Characterizing Opioid Withdrawal Experiences and Consequences Among a Community Sample of People Who Use Opioids

Abstract

Background

Opioid withdrawal symptoms are a highly salient and consequential health condition experienced by people who use opioids (PWUO). This study utilized qualitative interviews to explore opioid withdrawal experiences and consequences among PWUO in Los Angeles County, USA.

Methods

Semi-structured qualitative interviews were conducted with 22 PWUO (aged 27–63 years) between May 2021 and May 2022. Participants self-reported opioid and injection drug use in the last 30 days. We employed an inductive thematic approach to systematically code and synthesize textual interview data.

Results

Participants experienced withdrawal symptoms frequently, with many going to great lengths to avoid them. Withdrawal pain was described as incapacitating and interfered with PWUO’s ability to sustain regular employment and ensure stable housing. Avoiding withdrawal was described as influential in driving decisions to continue using opioids. Mechanisms for managing withdrawal included using other substances to the point of sedation. PWUO who transitioned from heroin to fentanyl use revealed more frequent, painful, and faster onset of withdrawal symptoms. Adverse withdrawal experiences and fear of precipitated withdrawal from buprenorphine were barriers to treatment initiation and continuation.

Conclusion

Withdrawal symptoms among PWUO increase health risk. Improved strategies to treat opioid withdrawal are urgently needed. Solutions such as safe supply and intentional opioid withdrawal interventions (educational trainings, withdrawal comfort kits) are needed to improve withdrawal management and reduce opioid-related harm.

Keywords:

• People who use opioids
• opiate withdrawal
• dependence
• treatment and prevention
• harm reduction

Acknowledgements

We would like to thank our study participants for their time and effort in this project. We would also like to acknowledge the following individuals who assisted in transcribing the qualitative interviews and meaningfully contributed to this article: Cheyenne Page, Gilbert Portillo, Jocie Chen and Avaion Ruth.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institute on Drug Abuse at the National Institutes of Health grant R01DA046049 (project officer: Heather Kimmel, PhD). This work was also funded through the NIH grant T32DA023356 (post-doctoral training grant).