain Barrier and Population Modeling of its Pharmacokinetic-Pharmacodynamic Relationship
  5. 5 Pharmacogenetics and Genomics: PharmGKB Summary - Oxycodone Pathway, Pharmacokinetics
  6. 6 Archives of Physical Medicine and Rehabilitation: Efficacy and Safety of Oxymorphone Immediate Release for the Treatment of Mild to Moderate Pain After Ambulatory Orthopedic Surgery - Results of a Randomized, Double-Blind, Placebo-Controlled Trial
  7. 7 Clinical Pharmacology & Therapeutics: Pharmacokinetics and Pharmacodynamics of Oral Oxycodone in Healthy Human Subjects - Role of Circulating Active Metabolites
  8. 8 Pain Physician: Opioid Pharmacology
  9. 9 Toxicologic Pathology: Gut Homeostasis, Microbial Dysbiosis, and Opioids
  10. 10 Regulatory Peptides: Opioid Receptors in the Gastrointestinal Tract
  11. 11 StatPearls: Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC, Hyperosmolar Hyperglycemic Nonketotic Syndrome)
  12. 12 Handbook of Experimental Pharmacology: Insights into the Role of Opioid Receptors in the GI Tract - Experimental Evidence and Therapeutic Relevance
  13. 13 F1000 Research: Targeting Mu Opioid Receptors to Modulate Gastrointestinal Function - What Have We Learnt so far from the Studies in Functional Bowel Disorders?
  14. 14 Journal of Gastroenterology: Physiology, Signaling, and Pharmacology of Opioid Receptors and their Ligands in the Gastrointestinal Tract - Current Concepts and Future Perspectives
  15. 15 Neuropsychopharmacology: Augmented Accumbal Serotonin Levels Decrease the Preference for a Morphine Associated Environment During Withdrawal
  16. 16 Biological Psychiatry: The Negative Affect of Protracted Opioid Abstinence - Progress and Perspectives From Rodent Models
  17. 17 American Journal of Psychiatry: The Neural Basis of Addiction - A Pathology of Motivation and Choice
  18. 18 Biological Psychiatry: Distinct Roles of Adenylyl Cyclases 1 and 8 in Opiate Dependence - Behavioral, Electrophysiological, and Molecular Studies
  19. 19 Biological Psychiatry: Brain Norepinephrine Rediscovered in Addiction Research
  20. 20 Neuropsychopharmacology: Beta-Adrenergic Antagonists Attenuate Somatic and Aversive Signs of Opiate Withdrawal
  21. 21 Journal of Neuroscience: An Anatomical Basis for Opponent Process Mechanisms of Opiate Withdrawal

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