Opioid Use Disorder: Signs, Withdrawal, Overdose, and Treatment
Plain, fact-first answers about how care works here. Want to talk to a person? Call (888) 464-2144.
- The Archangel Centers is a licensed outpatient addiction treatment provider.
- The Archangel Centers operates clinics in Tinton Falls, NJ and Charlotte, NC.
- Opioid use disorder is part of the outpatient continuum at The Archangel Centers.
- Medication-assisted treatment (MAT) includes Suboxone, Vivitrol, and Sublocade.
- The Archangel Centers works with most major commercial insurance plans with free benefits verification.
Opioid use disorder (OUD) is one of the most treatable substance use disorders, and one of the deadliest if untreated. The medications and therapies that work are well-established. The bigger barriers are stigma, access, and the unpredictability of the illicit opioid supply, which now is dominated by fentanyl. This page covers what opioid use disorder is in clinical terms, what withdrawal and overdose look like, what medication-assisted treatment can do, and what recovery looks like across the continuum of care.
If you or someone you love is at risk of overdose, naloxone (Narcan) is available without a prescription at most pharmacies and free through many state health departments. Carrying it is a basic safety step.
What opioid use disorder is
Opioid use disorder is defined in the DSM-5 by a problematic pattern of opioid use producing clinically significant impairment or distress, as evidenced by at least two of eleven criteria within a twelve-month period. The criteria span impaired control, social impairment, risky use, and pharmacological dependence (tolerance and withdrawal).
The category includes use of:
Tolerance and withdrawal are not enough on their own for a diagnosis if the person is using opioids as prescribed under appropriate medical supervision. Diagnosis requires the broader pattern of problematic use.
- Heroin (often contaminated with fentanyl in the current supply)
- Fentanyl and other illicit synthetic opioids
- Prescription opioids including oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, codeine, methadone (as prescribed for pain), and tramadol
- Buprenorphine (Subutex, Suboxone) misuse outside a prescribed medical context
Why opioids are so dangerous now
Two facts make the current opioid environment uniquely lethal:
- The illicit supply is dominated by fentanyl. Fentanyl is roughly 50 to 100 times more potent than morphine. Counterfeit pills sold as oxycodone, Xanax, Adderall, and other prescription medications often contain fentanyl in unpredictable doses, and heroin sold on the street is now usually a mixture of heroin and fentanyl, or pure fentanyl. See fentanyl.
- Tolerance shifts make any return to use a high overdose risk. A person who has been abstinent for any period, including a few days in jail or a hospital stay, loses tolerance quickly. A dose that was tolerable three weeks ago can be fatal today.
What are the signs of opioid use disorder?
Common signs include:
If a person's prescription opioid use has progressed to using more than prescribed, taking another person's medication, crushing or altering pills, or buying opioids outside a medical context, that is a clear indicator that OUD has developed.
- Taking opioids in larger amounts or longer than intended
- Failed attempts to cut down or quit
- Significant time spent obtaining, using, or recovering from opioids
- Strong craving
- Withdrawal symptoms when not using (sweating, runny nose, body aches, nausea, anxiety, insomnia, dilated pupils)
- Tolerance, needing more to get the same effect
- Continued use despite clear interpersonal, work, or legal problems
- Use in physically hazardous situations (driving, parenting young children)
- Continued use despite known physical or psychological harm
What does opioid withdrawal look like?
Opioid withdrawal is rarely life-threatening on its own (unlike alcohol or benzodiazepine withdrawal), but it is genuinely miserable and is the proximate reason many people return to use. Symptoms include:
Onset varies by opioid: short-acting opioids (heroin, immediate-release oxycodone) produce withdrawal within 8 to 24 hours; long-acting opioids (methadone, sustained-release opioids) take longer to onset and resolve. The acute phase typically lasts 5 to 10 days, with protracted withdrawal symptoms (sleep disturbance, low mood, anhedonia) sometimes lingering for weeks or months.
Medical detox can dramatically reduce the misery of withdrawal and is often the right starting point. For how we coordinate that, see medical detox in Tinton Falls or medical detox in Charlotte.
- Generalized aches and muscle pain
- Anxiety, irritability, restlessness
- Runny nose, watery eyes
- Sweating, chills, goosebumps
- Nausea, vomiting, diarrhea, abdominal cramps
- Insomnia
- Dilated pupils
- Yawning
- Strong craving
Overdose: recognizing it and what to do
An opioid overdose can kill within minutes by depressing breathing. Signs:
- Slow, shallow, or stopped breathing
- Blue or grey lips and fingernails
- Pale, clammy skin
- Pinpoint pupils
- Limp body
- Unresponsiveness, even to painful stimulation
- Gurgling or choking sounds
Medication-assisted treatment for opioid use disorder
Medication-assisted treatment (MAT) for OUD is among the best-studied interventions in addiction medicine. The medications:
At The Archangel Centers, the MAT options are Suboxone (the primary option), Sublocade, and Vivitrol. The decision among them is clinical, made with the medical provider, and is not a moral question.
For more on MAT, see medication-assisted treatment.
- Buprenorphine (Suboxone, Sublocade), A partial opioid agonist. Reduces cravings and withdrawal, and at appropriate doses blocks the effect of other opioids. Suboxone is the daily oral or sublingual formulation (buprenorphine combined with naloxone to deter misuse). Sublocade is a monthly injectable.
- Naltrexone (Vivitrol), An opioid antagonist. Blocks the effect of opioids entirely. Requires a period of opioid abstinence before initiation (typically 7 to 10 days), or precipitated withdrawal will occur. The injectable monthly formulation (Vivitrol) is the form most often used.
- Methadone A full opioid agonist. Highly effective and decades-evidenced, but dispensed only through federally licensed opioid treatment programs (OTPs). Methadone is not in The Archangel Centers' formulary; clients who need methadone are referred to a federally licensed OTP in their region.
What treatment looks like across the continuum
Treatment for opioid use disorder follows the continuum that applies to other SUDs, with MAT integrated throughout:
The single biggest predictor of sustained recovery from OUD is staying on MAT for an appropriate duration, integrated with therapy and recovery community. Premature discontinuation of MAT is associated with high overdose risk.
- Detox, if needed, at an accredited partner facility (we coordinate; see medical detox).
- Partial Care (PHP) for high-acuity presentations, especially after detox, with daily group therapy, individual sessions, and medical management of MAT.
- Intensive Outpatient (IOP) for moderate severity or step-down from PHP.
- Outpatient (OP) for ongoing MAT management and continuing therapy.
Therapy alongside MAT
Medication is one piece. Therapy carries the rest. Modalities used at The Archangel Centers for OUD include:
- Cognitive behavioral therapy for trigger identification and coping
- Motivational interviewing for ambivalence around use and treatment
- Trauma-informed care for the trauma that often underlies opioid use
- Relapse prevention work with detailed coping plans
- Family therapy for repair and ongoing support
- Group therapy with structured peer work
Co-occurring conditions in opioid use disorder
Depression, anxiety, post-traumatic stress, and chronic pain frequently co-occur with OUD and are part of the clinical picture from intake. See:
Pain conditions that contributed to original opioid prescriptions need ongoing management; we work with the client's medical team on non-opioid pain strategies.
Frequently Asked Questions
Is MAT "trading one addiction for another"?
How long do I have to stay on MAT?
What if I have already tried treatment before and relapsed?
Can I do MAT in outpatient treatment without inpatient first?
Will my employer find out I am on MAT?
Are there alternatives to MAT for OUD?
How quickly can The Archangel Centers admit me if I am ready today?
What happens after I finish IOP — is there ongoing support?
Admissions are confidential and staffed 24/7 at (888) 464-2144. Or browse a specific clinic page for hours, address, and the full program.