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How Do I Deal With Anxiety From Opiate Withdrawal?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Jan 15, 2024 • 10 cited sources

Opiate withdrawal symptoms can vary, but many people develop anxiety and restlessness. While you may feel awful at first, the most intense withdrawal symptoms will typically resolve within 4-10 days.[4] Medications like methadone and buprenorphine can also help to ease your anxiety and other withdrawal symptoms.

Common opiate withdrawal symptoms include many symptoms that can cause anxiety, such as these:[1, 2, 3]

  • Opioid cravings
  • Restlessness 
  • Fast heart rate 
  • Sweating
  • Dizziness
  • Nausea/vomiting

If left untreated, opiate withdrawal can lead to a relapse to drug use. While you could try to wait out your anxiety, it’s best to get it treated—for your comfort and safety. Talk to your doctor about Medication for Addiction Treatment (MAT) for opioid use disorder. 

Symptoms of Withdrawal Anxiety

Somebody who is going through opiate withdrawal may experience a range of mental health symptoms like generalized anxiety and restlessness. Symptoms of opiate withdrawal anxiety include: [9]

  • Feeling on edge
  • Restlessness
  • Irritability
  • Problems concentrating
  • Uncontrollable feelings of worry
  • Experiencing sleep disturbances

Withdrawal-induced anxiety may range from uncomfortable to extremely distressing, depending on the severity of opiate addiction and dependence, previous withdrawal experiences and mental health status.

Symptoms of a Panic Attack During Opiate Withdrawal

One manifestation of opiate withdrawal anxiety is panic attacks. Panic attacks differ from generalized anxiety because they come on suddenly and are characterized by intense fear when there is no identifiable trigger or danger. It is an acute episode that may last for a few minutes and then resolve but those few minutes are incredibly distressing.

The symptoms of a panic attack during opiate withdrawal include: [9]

  • Extreme sweating
  • Racing heart
  • Heart palpitations
  • Chest pain
  • Tingling
  • Trembling
  • Feelings of being out of control
  • Feelings of impending doom

A person going through opioid withdrawal may experience ongoing generalized anxiety with sudden and unpredictable panic attacks, although they won’t necessarily experience these episodes.

How Long Does the Anxiety Typically Last With Opiate Withdrawal? 

People develop anxiety and other withdrawal symptoms within about 8 to 48 hours of their last opioid dose. [4]

Without treatment, your opioid withdrawal symptoms can last between 4 and 20 days, depending on whether you were dependent on a short-acting opioid like heroin and some other prescription painkillers or a long-acting opiate like methadone. [4]

This doesn’t necessarily mean that your anxiety will last for the entire duration of your withdrawal symptoms—it depends on your mental health, proneness to anxiety and panic and other individual factors.

How Does Medical Detox Help With Anxiety? 

Medical detox involves 24/7 medical supervision, monitoring and care in a hospital setting and includes opioid withdrawal medications, supportive care and mental health support. Medical detox services can help relieve opiate withdrawal symptoms, including anxiety, restlessness and panic attacks. The medications used during medical detox include: [4]

  • Suboxone: Suboxone includes buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist. The buprenorphine component relieves opioid withdrawal symptoms like anxiety as well as cravings. It is also extremely safe, is difficult to overdose on, and has a low potential for misuse. 
  • Methadone: Methadone is a full opioid agonist that alleviates opiate cravings and withdrawal symptoms, including restlessness, agitation and anxiety.
  • Clonidine: Clonidine is an alpha-2 adrenergic agonist that binds to alpha-2 receptors in the brain, which are responsible for calming the body’s sympathetic nervous system, resulting in anxiety relief. This medication also alleviates physical symptoms that are associated with anxiety like rapid pulse and sweating. It is used as an adjunct medication in combination with a medication like methadone or Suboxone.

If you have a co-occurring mental health disorder, such as generalized anxiety disorder or panic disorder, your doctor may prescribe you an antidepressant or anti-anxiety medication that doesn’t have the potential for misuse. These may include selective serotonin reuptake inhibitors (SSRIs) like Zoloft or Lexapro.

Self-Care Strategies for Anxiety From Opiate Withdrawal

While medications are helpful for opiate withdrawal, you can also benefit from other therapies and self-care strategies. These are a few of the options your team might try.

Helpful Ways to Ease Anxiety Caused by Opiate Withdrawal

1. Hydration

Many people experience dehydration during opiate misuse and withdrawal.[5] A lack of fluids can leave you feeling very anxious. Keep yourself hydrated by drinking at least 2-3 liters of water per day. You should also take vitamin C and B supplements. [4]

2. Yoga

Yoga has been shown to help reduce stress and anxiety and can be a great way to supplement counseling and medications for OUD. [8]

3. Mindfulness

Most people associate mindfulness with sitting in “meditation,” but this is a misconception. Mindfulness practices are highly variable and can be as simple as even just a few minutes of gentle breathing exercises. Researchers say mindfulness activities could help people stay sober after treatment for a substance use disorder.[6] 

4. Sleep 

Your body needs rest as you heal. Insomnia is a common part of opiate withdrawal, but if you can sleep, you may feel less anxious. [7] Practice good sleep hygiene while in the process of recovery. This involves turning off all screens and electronics before bed. It could also involve doing a sleep meditation or using essential oils.

Treatment for Post-Detox Anxiety

Once opiate withdrawal resolves, you may find that you are still experiencing anxiety or panic attacks. This could be a sign of an underlying anxiety disorder that you didn’t know you had—and was likely influencing your opiate misuse. In fact, research indicates that people with anxiety and mood disorders are more likely to misuse opioids than people without one of these mental health conditions. [10]

This is why receiving comprehensive and integrated treatment for both opioid use disorder and co-occurring anxiety or mood disorder is so essential. Both conditions affect one another, and long-term recovery may be difficult to obtain if both disorders aren’t treated concurrently. 

Untreated co-occurring anxiety disorder could increase the risk of relapse to opiate use. As such, after you go through opiate detox, it’s important to transition into a dual diagnosis treatment program that can provide you with addiction treatment and mental health services. 

Dual diagnosis programs can help you obtain long-term recovery from both conditions by offering many services and therapeutic interventions, such as: [9]

  • Cognitive behavioral therapy (CBT)
  • Psychotherapy or talk therapy
  • Acceptance and commitment therapy (ACT)
  • Medications for Addiction Treatment (MAT), such as Suboxone or methadone
  • Antidepressants
  • Non-addictive medications for panic disorder
  • Support groups
  • Stress management classes
  • Relapse prevention classes

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

Sources
  1. Opioid Withdrawal in Adults: Clinical Manifestations, Course, Assessment, and Diagnosis. UpToDate. https://www.uptodate.com/contents/opioid-withdrawal-in-adults-clinical-manifestations-course-assessment-and-diagnosis. March 2022. Accessed July 2022.
  2. Influence of the Dose on the Severity of Opiate Withdrawal Symptoms During Methadone Detoxification. Pharmacology. https://www.karger.com/Article/Abstract/109982. 2008. Accessed July 2022.
  3. Opioid Withdrawal. Elsevier. https://www.elsevier.com/__data/assets/pdf_file/0019/537031/opioid-withdrawal-ClinicalKey.pdf. 2017. Accessed July 2022.
  4. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK310652/. 2009. Accessed July 2022.
  5. Substance Use Recovery and Diet. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/002149.htm. May 2020. Accessed July 2022.
  6. Mindfulness-Oriented Recovery Enhancement Mediates Hedonic Dysregulation in Opioid Users: Neural and Affective Evidence of Target Engagement. Science Advances. https://www.science.org/doi/10.1126/sciadv.aax1569?cookieSet=1. October 2019. Accessed July 2022. 
  7. Anxiety and Sleep. Sleep Foundation. https://www.sleepfoundation.org/mental-health/anxiety-and-sleep. March 2022. Accessed July 2022.
  8. Shohani M, Badfar G, Nasirkandy MP, et al. The Effect of Yoga on Stress, Anxiety, and Depression in Women. Int J Prev Med. 2018;9:21. Published 2018 Feb 21. doi:10.4103/ijpvm.IJPVM_242_16
  9. Anxiety Disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/anxiety-disorders. April 2023. Accessed December 2023. 
  10. Opioid Abuse Linked to Mood and Anxiety Disorders. Johns Hopkins Bloomberg School of Public Health. https://publichealth.jhu.edu/2011/martins-opioids. December 2011. Accessed December 2023.

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