Opioid Withdrawal Symptoms & Timeline

Opioid withdrawal occurs when a person who has developed physical dependence on opioids suddenly stops or significantly reduces their use.

While opioid withdrawal is rarely life-threatening, it can be extremely uncomfortable and challenging to endure without proper support. Understanding the symptoms, timeline, and treatment options for opioid withdrawal is essential for anyone seeking recovery from opioid dependence or supporting a loved one through this process.

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Understanding Opioid Withdrawal

Physical dependence on opioids develops because these substances bind to opioid receptors in the brain, spinal cord, and other organs. With continued use, the body adapts to the presence of opioids and requires them to maintain normal functioning. When opioid use is reduced or stopped, the body must readjust to functioning without these substances, resulting in withdrawal symptoms.

Opioid Withdrawal Symptoms

Opioid withdrawal symptoms can range from mild to severe, depending on factors such as the type of opioid used, duration of use, dosage, individual physiology, and whether the person attempts to quit “cold turkey” or gradually tapers their dosage.

Physical Symptoms

Early symptoms (typically beginning 8-24 hours after last use):

- Muscle aches and pains
- Restlessness and agitation
- Anxiety
- Lacrimation (tearing of eyes)
- Runny nose
- Excessive yawning
- Sweating
- Insomnia
Peak symptoms (typically 36-72 hours after last use):
- Nausea and vomiting
- Diarrhea
- Abdominal cramping
- Dilated pupils
- Goosebumps
- High blood pressure
- Rapid heartbeat
- Fever and chills

Psychological Symptoms

Psychological symptoms often accompany the physical symptoms and may persist longer. These can include:

Intense cravings for opioids
Irritability and mood swings
Depression
Anxiety and panic attacks
Difficulty concentrating
Decreased motivation
Anhedonia (inability to feel pleasure)

While opioid withdrawal symptoms can be extremely uncomfortable, it’s important to note that unlike withdrawal from alcohol or benzodiazepines, opioid withdrawal is generally not life-threatening.

However, complications such as dehydration from vomiting and diarrhea can become serious if not properly managed, and the distress of withdrawal can increase the risk of self-harm or suicide in vulnerable individuals.

How Long Does Opioid Withdrawal Last?

The duration of withdrawal varies significantly depending on the specific opioid used. Here’s a breakdown of common opioids and their typical withdrawal timeframes:

Short-Acting Opioids

Heroin

Onset: 8-12 hours after last use
Peak: 1-3 days
Duration: 5-10 days for acute withdrawal
Post-acute symptoms may persist for weeks or months

Prescription Pain Medications (Short-Acting)

Oxycodone (Percocet, OxyContin)
- Onset: 8-12 hours after last use
- Peak: 36-72 hours
- Duration: 7-10 days
Hydrocodone (Vicodin, Norco)
- Onset: 8-12 hours after last use
- Peak: 36-72 hours
- Duration: 7-10 days
Morphine
- Onset: 8-12 hours after last use
- Peak: 36-72 hours
- Duration: 7-10 days

Long-Acting Opioids

Methadone

Onset: 24-48 hours after last use
Peak: 3-8 days
Duration: 2-4 weeks or longer

Buprenorphine (Subutex, Suboxone)

Onset: 36-72 hours after last use
Peak: 4-5 days
Duration: 2-3 weeks

Extended-Release Formulations

Similar to their short-acting counterparts but may have a slightly delayed onset of withdrawal

Opioid Withdrawal Timeline

While individual experiences vary, here is a general timeline of what to expect during opioid withdrawal:

First 24 Hours

Anxiety and restlessness begin
Muscle aches develop
Insomnia
Runny nose and tearing
Sweating
Yawning frequently
Drug cravings

Days 2-3

Peak of physical symptoms
Nausea and vomiting
Diarrhea
Abdominal cramping
Goosebumps
Dilated pupils
Elevated blood pressure and heart rate
Intense drug cravings

Days 4-7

Physical symptoms begin to subside
Muscle aches and gastrointestinal symptoms improve
Sleep begins to normalize
Psychological symptoms may remain prominent
Cravings continue

Week 2

Most acute physical symptoms have resolved
Mood disturbances and psychological symptoms persist
Energy levels begin to improve
Cravings begin to decrease in intensity but remain present

Weeks 3-4

For most short-acting opioids, acute withdrawal is complete
For longer-acting opioids like methadone, physical symptoms may persist
Psychological symptoms continue to improve gradually
Cravings become less frequent but may still occur

Months 1-6

Physical symptoms generally resolved
Psychological symptoms may continue
Periods of anxiety, depression, and anhedonia may occur
Sleep disturbances may persist
Triggers may provoke intense cravings
Cognitive function gradually improves

How Is Opioid Withdrawal Treated?

Attempting to withdrawal from opioids alone without medical supervision can be extremely difficult and potentially dangerous due to complications such as dehydration and the high risk of relapse.

Fortunately, there are effective treatment approaches that can significantly reduce the discomfort of withdrawal and increase the chances of successful recovery.

Treatment for opioid withdrawal typically involves a comprehensive approach that addresses both the physical symptoms of withdrawal and the psychological aspects of opioid dependence. The primary goal is to manage symptoms safely while transitioning the individual toward long-term recovery.

Medical Detox for Opioid Withdrawal

Medical detoxification, or detox, is often the first step in treating opioid withdrawal. This process involves clearing opioids from the body while providing medical supervision and support to manage withdrawal symptoms.

Opioid detox includes:

24/7 medical monitoring to address complications promptly
Medication administration to reduce withdrawal symptoms
IV fluid replacement if needed for dehydration
Nutritional support to address deficiencies
Psychological support during the challenging early days of withdrawal
Seamless transition to ongoing treatment following detox

Medical detox typically lasts 5-10 days for most opioids, though this period may be extended for long-acting opioids like methadone. Throughout the detox process, vital signs are monitored, medications are administered as needed, and supportive care is provided to ensure safety and comfort.

Opioid Withdrawal Medications

Several medications have been approved for managing opioid withdrawal symptoms and supporting long-term recovery:

Medications for Symptom Management

Clonidine – A non-opioid medication that helps reduce anxiety, agitation, muscle aches, sweating, runny nose, and cramping. While not FDA-approved specifically for opioid withdrawal, it is commonly used off-label for this purpose.
Anti-nausea medications (e.g., ondansetron, promethazine) – Help control nausea and vomiting during withdrawal.
Anti-diarrheal medications (e.g., loperamide) – Help manage diarrhea and intestinal cramping.
Pain relievers (non-opioid) – NSAIDs like ibuprofen or acetaminophen may be used to address pain and discomfort.
Sleep aids (e.g., trazodone, hydroxyzine) – May be prescribed temporarily to help with insomnia during withdrawal.

Medication-Assisted Treatment (MAT) For Opioid Use Disorder

Medication-Assisted Treatment (MAT) combines medications with counseling and behavioral therapies to provide a “whole-patient” approach to treating opioid use disorders.

The FDA has approved several medications specifically for MAT:

Sublocade (Extended-Release Buprenorphine)
- Once-monthly injection that delivers a controlled, sustained level of buprenorphine
- Eliminates the need for daily medication adherence
- Maintains stable blood levels, reducing cravings and withdrawal symptoms
- Must be initiated after patients have been stabilized on oral buprenorphine
- Provides a barrier against misuse, diversion, and accidental exposure
Naltrexone
- An opioid antagonist that completely blocks the effects of opioids
- Cannot be started until 7-10 days after the last opioid use (after detox is complete)
- Available as a daily oral medication
- Particularly effective for highly motivated patients with strong recovery support
- No potential for misuse or dependence
Vivitrol (Extended-Release Naltrexone)
- Once-monthly injectable form of naltrexone
- Eliminates the need for daily medication adherence
- Blocks opioid effects for approximately 28 days
- Requires complete detoxification before administration
- Particularly beneficial for patients with compliance concerns

Research consistently demonstrates that medication alone, while helpful, does not provide the same level of benefit as medication integrated with opioid rehab once detox is over. The combination addresses both the physical aspects of dependence and the psychological, social, and behavioral factors that contribute to opioid use disorder/

Finding Help For Opioid WithDrawal Today

Recovery from opioid use disorder is possible, and professional treatment can make the withdrawal process safer and more comfortable. Taking the first step is often the hardest part, but it’s also the most important.

At Peachtree Detox, our compassionate professionals are available 24/7 to answer your questions, verify your insurance coverage, and help you begin your recovery journey. The call is completely confidential and comes with no obligation.

The withdrawal process is temporary, but recovery can last a lifetime. With the right support, you can overcome opioid dependence and build a healthier, more fulfilling future.

Call us at 470-613-7881 and verify your insurance now.

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