How Do Opiates Work?Opioids stimulate the production of beta-endorphins which bind to and affect opioid receptors in the body, mitigating pain. Beta-endorphins also indirectly boost neural concentrations of dopamine, a neurotransmitter responsible for feelings of happiness, reward, and euphoria. These dopamine-induced, recreational effects are the reason why people abuse opioids so regularly. Opioids are remarkably useful in modern medicine. Yet, because they produce such profound alterations in brain chemistry, regular abuse of them almost always leads to an addiction that may be intractable without outside intervention. Indeed, opioids are beguiling, and when under their spell, people report that use makes everything feel warm and pleasant and stress-free. Thus, without sufficient motivation to avoid the addiction outright, people may end up at their mercy – hopeless, unless someone rescues us.
Opiate Withdrawal SymptomsWhen a person takes a drug, over time their body becomes accustomed to the dose and requires more and more to achieve the desired effect – this is tolerance. As the body grows more tolerant, it begins to need the drug to function adequately – this is dependence. When a person’s body becomes chemically dependent on a substance, it enters a temporary state of dysfunction when that substance is absent – this is opioid withdrawal syndrome. The worst aspects of opioid withdrawals occur within the first week, though some symptoms persist even longer. In all, withdrawal symptoms will last around one month, but depending on the person, it could take several months for all symptoms to abate. Long-lasting withdrawal symptoms typically include anxiety, depression, and insomnia.
Opiate Withdrawal TimelineGiven that each person’s body is unique, a perfectly precise timeline for opiate withdrawals is impossible to establish. That said, we can construct a general timeline with which most cases of opiate withdrawal follow.
Days 1-2These first days are usually the most grueling, and because consuming more opioids resolves the withdrawals immediately, relapse becomes an intense temptation. In the earliest phases after the last dose, the soothing effect of the opiate will wear off, replaced by cravings for more opiates, restlessness, and anxiety. These symptoms will steadily become more powerful as the drug exits the system and leaves behind a chemical void in its wake. Opioids with shorter half-lives, such as heroin, can produce withdrawals as soon as six to twelve hours following the last dose. Opioids with longer half-lives, such as buprenorphine or methadone, only begin producing symptoms after one or two days, once they finally wear off. For shorter-acting opioids, withdrawal symptoms peak between one to three days after the last dose and slowly fade throughout the first week. At this time, the most conspicuous symptoms are muscle aches and pains. Opioids numb the nerves in our muscles, and once this numbness abates, the rebounding, over-excited nerves can’t regulate pain properly, causing pain and discomfort all over, but especially in the back and legs. The intensity of these pains can range from inconvenient to excruciating. Symptoms arising in the first two days may include:
- Muscle aches and pains
- Lacrimation (teary eyes)
- Difficulty sleeping
- Loss of appetite
- A runny nose
- Profuse sweating
- Severe Anxiety
- Panic attacks
Days 3 – 5The worst of the pain should now be over, but it may not be entirely gone. At this point, it may become difficult to keep food down due to nausea and vomiting. Diarrhea tends to lessen at this point, but mostly due to the loss of appetite. Overall, the withdrawal symptoms of short-acting opioids should be subsiding. However, abusers of long-acting opioids may be suffering the peak of their withdrawals, experiencing excessive sweating, appetite loss, digestive issues, and trouble sleeping. Symptoms experienced between the third and fifth days may include:
- Stomach aches