When a person stops taking opioids, most will experience withdrawal symptoms. These symptoms combine to form a disorder called opioid withdrawal. When withdrawal symptoms start and their severity, according to the American Psychiatric Association, depends on the type and dosage of the opioid taken. Heroin withdrawal can begin within 6-12 hours of the last dose, while in other opioids, the withdrawal symptoms may not begin for 1-4 days.
Opioid withdrawal syndrome is characterized by the following symptoms.
At least one of the following two (2) symptoms:
- Administration of an opioid antagonist — such as naloxone or naltrexone — after a person has used an opioid (whether a prescription pain killer or heroin)
- Stopping or reducing heavy and prolonged opioid use (e.g., after weeks or months of use).
Three (3) or more of the following symptoms that develop after stopping regular opioid use:
- Nausea or vomiting
- Pupils dilate, profuse sweating, or goosebumps
- An intense state of unease or dissatisfaction (dysphoria)
- Muscle aches
- Severe runny nose or tearing of the eyes
These symptoms must cause clinically significant distress or impairment in the individual, in either work, social, schooling, or some other important area of their life. The symptoms cannot be better attributed to another medical condition or mental disorder.
Related Information to Opioid Withdrawal
Over 60 percent of people who use heroin in the past 12 months will experience opioid withdrawal, according to the American Society of Addiction Medicine. Opioid withdrawal is often seen in a person who is diagnosed with opioid use disorder, as they attempt to stop using the drug in a regular pattern of discontinuation and relief from the discontinuation symptoms. In order to reduce the withdrawal symptoms, a person will often times return to taking an opioid, resulting in a vicious circle of reinforcing use.
According to the National Institute on Drug Abuse, opioid withdrawal is best managed through an approach called “medication assisted treatment,” where a person receives behavioral counseling as well as medications that help relieve the withdrawal symptoms. Medications used to treat withdrawal symptoms typically include buprenorphine (brand names Suboxone or Subutex), methadone, and extended release naltrexone (brand name, Vivitrol).
Unfortunately, despite this recommendation and the scientific evidence supporting its use, most private substance use disorder treatment programs (“rehab” programs) do not use medication assisted treatment (MAT). Check with the program you’re considering before agreeing to treatment about whether they use this method or not; avoid programs that don’t use MAT.
The ICD-9-CM/DSM-5 diagnostic code is 292.0; the ICD-10-CM diagnostic code for moderate to severe opioid use disorder is F11.23. (Do not use the ICD-10-CM withdrawal code with mild opioid use disorder.)