Opioids aren’t the most dangerous drug to go through withdrawal from

Image: AP Photo/Bob Edme
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Earlier this week, we learned that the morning Prince died, he was supposed to meet with and opioid addiction expert. The number of deaths that have involved prescription opioids in the US has increased almost fourfold over the past 15 years as a result of accidental overdose.

Most overdoses occur as a result of building up a tolerance to a drug. Over time, the same amount of a substance doesn’t give you the same high as it did before. However, sometimes weening your body off drugs can be equally dangerous.

“Withdrawal can kill you,” Joshua Lee, an addiction specialist at New York University Langone Medical Center, said. “Alcohol withdrawal is the classic example, where you can have autonomic instability, increased heart rate, increased blood pressure, your heart’s working overtime, your circulatory system is going haywire, your brain freaks out, and you can have seizures that are unstoppable without treatment.” Withdrawal from benzodiazepines—a class of drugs including Valium, Ativan, and Klonopin used to alleviate anxiety—have similarly sometimes fatal symptoms.

Opioid withdrawal is not pleasant either: After about a day, most of the drug will have left the body. The first symptoms include runny nose, sweating, tearing, and muscle aches, combined with some psychological symptoms like anxiety and insomnia. After three days, symptoms can become more severe: vomiting, diarrhea, rapid heart rate, and high blood pressure. These may fade after a week, but sometimes persist for up to six months.

Lee explained that when our bodies go through withdrawal, they’re responding to a change in what has become their normal state. The brain becomes used to operating in an alcohol or opioid-saturated state, and has adapted the rest of the body to do so as well. “It’s kind of the opposite of what you’re getting when you’re intoxicated,” Lee said. “In part, it’s because the brain was doing all this work behind the scenes to basically make you functional while you were [intoxicated],” and without these drugs you are overcompensating.

Withdrawal happens when our bodies become physically dependent on any substance. Any medication taken on a regular basis—like those for hypertension or diabetes—has the potential to produce physical dependence even if patients aren’t abusing them. Additionally, our bodies can grow accustomed to substances like caffeine, nicotine, and even opioid painkillers appropriately prescribed by doctors. “[Your] brain becomes used to the caffeine…and is expecting more,” Lee said. “All the sudden, it’s not there, and you get withdrawal.”

Symptoms of any withdrawal are awful: They can range from a mere headache to muscle aches, gastrointestinal problems, agitation, and even hallucinations. In most cases, withdrawal will be the most severe during the first week; symptoms can persist for months or even years, though.

Alcohol and benzodiazepine withdrawal are the only forms that pose a serious risk of fatality; in most other cases, though withdrawal can be awful, it won’t be fatal. “With the right medical care, all of these withdrawal symptoms are completely manageable,” Lee said. “But there are hurdles, which is why people have a hard time on their own.”