Hi everybody. The question I’m going to answer today is how long does opiate detox last? For those of you new to the channel, my name is Dr. B. This is Dr. B Addiction Recovery. It’s all things about substance abuse on this channel. If you do like our content, please subscribe and think about the like button. And we also have a Patreon account below where for as little as $3 a month, you can contribute to our sustained content. Let’s get started. The question that has been proposed to me is how long does opiate detox last?
I am going to change this question both because I think it’s asking something else and second, I want to change the framework of the question. Let me start with the second one. I want to change the framework of the question. And what I mean by that is I don’t like the term detox, and it’s actually no longer really used by the bodies in power. Detox, it is now called medically assisted withdrawal management or something like that. And for years, I’ve been
sort of against this term because I think it is misleading. Let’s think about it. What do we mean by detox? And let’s just stick to opiates for simplicity. When you say I’m going to detox or I’m going to detox off of opiates, what do you really mean by that are you saying that you want to get through their withdrawals okay so that would be withdrawals are you saying that once this stuff is out of your system you’re reset and sort of at a new
place in your long-term recovery well you are at a place and it’s good that somebody gets through those initial withdrawal symptoms, but I would say you’re a long ways away from recovery. But when you use the term detox, it implies some sort of a closure and a huge hump that you’ve gotten over. I don’t want to underestimate the difficulty of going over withdrawal symptoms,
but nevertheless, most folks, pretty much all folks in this situation have a long ways to go. So that’s how I want to change the framework of the question. In terms of what the question is asking, I do believe from looking at it, multiple sources of it coming in, the question is really asking is, how long do withdrawal symptoms last from opiates? And now we can get into that part. In general, you can say it depends on the person, age, sex, length of use, other comorbidities or medical issues that
might be exacerbated by this. But in a more formal answer is it depends on what was the opiate use and the half-life. Certain opiates that might be long acting or short acting are going to make the withdrawal symptoms come in quicker or later. That same characteristic, for example, if you’re talking about methadone, will make their withdrawal symptoms last longer or shorter. In general, we can say the acute withdrawal can last anywhere
from one to two weeks, and in general, we can say they come on anywhere from one to three days. Again, these are generalizations and there’s particulars with each person. And we’re just simply assuming opiate addiction, nothing else, the typical opiate and making generalizations that have been sort of validated by formal data. So we can say it starts one to three days afterwards, lasts one to two weeks. We can
also say that in general that opiate withdrawals are thought of as subjectively extremely difficult and painful, objectively or medically relatively safe. What do I mean by that? And it should be taken with a grain of salt. We know that benzodiazepine, alcohol, barbiturate withdrawals can get you very sick and potentially be life-threatening. In general, we can say that
opiate withdrawals are not life-threatening and take that with a grain of salt. It depends on you and the other medical conditions you have and consult with your physician. They are also considered to be, it’s funny, the literature describes it as mild flu symptoms, and I don’t think anyone that’s gone through heroin withdrawals would call it mild flu symptoms, but the constellation of issues we can potentially see with flu, and let’s
call it severe flu symptoms, is sort of analogous to what you may see initially up front with opiate withdrawals, runny nose, maybe congestion, teary eyes, severe joint and body aches, nausea, vomiting, diarrhea, abdominal cramps, severe sweating, you could have some physiological vital sign parameter changes with the anxiety and restlessness that could cause elevated
heart rate, elevated blood pressure, and then there’s also the insomnia and so forth. These symptoms can last one to two weeks and they start to eventually get better. I’m not discussing any medication or assistance we can give the person, but just the raw withdrawal symptoms from opiates. Eventually we have what is called, or the acronym they often use, is POS, post-acute withdrawal syndrome.
And this is interesting. That term applies to any drug, but the ones that really have prolonged syndromes usually are opiates, benzos, and alcohol. I myself really reserved the term POS for opiates. Another term is protracted withdrawal syndrome. What do we know about this thing? We know it could last for weeks, months, and I argue, and even with opiates, years, depending on what your baseline genetic predisposition was to using opiates. It is not as much physical as it is a
constellation of psychological symptoms and some of these can include difficulty with cognitive tasks, irritability, mood changes, difficulty with sleeping, anxiety. Some of the times they’ve even been described the obsessive compulsive behavior, apathy or pessimism, which is really the same as depression. But these symptoms can last up to months. And as I argue clinically from my experience years,
and there’s a subtlety in there and i won’t get into it or try to argue about it more importantly i think up to six months out they’ve even measured physiological changes including things like blood pressure heart rate ekg changes. And this was done many, many, many years ago. The fact that there’s physiological parameters associated with psychological symptoms has led others in the past, remote past, to argue that those physical parameter changes are what induce relapse and therefore the
set of vague psychological symptoms aren’t really the issue the person’s still going through physical withdrawals. There’s a lot to say about that and it’s important because even after a person gets through acute withdrawals, those protracted withdrawals over time are a large reason for relapse, whether we want to call them psychological or physical. In addition to some of the stuff I described, these people also have a decreased capacity to deal with stress, and the number one cause of relapse is stress.
And so that’s why you often see people that say, I can do this, I’ve had six months clean before, I’ve had a year clean, and they’re going about this year after year after year after year in this vicious cycle of trying to achieve this thing. And I’m referring mainly to people that refuse maintenance medication. But the real important point is that in that long-term withdrawal syndrome
that is often referred to as pause, that itself is a pretty important cause of relapse. And so even if a person gets through the acute withdrawals, those long-term issues can cause relapse. So withdrawals take on the acute form and the long form. And I want to differentiate one other point here. We often discuss what are your withdrawals and what are your cravings.
Especially in the initial phases, we can easily say without too much argument that, you know, withdrawals can cause relapse because they’re intolerable. Cravings can cause relapse because it’s just cravings. If you notice as time goes, what we’re calling long-term or protracted withdrawals really can potentially at the same time become cravings. And the line between the two is blurred. This is a very dangerous thing to not think about three months,
four months, five months, six months, eight months out. And this is where I want to reintroduce the concept, and as much as I harp on it regularly, of the importance of maintenance medication, buprenorphine products, or if someone’s on methadone. These set of medications can really mitigate a lot of things. Acutely, you know, if you get on them rapidly, you won’t go through a few days of withdrawals. You’ll have some discomfort.
You may have some adjustment issues. Some people do, some people don’t, but nevertheless, you’re increasing your probability of success in the initial stage. If you get through that initial stage, the first few weeks, the first couple of months, and really concentrate on your higher cognitive function and behavioral patterns and do a lot of mental health housekeeping and counseling and so forth well and you can make it into the long term now you’re really increasing your chances because
during that long term phase you’re mitigating both withdrawals and cravings which have sort of blended into the same thing. I hope that video helps your understanding of withdrawals and the role they play in relapses. I hope it gives you a little bit on the importance of maintenance medication. If you do like this video, click on the link above. There is a whole bunch of videos
that addresses every single one of these issues. And don’t forget, please click subscribe and like if you are so inclined. Have a great day. I’ll see you soon.