Is Opiate Withdrawal Life Threatening?

Medically reviewed by

Dr. Richard Foster, LICDC-CS

March 12, 2019

In order to better understand this question, we must first seek to understand this class of drugs and also how withdrawal from them impacts a user. An opiate is a drug obtained from opium, and may exist in one of the following three forms, as a natural, synthetic, or semi-synthetic opiate. These drugs are now most commonly referred to as simply opioids.

Opiate And Opioid Abuse

Opioids such as heroin, morphine, and prescription pain relievers are being abused in epidemic proportions all across the world. According to the National Institute on Drug Abuse, between 26.4 million and 36 million people abuse an opioid globally. The aftermath of this abuse has created a devastating effect on society, an impact that is increasingly witnessed all across the United States.

By 2014 in the United States, as cited by the Substance Abuse and Mental Health Services Administration, 435,000 people were using heroin on a regular basis and 4.3 million were using narcotic pain relievers in a non-medical way. The deaths from prescription opioids have climbed in the United States to four times greater than they were in 1999, as reported by the CDC. A link between nonmedical opioid abuse and heroin use is being revealed more each day in the United States.

This pressing problem of prescription opioid and heroin abuse must be confronted. As individuals turn more and more from prescription opioid painkiller abuse to heroin, due largely to the cheaper price and greater access, the understanding of opioid effects and dangers are even more crucial.

What Is The Appeal Of An Opioid?

To grasp why opioids are tempting to an individual and also why the risk of withdrawal is such an urgent concern, it is critical to understand the effects of what they do. People fall prey to opioids for a variety of reasons. Some abuse begins from medically prescribed use—that is to say, a person may begin misusing their prescription in an attempt to self-medicate their pain, to an extent that the abuse draws them into an addiction. Other individuals may seek diverted painkillers or illicit street drugs such as heroin for recreational purposes.

With low to medium doses, as is typical of prescribed use, the effect from opioid painkillers does not induce significant intoxication or impairment, however, in higher doses—as is characteristic of abuse and addiction, these drugs yield feelings recreational users seek. In these amounts, an illicit opioid will yet create analgesic (pain-relieving) effects, while also creating an unnatural sense of intense euphoria and comfort. Also, over a period of time, more of the drug will need to be administered for the same effect, this is called a tolerance.

Examples of commonly abused opioids, include:

• Heroin
• Codeine
• Methadone
• Fentanyl
• Hydrocodone (Vicodin)
• Hydromorphone (Dilaudid)
• Meperidine (Demerol)
• Morphine
• Oxycodone (Percocet or Oxycontin)

Each of these drugs can cause a physical dependence, which simply means a person’s brain has adapted to expect the drug, while reducing its own production of naturally occurring opioids. Once these drugs are attached to the receptors in the brain, they send off a signal to the brain which then blocks pain, slows breathing, and creates a calming and pleasurable effect for the user.

Within this state, they may then lean on these drugs to prevent withdrawal symptoms. The moment the person ceases to take the drug, the body will need space to recover. These withdrawal symptoms can happen anytime when the drug has been used for an extended period of time and is suddenly stopped or reduced. When this happens, a host of uncomfortable and even painful symptoms arise.

What Are The Symptoms Of Withdrawal?

In order to protect a person from the effects of withdrawal and seek help, it is important that you understand what happens should a person begin withdrawing from an opioid drug. The severity of withdrawal may somewhat vary, depending on the drug or drug of abuse and the rate and amount of drug a person used. What follows are some of the general symptoms of opioid withdrawal.

Early symptoms:

• Agitation, anxiety, or restlessness
• Inability to sleep (insomnia)
• Muscle pain, restless limbs, or tremor
• Increased tearing and/or a runny nose
• Sweating or chills
• Yawning
• Cravings

Later symptoms:

• Nausea
• Abdominal cramping
• Gastrointestinal distress (diarrhea and vomiting)
• Dilated pupils
• Goose bumps

In example, these withdrawal symptoms generally start within 12 hours of the last usage of heroin or within 30 hours of the last methadone exposure. While these symtoms are not always easy to overcome, they are not, in themselves, life-threatening, however, should you even begin to suspect that yourself or someone close to you is experiencing withdrawal, seek medical attention immediately.

This protects you not only from discomfort but from any complications that could be deadly. You should never attempt to quit using an opioid “cold turkey,” as it only serves to intensify withdrawal symptoms and risk.

How Can Withdrawal Become Deadly?

Not every withdrawal scenario is the same. A person’s withdrawal relies heavily on their state of physical health, any concurrent drug use, and any accompanying medical conditions. A patient more rarely has added complications unless they have a comorbid medical illness, however, it is still possible. The following are situations that may arise secondary to opioid withdrawal:

Rapid-detox — There have been reports of rapid-detoxes, or anesthesia-assisted opioid withdrawal resulting in death. A report published on The JAMA Network, spoke of these forms of detox, citing that “There are also significant concerns about risk, including marked increases …respiration… pulmonary distress; pulmonary edema; acute renal failure; ventricular bigeminy; psychosis; delirium; suicide attempts; and deaths associated with the procedure.”

Cardiac complications — When a person withdrawals from opioids, they may experience effects on their heart. These are not necessarily fatal, however, research reports that in some cases, the stress of withdrawal could cause a condition called Takotsubo cardiomyopathy (TTC), which may lead to heart failure. Heart failure, if left untreated, can be deadly. This publication elaborates, noting that

“TTC is a stress-induced reversible acute myocardial dysfunction that must be recognized as a cause of heart failure… Increased sympathetic activity secondary to the withdrawal of sympathetic antagonists, such as methadone, can lead to the development of TTC.”

What is frightening, is that the patient within the publication did not have history of coronary artery disease, thus, a person with a present cardiac risk may experience greater danger. Fortunately, if this risk is addressed and treated, the fatality may potentially be avoided.

Aspiration — Complications of withdrawal can include a person vomiting and then breathing in the stomach contents into their lungs. This event is called aspiration, and it can create a lung infection, suffocation, and in the most severe cases, death.

Seizure —Though seizures are not typically associated with opioid withdrawal, they have been reported within certain research publications. Additionally, if a person is withdrawing from another drug of abuse (such as benzodiazepines) at this time, they may experience a seizure because of this concurrent drug addiction. Should a person have a seizure during this time, they may injure their head in such a way that could also cause a fatality.

Dehydration — Diarrhea and vomiting can dehydrate the body and cause electrolyte imbalances. There has been reports of individuals losing their lives due to the extreme dehydration that resulted from an opioid addiction and the subsequent cold-turkey withdrawal.

Mental imbalances — Withdrawal can be very mentally and emotionally draining, to the extent it may cause intense depression and even suicidal ideation (thoughts of suicide). In this capacity, should a person carry out these thoughts with an attempt on their life, the effects of withdrawal could then be tied to a fatality, should they succeed.

Relapse — The largest life-threatening complication is the return to drug use. One of the most worrisome and problematic symptoms of withdrawal are cravings. Many times an opioid overdose death happens to a person who had just detoxed. Withdrawal lowers the person’s tolerance to the drug, hence, should a person take the same amount of an opioid—or even in some cases, a smaller dose than they used to take—they may overdose in a fatal way.

As you can see, for some, withdrawal from opioids goes beyond uncomfortable into a realm of dangerous and even life-threatening complications. This is why it is so important to seek help and assistance during the withdrawal process, as your very life may depend on it.

Getting The Help You Need

Facing withdrawal from these drugs is a very hard and even dangerous path. In order to protect yourself or a loved one, we strongly urge you to seek a medical detox. This will allow you greater safety and the support of highly-trained professionals to care for you at this crucial time. There are multiple settings in which withdrawal can take place, these include:

• At home, using medicines and a strong support system. (This method is difficult, and withdrawal should be done very slowly.)
• Using treatment facilities set up to help people with a medical detoxification.
• In a regular hospital, if symptoms are severe

After you successfully detox, we also recommend that you seek professional help, so that you may undergo research-based treatment to help you build a strong foundation for a drug-free life. Depending on the situation, this may include an outpatient or inpatient drug rehab center. When getting treatment, it oftentimes involves medicines, support, and counseling. Discussing your care and treatment goals with your healthcare provider is important.

Regardless of the setting, the most impactful and life-changing treatment has been shown to be that which includes various behavioral therapies, medication-assisted therapies, dual diagnosis care, individual and/or group counseling, and various other treatment modalities.

Prevent This Risk, Seek Help Now

If you or a loved one is fearful about encountering opioid withdrawal, or if you are suffering from opioid drug abuse, contact us today for more information. RehabCenter.net can help you to get started on a path towards treatment and a drug-free life. We can offer you resources and tools to make finding and obtaining treatment an easier process.