"It's only like having the flu, right?"
Oh, if only it were that simple. I was asked this question so many times when I was caught in the grip of addiction. "Why didn't you just stop using?" It was always thrown out there like some brilliant, never-before-heard idea. In the beginning, I'd try to explain but after a while, you just give up. You shrug. It's truly not worth wasting your breath trying to describe the sheer, unimaginable torture—the profound physical and mental agony—that crashes down on someone who tries to quit opiates cold turkey without any help. And you know what's really frustrating? I even heard this question from people in the medical field. It always baffled me how folks with so much education could be so completely off-base, and sometimes, it felt like they were deliberately causing harm or just didn't care about an addict's comfort or well-being.
Just a heads-up: We're still learning the exact, intricate dance of chemicals and signals that causes those brutal withdrawal symptoms when we stop taking opiates (and other similar substances), but we've got a really good idea now. Also, it's worth remembering that withdrawal can feel different for everyone and depend on the specific substance, even though the basic stuff happening inside your body is pretty much the same. My own journey was mostly with fentanyl. And just so we're clear, the fentanyl you hear about on the streets, often made by cartels, isn't the same as the pharmaceutical kind; it tends to stick around in your body longer and can be incredibly unpredictable. But generally, almost all opiates and opioids will bring on similar symptoms once you stop. And for this article, I'll use "opiates" and "opioids" interchangeably because once they're in your body, they work on your system in a very similar way.
To really get what your body goes through during detox, it helps to first understand what happens when you take an opiate, and then how your body actually gets hooked.
Think of your body as a super-complex communication network, constantly sending and receiving messages. Things like pain, sleep, hunger, thirst, happiness, and pleasure? They're basically just chemical and electrical signals zipping from different parts of your body up to your brain. This whole system is managed by an amazing team of neurotransmitters and hormones. While there are tons of these chemical messengers, three big players—norepinephrine, dopamine, and serotonin—are super important for keeping everything running smoothly, and they get seriously messed up by opiate use and withdrawal.
When you take an opiate, it zooms into your bloodstream and makes its way to your brain and spinal cord. There, it finds special little docking stations called opioid receptors. Now, your body actually makes its own natural painkillers, called endorphins, and they fit perfectly into these same receptors. Opiates basically cut in line, mimicking your natural endorphins. When they bind, they create a powerful rush: incredible pain relief, a wave of intense euphoria, and a calming effect on your whole central nervous system (which is why your breathing and heart rate slow down).
But here's the tricky part: if you keep taking opiates, your brain starts to get used to having this external supply. It's like, "Hey, why should I make my own endorphins when these guys are doing all the work?" So, it slows down its own natural production and even reduces the number and sensitivity of its opioid receptors. This is what we call tolerance—you need more and more of the drug just to feel the same effect. As tolerance grows, your body also develops physical dependence. This isn't about wanting the drug; it's about needing it. Your system has become so reliant on opiates that it literally can't function "normally" without them. Take the drug away, and your body's natural systems go into a full-blown panic, leading to those agonizing withdrawal symptoms. Plus, the brain's reward pathways, especially those linked to dopamine, get profoundly rewired, making you crave the drug and making it incredibly hard to stop.
Here's a general idea of what acute opiate withdrawal feels like, based on a typical short-acting opiate like heroin or fentanyl. If someone's using longer-acting opiates, like methadone or buprenorphine, the withdrawal will start later and last longer.
8-12 hours after last use: As those opiate molecules start to unhook from your brain's opioid receptors and leave your system, your central nervous system begins to feel really out of whack. It's been so used to the opiates doing the job of your natural feel-good chemicals that, without them, it struggles to keep things balanced. Your brain tries to get things back on track, messing with the levels of norepinephrine, dopamine, and serotonin, which have been suppressed by the drugs. During this time, you might notice a runny nose, a bit of nausea, and you'll probably start yawning a lot, with tears welling up. Your muscles will begin to ache, you'll feel cold easily, and goosebumps might pop up. Your normal feelings of hunger and thirst might start to fade.
12-16 hours after last use: By now, the opiates are rapidly leaving your body, and your brain is in full-on alarm mode. It's screaming at your body to produce more natural neurotransmitters, but because it's been relying on outside help for so long, it's forgotten how to make the right amounts. This creates a massive chemical imbalance, flooding your nerves with desperate signals. Your body kicks into a widespread emergency response, almost like it's having a severe allergic reaction. You'll start expelling fluids and solids—and I mean rapidly—from every possible exit. Yawning becomes almost constant, several times a minute, with tears streaming down your face. You'll be vomiting uncontrollably and dealing with severe diarrhea, which quickly leads to dehydration. Your heart rate will skyrocket, and your blood pressure might go wild. Your body completely loses its ability to control its temperature, so you'll swing wildly between intense shivering chills and drenching sweats, sometimes every few minutes. You might start losing control of your muscles, with involuntary spasms and that awful restless leg feeling; you'll have an intense, desperate need to stretch, but no matter how far you try, it's never enough. The thought of eating or drinking anything will make you even more nauseous, and goosebumps will probably cover most of your body.
16-24 hours after last use: The intensity of all these symptoms ramps up significantly. Your body is in complete freak-out mode. The brain is trying to flood your system with norepinephrine, dopamine, and serotonin to fix things, but it's too late. It's going to take several more days for your body to even begin to sort itself out.
24-72 hours: This is the absolute peak. Symptoms are at their maximum and don't let up. Because dopamine is so out of whack, your brain can't trigger the "sleep" response. You'll be awake for most, if not all, of this time, maybe catching only an hour or two of restless sleep each day. You're utterly exhausted, physically and mentally drained. Sadly, most fatalities during acute opiate withdrawal happen in this window, mainly due to severe dehydration and electrolyte imbalances from the relentless vomiting and diarrhea.
96 hours: Finally, symptoms will slowly start to ease as your body gradually begins to find its balance again. You might actually be able to get 3-4 hours of fragmented sleep now.
120+ hours: Your thirst and hunger will slowly creep back. Those awful hot and cold flashes will start to fade. You'll still feel pretty rough, but the absolute worst of the physical withdrawal is finally over, and you'll start to feel a noticeable improvement. It'll take a few more days for all the acute physical symptoms to completely disappear.
Just when you think the physical nightmare is over, you have to face the long, drawn-out psychological symptoms, known as Post-Acute Withdrawal Syndrome (PAWS). Because of chronic opiate addiction, your brain's pathways have been significantly rewired—it's literally changed how it works. The delicate balance of your neurotransmitters and hormones is still profoundly out of sync, leading to extreme emotional ups and downs. You might experience intense mood swings, deep depression, crippling anxiety, a profound inability to feel pleasure (anhedonia), persistent sleep problems, soul-crushing fatigue, and real trouble focusing. This phase can last for months, often up to 9 months or even longer, as your brain slowly tries to heal and get back to normal. While some brain pathways might recover a bit, it's widely accepted that the brain's reward system and craving pathways are permanently altered. You will always carry a vulnerability to relapse, and for many, a persistent psychological craving for opiates, for the rest of your life.
We can delve into the question of whether an addict "deserves" this suffering at a later time, as this post is purely scientific. However, over the last 10 years of my addiction, I've witnessed some of the worst aspects of our society, often from those who have sworn a duty to "do no harm" or "protect and serve" all citizens. And they do—just not always the ones who truly need it most. American society, in many ways, is unlike any other civilization on Earth in its approach to addiction.
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