Understanding Opioid Withdrawal in Teens and Young Adults: A Parent’s Guide

by Dr. Wesley Sassaman, DNP, MPH, MSN-NE, MBA, FNP-C, CARN-AP

The rising prevalence of opioid addiction, particularly fentanyl, among teens and young adults is a reality many families face today. Watching your child experience the pains of addiction and withdrawal can be heart-wrenching. However, understanding the process and knowing how to play a supportive role can make a significant difference in their recovery. This guide aims to provide parents with insights into opioid withdrawal symptoms, timelines, and practical support strategies, backed by evidence-based information.

What is Opioid Withdrawal?

Opioid withdrawal occurs when a dependent individual abruptly stops or reduces opioid use. Opioids, such as fentanyl, bind with brain receptors to produce pain relief and euphoria. Over time, the body adjusts to these effects, creating dependency. When the drug is removed, the body struggles to recalibrate, triggering withdrawal symptoms (Álvarez-Bagnarol et al., 2022).

Symptoms of Opioid Withdrawal

Withdrawal symptoms are a combination of physical, psychological, and behavioral challenges. They reflect the body’s intense effort to restore balance:

Physical Symptoms

Rapid heart rate, sweating, and chills driven by norepinephrine surges (Grant et al., 2024).
Muscle aches caused by elevated inflammatory markers like substance P (Álvarez-Bagnarol et al., 2022).
Gastrointestinal issues such as nausea and diarrhea linked to serotonin disruption (Li et al., 2022).
Tremors and fatigue due to suppressed GABA activity (Grant et al., 2024).

Psychological Symptoms

Anxiety and restlessness due to cortisol increases and dopamine deficiencies (Shi et al., 2021).
Cravings for opioids as a result of sharp dopamine suppression (Pagare et al., 2024).
Insomnia and mood swings triggered by neurotransmitter imbalances, including serotonin (Grant et al., 2024).

Behavioral Symptoms

Increased yawning and inability to remain still.
Social withdrawal and irritability as the child copes with emotional upheaval.

Understanding the Timeline of Withdrawal Symptoms

While the withdrawal experience varies between individuals, the process generally follows a predictable timeline:

Early Symptoms (6-24 Hours After Last Use)

Early signs such as anxiety, sweating, and slight nausea emerge as norepinephrine levels begin to rise. Physical discomfort underscores this phase (Grant et al., 2024).

Peak Symptoms (24-72 Hours)

Withdrawal intensifies during this stage, with severe vomiting, diarrhea, muscle pain, and insomnia. Neurochemical disruption peaks, particularly in dopamine and cortisol levels (Shi et al., 2021).

Subacute Symptoms (4-10 Days)

Physical symptoms subside but psychological effects like depression and anxiety linger as serotonin and dopamine systems remain imbalanced (Grant et al., 2024).

Post-Acute Withdrawal (Weeks to Months)

Cravings and mood swings persist due to the slow recovery of the brain’s reward pathways. This phase is critical for long-term recovery and relapse prevention (Psarianos et al., 2024).

The Clinical Opioid Withdrawal Scale (COWS)

The COWS is a reliable tool medical professionals use to measure the severity of opioid withdrawal. With 11 parameters scored between 0 and 4—including resting pulse rate, pupil dilation, sweating, and gastrointestinal upset—parents can use this framework to observe and relay symptom severity to healthcare providers (Álvarez-Bagnarol et al., 2022).

Why is COWS Helpful?

Tracking Withdrawal Progress – COWS offers a structured way to gauge which stage your child is in and how symptoms are evolving.
Identifying When to Seek Medical Help – A moderate-to-severe score (>15) often indicates the need for intervention.
Empowering Parents – Understanding symptoms through this scale can help parents have more informed discussions with treatment teams.

How Parents Can Support Their Child

You play a pivotal role in your child’s recovery. Providing emotional, physical, and logistical support creates a foundation for their resilience.

1. Be Present and Listen

Withdrawn teens may feel isolated and misunderstood. Practice active listening by asking open-ended questions like, “Can you share how you’re feeling today?” Avoid judgmental responses that may discourage them from opening up (Grant et al., 2024).

2. Encourage Professional Help

Medically-assisted detoxification can manage severe withdrawal symptoms. Medications like buprenorphine can stabilize dopamine levels, helping to ease cravings (Pagare et al., 2024). Additionally, therapy options like cognitive-behavioral therapy (CBT) provide tools to foster emotional regulation and combat relapse triggers (Parmenter et al., 2024).

3. Create a Calm Environment

Withdrawal is both physically tolling and psychologically overwhelming. Small comforting gestures, such as blackout curtains to promote better sleep or heating pads for muscle pain, demonstrate unwavering care. Engaging aromatherapy or soft music adds calming benefits.

4. Monitor for Relapse

Relapse doesn’t equate to failure. It signals the need for renewed support and possible adjustments to the treatment plan. Be observant of mood changes or hidden paraphernalia, which could indicate renewed substance use.

5. Support Healthy Habits

Physical Activity: Low-impact exercises like walking or yoga stabilize serotonin and cortisol, easing stress (Wang & Zou, 2022).
Nutrition and Rest: Provide nutritious meals to rebuild strength, and encourage regular sleep routines disrupted by withdrawal (Mukherjee et al., 2021).

Resources for Parents

NARCAN Availability: Administering naloxone during an overdose can save lives while waiting for emergency services.
Peer Support Groups: Group therapy fosters connectivity with others undergoing similar challenges.
Educational Workshops: Learn how to set boundaries, support behaviors conducive to recovery, and avoid enabling.

Hope Beyond Addiction

Your child’s road to recovery won’t be easy, nor will it be linear. Offer compassion to yourself and your teen as you tackle this challenge together. Celebrate small successes; even attending therapy or experiencing a symptom-free day is progress worth recognizing. Recovery requires a strong team, and your unwavering support as a parent can make all the difference.

Remember, there are professionals and resources dedicated to helping families like yours. No matter how overwhelming the path may feel, you are not alone, and your family can emerge stronger on the other side.

For even more practical tips and detailed insights on how you can help your teen or young adult transition from street-based fentanyl to Suboxone without the burden of withdrawal, visit wesleysassaman.com. Discover the steps you can take to guide your child toward stability and recovery while ensuring their comfort and well-being throughout the process.

References:

Álvarez-Bagnarol, Y., et al. (2022). Neuronal correlates of hyperalgesia.

Grant, I., et al. (2024). Effects of opioid withdrawal on psychobiology.

Pagare, P. P., et al. (2024). Recent progress in opioid receptor modulators.

Psarianos, A., et al. (2024). Exercise programs for opioid-dependent patients.

Shi, Z., et al. (2021). Role of withdrawal in mesocorticolimbic drug cue reactivity.Wang, J., & Zou, Z. (2022). Exercise impacts stress biomarkers.

Mukherjee, D., et al. (2021). Reregulation of cortisol levels and sleep in patients with prescription opioid use disorder during long-term residential treatment.

Parmenter, M. E., et al. (2024). Cyclobenzaprine’s effects on withdrawal symptoms.

About the Author

Wesley Sassaman, DNP, is a medical professional with years of experience in addiction and mental health. Working on the front lines of the fentanyl epidemic, Dr. Sassaman is dedicated to empowering families affected by fentanyl addiction by providing them with the knowledge and resources to navigate the difficult road to recovery. With a deep understanding of the biopsychosocial model of addiction, Dr. Sassaman combines expert insights with compassionate guidance, offering

hope to those struggling with the devastating effects of street-based fentanyl addiction. This essential guidebook invites readers into a transformative conversation, bridging the gap between despair and hope while illuminating a path toward healing and resilience.