Dependence and withdrawal from opioids are due to the changes in brain chemistry habitual opiate use causes. Opiate dependence can lead to death if untreated.
What Are Opioids?
To best understand what causes opioid dependence and subsequent withdrawal, understanding opioids at their core is essential.
Opioids are a specific class of substance that is created from the opium poppy or synthesized to work similarly. The effects of opioids on the brain are significant, producing not only a variety of intended and unintended effects but creating a significant risk for abuse as well. Opioids bind with specific receptors in the brain and central nervous system, and in doing so, they can act as some of the most powerful painkillers in the world.
Nearly all prescription opioids are designed and prescribed to block pain signals that are sent by nerves to the brain. This signal block is the core of opioid functionality and is why they can treat moderate to severe levels of pain with relatively small dosages. While people that use them to control pain find relief when they are used properly, misusing opioid prescription pain relievers is one of the leading ways that opioid addictions are created.
When people with pain use opioids they feel pain relief, but something different happens when there are no powerful pain signals to block out. Those without significant pain that use opioids find that taking prescription opioids creates a more euphoric feeling. This is the reason that it is so easy to develop a physical dependence on opioids.
Opioid Use Disorder Affects Millions
Opioids are so commonly abused, that there is now an official diagnosis called Opioid Use Disorder. Opioid use disorder is seen as an overpowering urge to use opioids, combined with increased opioid tolerance, and the development of opioid withdrawal symptoms when use is stopped. This means those who may have opioid use disorder may need additional measures in their treatment plans to navigate detox and post-acute withdrawals successfully.
The increased tolerance to opioids that results from opioid use disorder is also a major contributor to higher rates of relapse that have been reported. In a recent report from the Centers for Disease Control and Prevention, more than 92,000 people died from drug overdoses, which indicates almost a 30% rise over the prior year.
Opioid use disorder has become so prevalent, that there have been medications developed specifically to help treat patients with OUD. Two common therapies are using the Methadoneexternal icon and buprenorphine external icon. These can even be used on pregnant patients with OUD.
How Do Opioids Affect the Brain?
The primary effect of opioids on the brain is to block pain signals and to make you feel calm and happy. This means that when someone uses opioids daily, then suddenly stops, the brain doesn’t know how to feel calm and happy without opioids.
The result is that the individual will feel incredibly anxious or panicked, as well as emotionally disrupted, becoming irritable or even violent. Sometimes an NSS-2 Bridge can be used to minimize the effects of the sudden cessation of opioid use.
What Causes Opioid Withdrawal and Dependence?
The foundation of dependence is tolerance, and when someone takes an opioid for long periods, their body and brain become accustomed to operating relatively normally with that dosage of opioids in the system. Since opioids are a depressant, they cause feelings of calm, euphoria, and bliss in those who abuse them. This leads them to take opioids more often to feel that same feeling.
Except that the opposite happens, and instead of feeling more of that high, the opioids become less effective, and more are needed to even come close to the high they want. This is the tolerance building up. Once tolerance has built up enough, there will be a significant chemical dependency in place in the body.
Once the dependency is in place, the opioids cannot be stopped or the system goes into a form of shock. Heart rate, blood pressure, and respiration all spike, and the withdrawals begin. The withdrawals are the body struggling to function the same without opioids.
Opioid Withdrawal Symptoms and Timeline
Once an individual commits to getting professional help, they can be well on their way to long-term recovery success in just about two weeks. Upon checking into an inpatient treatment program, the detox stage will start immediately, leading into the acute withdrawal stage, and the post-acute stage signals the end of the detox stage and the beginning of lifelong recovery efforts.
The first stage is the detox stage, which will start to occur as soon as the rest of the drug has been metabolized without being replaced, and is out of the system. In the case of many opioids, this means that the patient may start to feel the first withdrawal symptoms in just a few hours after their last dose. This can become immediately uncomfortable for many people, and even painful for some, depending on their medical history and addiction profile.
When the withdrawal symptoms begin, the acute withdrawal stage has started, and many of the common symptoms of opioid withdrawal will begin. The symptoms most often encountered first are nausea and abdominal cramping, along with significant intestinal distress. Once a symptom begins, it will take 1-2 days for it to peak in severity, and it will generally last for 3-5 days in total. The acute stage will commonly last 7-10 days.
The post-acute stage is where most if not all of the physical withdrawal symptoms have run their course and dissipated, but the individual is left with some of the longer-lasting mental or psychological symptoms. These can include things like depression and anxiety, along with continued periodic cravings for opioids.
Treating Opioid Addiction
It is vital for those living with opioid addictions to understand that help is available and that treatment for opioid use is often found right in your neighborhood. Local treatment centers are often able to offer several types of opioid treatments, including medication assistance and inpatient detox services.