Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN
Written By: Phillippe Greenough
Article Updated: 01/24/2021
Number of References: 21 Sources
The symptoms of Opana withdrawal, while rarely dangerous, are very unpleasant and uncomfortable. A strong opioid painkiller, this drug can produce strong physical and psychological symptoms, typically lasting around a week. Some of the symptoms include insomnia, anxiety, depression, diarrhea, and deep aches. Here we will take a look at the specific causes of Opana withdrawal, the symptoms and effects themselves, the timeline involved, as well as some effective treatments to reduce the discomfort, and increase the chances of someone successfully completing withdrawal from Opana.
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As with many drug withdrawal syndromes, the symptoms of Opana withdrawal can vary in duration between people. For the most part, the timeline of the acute phase is fairly standard, but the post-acute phase can exhibit substantial differences in length. With Opana’s intermediate half-life of ~7 to 9 hours, withdrawal symptoms can begin within 12 hours of the last use. These symptoms can be quite severe in heavy users, and while these symptoms are rarely dangerous on their own, if someone has a pre-existing health issue this could lead to dangerous complications. In particular, those with heart health issues or diabetes are at an increased risk of dangerous outcomes during withdrawal. These symptoms will begin mild and escalate over several days before stabilizing and finally resolving over the following few days.
The symptoms of Opana withdrawal can be divided into two distinct phases: acute and post-acute withdrawal. The acute phase is what most people probably picture when they think of opioid withdrawal and is characterized by sometimes intense physical symptoms along with psychological symptoms. The acute symptoms of Opana withdrawal can last for around a week and are outlasted, sometimes significantly, by post-acute Opana withdrawal symptoms. While the post-acute phase can be prolonged, the symptoms are strictly psychological in nature.
A general overview of the Opana withdrawal timeline may look like this:
The first symptoms of Opana withdrawal to emerge are usually increased anxiety, sweating, and a very runny nose. These may begin within 12 hours of the last Opana use and will be joined by chills and hot flashes, which may sometimes alternate or occur simultaneously. The first night usually exhibits insomnia and severe restlessness with someone unable to get much meaningful rest. The next day, tremors and shaking often arise along with stomach issues such as cramps, diarrhea, reduced appetite, and possibly vomiting. Irritability will increase and energy levels typically plummet, leaving someone unable or unwilling to do almost anything other than move between their bed and their bathroom. In addition, aches and pains usually emerge during the second day and include muscles, joints, and even bones. Cardiovascular fluctuations can occur as well, although these are usually just a nuisance and not dangerous unless someone has underlying heart problems or diabetes. All of these symptoms will often increase over the first three or four days before plateauing and finally resolving over the next few days.
Some symptoms of Opana withdrawal that can be expected during the first week can include:
The second week usually shows some improvement, although the beginning of the week is often very rough. The physical symptoms may be on their way to resolution, but several days of little to no sleep or food, coupled with the stress of withdrawal, can leave someone mentally and physically distraught. With the exception of mild insomnia, the physical symptoms are usually almost totally resolved by day seven or eight after the last time someone used Opana, although the psychological symptoms are often still present. The psychological effects may be more pronounced during this time as well since the physical symptoms are no longer present to distract from the mental effects. Depression and strong cravings for Opana may emerge during the second week if they haven’t already. Fatigue and lethargy are usually still pervasive, and anxiety remains high.
Some of the symptoms of Opana withdrawal that may persist into the second week could include:
By the beginning of the third week, the physical symptoms are usually fully resolved. While sleep may remain somewhat difficult, it is much improved since the last week. With appetite returning to normal and diarrhea subsiding, better eating habits and more effective digestion can go a long way towards improving someone’s state of mind and body. Depression, cravings, and anxiety are often still present, sometimes at high levels, and irritability and low energy levels often remain. By the beginning of the fourth week, there is often substantial improvement. Someone will be physically much healthier, although the psychological symptoms may persist. While the worst may be behind someone, there is still a long journey ahead.
Some of the Opana withdrawal symptoms that may linger until the third or fourth week may include:
The post-acute Opana withdrawal symptoms, while less directly unpleasant, can make continued sobriety very difficult. Being strictly psychological in nature, these symptoms can be a hurdle to meaningful interpersonal connections and continued recovery. They are usually depressive in nature, and can cause someone to be depressed, unmotivated, and exhibit a general negative affect. While not directly dangerous, the sometimes profound depression that can manifest may increase the risks of both relapse and/or suicide, so these post-acute symptoms should not be taken lightly.
Some of the most common post-acute Opana withdrawal symptoms include:
This time, maybe surprisingly, may pose the greatest risk of relapse. Cravings can remain strong, and without the physical symptoms to remind someone how bad it is, the idea to use Opana again can often seem more attractive within the first few weeks of withdrawal. It is highly recommended to seek additional care after withdrawal has been completed, as the road to recovery can sometimes be difficult. Having help on the way can increase someone’s chances of long term recovery as well as making the process less difficult and stressful. Both medications and therapies can be used to reduce the severity of these symptoms until the body and mind can repair themselves, and this is often highly recommended.
Withdrawal from Opana is a very unpleasant experience, although the intensity of this unpleasantness can vary. There are several factors that can alter the severity of symptoms, some of which are based on choices someone makes, while others are totally out of their control. Some of these factors can influence both the intensity and the duration of Opana withdrawal symptoms.
Some factors that can influence both the duration and the intensity of Opana withdrawal include:
The largest contributor to the intensity of Opana withdrawal symptoms is certainly the amount of the drug someone used. The downregulation that occurs is directly influenced by the amount of Opana someone uses; more Opana equals more downregulation. The more downregulation that occurs results in more severe withdrawal symptoms. In addition, the length of time someone used Opana can directly affect the duration of symptoms. Remodeling will also occur alongside downregulation, although the effects of remodeling will take some time to be felt. The longer someone uses Opana, the more remodeling occurs, thus the longer it takes to reverse once someone stops using the drug.
Co-occurring mental health issues can influence the intensity of withdrawal symptoms, although in a less direct manner. Since anxiety and depression are such common symptoms of Opana withdrawal, if someone had a prior issue with either of these mental health issues, they may experience worse psychological symptoms during Opana withdrawal. This may also result in the symptoms taking longer to resolve once they do quit using the drug. Finally, the risk of suicide is usually increased during withdrawal, so increased depression or anxiety could contribute to an even greater increase in the risk of suicide.
It has been shown that elderly people have a lower clearance rate of Opana than younger people do, and this could affect the withdrawal timeline. With a slower clearance rate, Opana will remain in the body at higher levels for a longer time. This could result in a more drawn out, although less intense, withdrawal experience.
Genetics plays a role in addiction, for sure, although the exact extent of this role is unclear at present. While it may be a very tangential influence, genetics probably plays some role in the intensity of Opana withdrawal symptoms, however indirect it may be. Addiction does tend to run in families and this could influence both the age someone starts using Opana or the frequency or intensity of use once they do begin.
Opana is a very powerful opioid painkiller whose active ingredient is oxymorphone. Oxymorphone is about 3 times as potent as morphine per milligram when taken orally and it has a fairly long half-life as far as many opioids are concerned at between 9 to 11 hours. This half-life is dose-dependent due to the extensive metabolism that Opana undergoes, with higher doses leading to a longer total half-life. Opana is a strong μ-opioid receptor agonist with fairly weak interactions at both the κ (Kappa) and δ (Delta) opioid receptors.
The opioid system is a powerful neurotransmitter system in the brain and body that is, in part, responsible for the perception of pain, mood, and pleasure along with a multitude of other functions. When using Opana, the opioid system is activated much more strongly than is possible from the natural opioid peptides produced by the body. This produces euphoria, pain relief, gastrointestinal slowing, somnolence, and a general depression of neurological functions. Through chronic use, the brain and body will begin to adapt to the presence of Opana through a process called downregulation. This is the act of the body reducing the sensitivity and/or the number of opioid receptors in an attempt to main balance and effective homeostasis.
Once downregulation occurs, the normal opioid peptides will be unable to stimulate opioid receptors to the necessary degree. This will result in developing tolerance in the short term, where more Opana, or any opioid drug, is needed to produce the same effects they previously produced. Through continued use and further downregulation, this produces a physiological dependence on the drug, where someone will begin to feel unwell, both mentally and physically when they go too long without using opioids. Further use can deepen this dependence through a process known as neurological remodeling, which is where the brain makes structural changes to better operate in this chronically downregulated environment. Remodeling is responsible for the long-term effects of Opana withdrawal, including the prolonged psychological symptoms that can last for long periods after drug use ceases.
Entering an Opana detox center can provide a multitude of benefits, both short and long-term. As far as the short term, the process of Opana withdrawal and detox can be made much less unpleasant through medications, therapies, and medical supervision to reduce possible risks. In the long term, the therapies provided can help someone develop healthy coping skills and relapse prevention practices. Additionally, these centers may provide referrals to continuing care programs after detox has been completed. These centers are often the first step towards long term recovery and a new life free from Opana addiction.
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