Opiate Withdrawal Symptom Discomfort Scale
* = Annoying ** = Uncomfortable *** = Very Uncomfortable **** = Agonizing
Opiate Withdrawal Symptoms – Daytime
Dr. Brian Earthman, MD
Psychiatry and Addiction Medicine Chief Clinical Advisor, Withdrawal-Ease
* Pupil dilation (large pupils): Pretty self explanatory. When your body is in withdrawal, your pupils get very large and as a result, your eyes can become a bit more sensitive to sunlight.
* Racing heartbeat: Your heart will race a bit but it’s nothing to worry about. Your heart will feel like you have just exercised or had an anxiety attack. One of the more unsettling withdrawal symptoms.
* Watery eyes and nose (not related to allergies): No itchiness, just tears running down your cheeks, constantly.
* Tremors (hands and feet): The tremors are mostly in your hands but can also be evident in other parts of the body. Confucius says: Just think of your body as a “tree”; when the wind blows the smallest branches shake the most. The same can be said for these tremors.
** Excessive sweating: The sweating can be in sudden bursts or over an extended period of time and can include the hands and feet. Attractive, eh?
** Yawning: I’ve never yawned more than when I was in opiate withdrawal. It’s due to some sort of chemical misfire in the brain that is very common during the detox process. So in addition to looking and feeling awful, everyone around you will think that you’re terribly rude. It’s kind of funny… unless you’re the yawner.
** Goose flesh (goose-bumps): Goose-bumps are the by-product of the shivering that you’ll experience during withdrawals. Although not terribly uncomfortable, they are prevalent throughout the withdrawal process and will probably rival any prior goose bumps you’ve ever had, both in size and quantity.
** Lack of appetite: You will not feel any urge to eat at all either due to an upset stomach or lack of appetite. However, as we discuss in the Survival Guide, your body needs fuel to speed up this withdrawal process so you need to make a conscious effort to keep yourself well hydrated and well nourished.
** Muscle/Joint aches: Your knees, shoulders and hips may hurt along with other joints; especially in the extremities.
** Sudden muscle twitches: These sudden muscle jerks can be somewhat alarming but they are nothing to worry about and they are also a very common opiate withdrawal symptom. They are all part of the withdrawal process and will dissipate over time. The muscle jerks are very sudden and can happen anywhere in your body, but the most common areas are the legs and the head. Occasionally, the whole body will suddenly just “jerk.” The best way to describe these twitches is when you nod off and suddenly wake up. It feels as if your body just involuntarily gets an electrical shock. They are very unnerving but not terribly uncomfortable.
***Back pain: Usually lower back pain but sometimes it can also be in the thoracic region (middle back)…basically, pain in your back. It’s important to remember that chronic pain can sometimes be exacerbated during withdrawal and many discover that their chronic pain sometimes improves as the detox process concludes.
*** Shivering: Throughout your withdrawal process, you’ll either be shivering and cold, or hot and sweaty. It will be rare that you’re ever totally comfortable from a body temperature standpoint and it will become a constant battle to keep either cool or warm enough.
*** Restless Leg Syndrome (RLS): One of the most frustrating opiate withdrawal symptoms along with the lethargy. You feel as though your “bones itch” and have the urge to constantly move your legs and sometimes your whole body. I would sometimes also find myself kneading, punching and karate-chopping my thighs when I sat down just to somehow make it feel better. You know when you go to the dentist for a cleaning and afterwards you have this constant urge to bite down? Think of that feeling all over your body. But it’ll pass just like everything else.
**** Flu-like symptoms: This can be a combination of withdrawal symptoms but flu-like symptoms feel as though your body is fighting something off… and losing.
**** Upset stomach (diarrhea, cramping and nausea): This is also a very common withdrawal symptom and one that can be a primary source of discomfort and inability to function. Most people going through withdrawals will have nausea, vomiting, diarrhea or all three. Thus, it is important to stay hydrated.
**** Lethargy/Low energy: This is a major one. You will not have ANY energy. You’ll feel as though even going to the bathroom is a chore both physically and psychologically. But don’t worry about getting to the bathroom. Your stomach will give you all the incentive you need to get there!
**** Depression and Anxiety: Perhaps the most insidious and cruel part of withdrawal is the depression you will most likely experience. Depression is very common opiate withdrawal symptom and it can be quite acute. The depression that most people feel is centered around the guilt and shame of their predicament. Many people have feelings of worthlessness and dread as well as feelings that their situation will never get better. If you get to feeling so depressed that you want to harm yourself or others, please seek professional help immediately, or call 1-800-662-HELP. Just remember that your depression is a chemically induced reaction that your brain is having due to the lack of opiates. I can’t tell you NOT to be depressed but I can encourage you to keep it all in perspective.
Opiate Withdrawal Symptoms – Nighttime
* Watery eyes and nose (not related to allergies): No itchiness, just tears running down your cheeks. Constantly.
* Racing heartbeat: Not as bad at night but still a factor.
** Back pain: Usually lower back pain but sometimes it can also be in the thoracic region (middle back). It can be particularly bad at night when lying down or when you wake up.
** Flu-like symptoms: You’ll still have flu-like symptoms at night but since your first thought when you have the flu is to lie in bed, we’re only giving it 2 stars at nighttime.
** Upset stomach (diarrhea, cramping and nausea): If you have any intestinal issues during the day, hopefully your natural slower motility will help calm things down. It’s still a major issue to deal with at night since you may be nauseous and may need to visit the bathroom several times which will further impede your ability to sleep.
** Goose flesh (goose-bumps): You’ll still have the goose bumps and they will be more noticeable at night due to your sensitivity as described in the muscle jerks section below. You’ll feel that tingly, goose flesh sensation and it can be more bothersome at night.
** Shivering/Hot flashes: The body temperature issue will continue at nights and will be more uncomfortable because you will constantly have to be throwing your sheets or blankets on and off.
*** Excessive Sweating: The sweating can be in sudden bursts or over an extended period of time and can extend to the hands and feet. We add an extra star here for all of the sheets and pillowcases you’ll need to wash.
*** Sudden muscle jerks: The muscle jerks seem to be more prevalent at night but we believe that it has more to do with the fact that you’re lying still and hence more aware of subtleties in muscle movement as opposed to when you are up and about. The legs seem to be particularly annoying and “jerky” and can keep you awake too. Combined with Restless Leg Syndrome, the muscle jerks make you a horrible bed partner and make this symptom worthy of 3 stars!
*** Hypnic or Hypnagogic Jerks: One of the most surprising and dramatic opiate withdrawal symptoms that can occur when you try and fall asleep is what some people call “Hypnic Jerks.” Although the origins of this syndrome are not fully known, the actual event can be terrifying if you’re not expecting it. Just before you fall asleep (if you’re lucky enough to get this far!) your brain’s sympathetic nervous system can activate your “fight-or-flight” response. You will suddenly wake up and feel as though you’ve had an electric shock or the sensation that you are falling and have just hit the ground. Some people even think that they’ve just had a stroke. Not to worry though. It’s not dangerous and it’s most likely a result of sleep deprivation or due to the fact that your sleep rhythms are off a bit. We’re giving it 3 stars here because they don’t happen to everybody but if they do and you’re not expecting it, it’s a four-star opiate withdrawal symptom.
**** Depression/Anxiety: Although you would hope to be asleep, depression is a significant factor at night when you are “alone with your thoughts.” You will have a tendency to dwell on things and obsess a lot lying in bed so we believe that this is just as much of an issue at night as it is during the day, if not more.
**** Restless Leg Syndrome (RLS): Ever get so mad you feel like you could kick a puppy? That’s what RLS at night is like. At least for me it was. Very frustrating. You feel as though your “bones itch” and have the urge to constantly move your legs and sometimes your whole body. It will cause you to toss and turn because it will seem as though there’s no comfortable position. You may even find yourself walking around the house or rubbing your thighs in order to relieve the RLS.
**** Insomnia: Not being able to get to sleep when you are going through withdrawals is another very common and very upsetting symptom of withdrawal. The insomnia is a combination of regular sleeplessness that is only exacerbated by other common symptoms of withdrawal. Two of the main offenders that make it difficult to sleep are the muscle jerks and restless leg syndrome which both seem to be amplified when you try to sleep. The other factor of insomnia is the hypnic or hypnagogic jerks that are described above.
The information on opiate withdrawal symptoms above is an excerpt from
The Withdrawal Ease Opiate Withdrawal Survival Guide
Our new, online Withdrawal Survival Guide now has 60-pages of essential information including tips and techniques, “The Art of Opiate Tapering”, and a new section on Suboxone.
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