When you’re in early recovery from opioid use disorder (OUD), you might know a little bit about what to expect during the withdrawal period. Many people anticipate physical withdrawal symptoms like chills, sweating, fever, and pain. Mental symptoms, which can also intensify during and beyond the first week off opioids, might catch you a little more off guard.

Knowing what to expect from early opioid recovery might inspire you to take the leap and begin OUD treatment with counseling or medication-assisted treatment (MAT), which can lessen withdrawal symptoms or make them more manageable. Keep reading to learn about common mood and cognitive changes that can happen in early opioid recovery.

Why Mood and Mental Changes Happen in Early Opioid Recovery

When you have OUD, your brain and nervous system become dysregulated due to the cycle of relief from taking opioids and the crashes that occur when their effects wear off. This keeps your brain’s stress system active. Your brain also becomes less responsive to dopamine, a neurotransmitter involved in regulating your mood, sleep, and pleasure.

Physical withdrawal symptoms may ease while the brain’s stress response stays active. Stress hormones can remain high as your brain adjusts to changes in opioid use.

Without the opioids and with less response to dopamine, your brain may have some difficulty regulating your mood, sleep, and pain. These changes may contribute to mood and cognitive withdrawal symptoms that last for days or weeks. Withdrawal symptoms typically peak within 72 hours for short-acting opioids and between 72 and 96 hours for long-acting opioids.

Some people have withdrawal symptoms that continue after the first few days or weeks. This is sometimes called protracted withdrawal or post-acute withdrawal syndrome (PAWS). Symptoms such as anxiety, low mood, irritability, and sleep problems may last for weeks or months, but this doesn’t happen to everyone.

Common Sleep and Cognitive Changes in Early Opioid Recovery

As your brain adjusts to a lack of opioids, you might notice changes in how you think or problems with memory and making decisions. Together, these are called cognitive changes. You might also notice that it becomes more difficult to get a good night’s sleep or to take a nap even if you feel tired or yawn often.

Trouble Concentrating

It’s common to have trouble focusing or concentrating when going through opioid withdrawal, especially during the first few weeks. Trouble concentrating can affect your ability to work, your ability to communicate, or your safety, so it’s important to be extra careful during this time.

Alongside trouble concentrating, you might experience memory problems because memory function is tied to dopamine. Let your OUD care team know if memory or concentration problems are prolonged or cause safety concerns in your life.

Mental Fatigue

Mental fatigue, also called cognitive fatigue, can make focusing and making decisions feel like chores. You might feel like your brain has to work extra hard, which can affect your overall energy levels and make it difficult to make plans, follow rules, or follow instructions.

If you experience mental heaviness or fatigue during early opioid recovery, consider developing and following a structured routine until these symptoms improve. It might help to keep a diary tracking your sleep patterns and appetite to help your OUD care team identify the types of support you need.

Sleep Disruptions

Insomnia is a common withdrawal symptom, which can start just six to 24 hours after your last opioid dose. You might find it hard to fall asleep or to stay asleep through the night.

If insomnia is a major concern during early opioid withdrawal, you may be able to manage it with temporary sleep medications. Tell your OUD care team if sleep disturbances are particularly disruptive during the first week of opioid recovery.

When To Seek Professional Support

If you’re in the early stages of recovery with or without MAT, it’s important to pay close attention to how you feel and reach out for extra help when you feel you need it. Plan on keeping in close contact with your care team during early opioid recovery for observation and monitoring.

Let your counselor or OUD care team know if you:

• Have mood symptoms that affect how you function
• Experience intense opioid cravings
• Feel that your concentration problems or mental fatigue affect your safety or ability to work
• Experience increasing anxiety or panic attacks
• Have trouble sleeping despite taking steps to improve your sleep

Get Help Right Now

Signs of overdose? Give naloxone if you have it, then call 911.

Thoughts of hurting yourself or others? Call or text 988 to reach the 988 Suicide & Crisis Lifeline, or go to an ER.

When To Seek Immediate Care

Withdrawal from opioids alone is usually not life-threatening, even though it can feel very uncomfortable and distressing. However, some street opioids may contain other drugs that can cause more serious withdrawal symptoms and may need medical treatment.

Returning to opioid use after a period of not using can raise the risk of overdose because your tolerance may be lower. If you think you or someone else is having an opioid overdose, give naloxone or another opioid overdose reversal medicine if it’s available and get emergency medical help right away.

It’s also important to seek medical help right away if mental symptoms like hopelessness or depression make you want to harm yourself or others. Your care team can take fast action to make sure you get the support you need, even in a pinch.