What to Know About Opioid Withdrawal: Symptoms, Timeline, and Treatment Options
By We Level Up | Author Alex Evans, PharmD, MBA | Editorial Policy | Research Policy
Opioids are a class of drugs that include prescribed pain relievers, such as oxycodone and morphine, and illegal drugs, such as heroin. However, opioids can be highly addictive. When people use opioids for a long time, they become physically dependent on the drug.
Unfortunately, the opioid crisis has had a devastating impact in the US. For those trying to break free from opioid dependency, withdrawal is often the first challenge, and without proper care, it can cause relapse.
Opioid withdrawal happens when someone stops using opioids. Their body goes through a period of adjustment that may cause uncomfortable physical and emotional symptoms. They may experience restlessness, heavy sweating, trouble sleeping, and digestive problems. Severe symptoms may require hospitalization. Luckily, there are several treatment options available to manage withdrawal symptoms.
In this article, we’ll cover the withdrawal symptoms, timeline, and treatment options available for opioid withdrawal.
Key Takeaways
- Opioid withdrawal occurs when you stop or significantly reduce opioid use after developing physical dependence.
- Withdrawal symptoms typically begin within 12-24 hours after the last dose, peak in intensity during the first few days, and subside within 7-10 days. Psychological symptoms may persist for weeks or months.
- Treatment options for opioid withdrawal include medical detox, medications like methadone and buprenorphine, behavioral therapies, and support groups.
- After completing detox, ongoing treatment and support are essential for maintaining long-term recovery and preventing relapse.
What is Opioid Withdrawal
Opioids are a class of drugs that include prescribed medications such as oxycodone, hydrocodone, and morphine, as well as illicit substances like heroin. These drugs interact with the opioid receptors in your brain to block pain signals. They can also cause your brain to release dopamine, a chemical that makes you feel good. If you use them as directed by a doctor, prescription opioids are usually safe for a short period.
However, the prolonged use of opioids can make your body adapt to the presence of the drug. It may lead to physical or psychological dependence, or what we can call opioid addiction.
Physical dependence on opioids can develop quickly. Certain factors can influence your likelihood of developing opioid dependence and also opioid use disorder, such as genetics, environment, mental health, how long you’ve been taking the drugs, and how much.
And when you suddenly reduce or quit using opioid drugs on your own, the physical dependence and addiction can affect you in many ways. While not typically life threatening, your body may experience a range of withdrawal symptoms that can be very uncomfortable. The discomfort of withdrawal symptoms may drive you to continue using opioids to avoid or alleviate these symptoms.
One thing that can help you during this withdrawal process is proper care and discussion with your healthcare provider. They can help you assess the severity of withdrawal symptoms you’re experiencing and create an appropriate treatment plan for your condition.
Symptoms of Opioid Withdrawal
Opioid withdrawal symptoms are generally divided into two stages: early and later.
How intense the symptoms are depends on:
- Type of opioid used
- How long you’ve been using it,
- How long the drug stays in your body,
- Your health
- Whether you are quitting under the supervision of a healthcare provider
For short-acting opioids, like heroin, withdrawal can begin as soon as 4 hours after the last dose. They may include:
- Restlessness
- Anxiety
- Irritability
- Muscle aches and pains throughout your body
- Sweating
- Runny nose and watery eyes
- Yawning
- Insomnia
- Rapid breathing
These symptoms are shorter in duration and are more intense.
However, for long-acting opioids like methadone, withdrawal symptoms can show up within 72 hours after you take the last dose. They may include:
- Nausea and vomiting
- Diarrhea
- Abdominal cramps
- Goosebumps
- Dilated pupils
- Increased heart rate and blood pressure
In some cases, physical symptoms go away, but psychological symptoms, like depression and cravings, may last for weeks or even months. This condition is known as post-acute withdrawal syndrome (PAWS).
Even though withdrawal symptoms are rarely life-threatening, they can be very uncomfortable and distressing.
The Opioid Withdrawal Timeline
The timeline for opioid withdrawal varies from person to person. It also depends on the type of opioid used. Short-acting opioids like heroin may produce withdrawal symptoms sooner than long-acting opioids like methadone.
However, opioid withdrawal generally follows the following three stages:
Early Stage: Mild Symptoms Begin
A person’s craving for opioids typically begins after they miss a dose. Withdrawal symptoms often begin to appear as soon as 4 hours after the last dose for short-acting opioids and within 30 hours of the last dose of methadone.
During this stage, you may notice:
- Restlessness and irritability
- Muscle aches
- Trouble sleeping
- Light sensitivity
- Yawning
- Runny nose and watery eyes
Peak Stage: Intense Symptoms
As your body continues to adjust to the absence of opioids, withdrawal symptoms may intensify and reach their peak level. With short-acting opioids, withdrawal symptoms often become severe within 1-3 days. For long-acting opioids and extended-release drugs, the peak may take longer after you stop taking opioids.
Common symptoms during this withdrawal phase are:
- Nausea, vomiting, and diarrhea
- Severe cravings for opioids
- Sweating and chills
- Flu-like symptoms such as fever, body aches, and fatigue
- Increased heart rate and blood pressure
- Mood changes, including depression, anxiety, or hopelessness
This withdrawal phase is especially challenging for most people, as it involves physical and emotional distress. Some people may feel too sick to get out of bed and are at a high risk of relapse.
Last Stage: Gradual Improvement
For many people, physical withdrawal symptoms begin to gradually get better after 7-10 days. However, psychological symptoms like depression and cravings may persist. These lingering symptoms are often part of Post-Acute Withdrawal Syndrome (PAWS), which can last for weeks or months.
During this stage, ongoing support and treatment can help you prevent relapse and address the underlying causes of opioid misuse, such as anxiety, pain, or trauma.
What is the withdrawal timeline for different opioids?
- Heroin: Withdrawal symptoms begin to show up within 12 hours after a person misses their last dose, peak within 1-3 days, and typically resolve within 5-7 days.
- Short-acting opioids (e.g., hydrocodone, fentanyl, oxycodone): Symptoms start 8-24 hours after last use, intensify at 1-3 days, and last 7-10 days.
- Long-acting opioids (e.g., extended-release drugs, methadone): Symptoms may take up to 36 hours to appear, hit a peak at 72-96 hours, and continue for 14 days or maybe more.
How Long Do Opioids Stay in Your System?
Opioids can stay in your body for a few hours to several hours after your last use. However, there are still many factors that determine how long opioids are detectable in your body. They may include:
- The type of opioid
- The amount of drug taken
- How it is taken (injecting or snorting)
- How your body processes it
Individual physical health factors such as age, weight, hydration levels, and rate of metabolism also affect the window of time when testing for opioids. For example, people with slower metabolism or liver and kidney problems may take longer to get rid of opioids from their body. Chronic and heavy opioid use can also lead to accumulation in the body and so it can take longer to get rid of them. Lastly, different opioids interact with your body’s receptors in a similar way, but the amount of time their effects are active can vary.
Opioid testing is usually done by testing either urine or blood. How long opioids can be detected depend on the factors above. Heroin, for example, can be detected in a urine drug screening for around 2-3 days after last use.
Treatment Options For Opioid Withdrawal
Opioid addiction is a medical condition that changes how the brain and the body work. It is not something people can stop on their own. Overcoming opioid addiction is possible and often requires professional help and support.
Successful, lifelong treatment to stay opioid-free includes long-term medication, counseling, or behavioral therapies. With the right treatment, you can manage opioid withdrawal symptoms safely and begin long-lasting recovery.
Medical Detox for Opioid Withdrawal
Medically managed detoxification is often the first step in treating opioid addiction. It involves the removal of opioids from your body safely under medical supervision. Doctors and healthcare professionals help make the withdrawal process safe and as comfortable as possible, especially for those with severe dependencies or long-term use. Medical detox is often done in hospitals or treatment centers, but some can do it as outpatients.
Which medications are used for opioid withdrawal? For mild withdrawal symptoms, over-the-counter medicines like aspirin, ibuprofen, or acetaminophen (Tylenol) can help with pain or discomfort.
More severe withdrawal symptoms may require hospitalization and other medications. In these cases, your doctors may prescribe several medications to help reduce the severity of withdrawal symptoms. Options include:
Methadone
This long-acting opioid reduces cravings and withdrawal symptoms by activating opioid receptors without producing high. It is often used for people with severe opioid addiction and can be tapered gradually to help the body adjust.
Buprenorphine
It is a partial opioid agonist that minimizes withdrawal effects. It helps reduce cravings and withdrawal symptoms and is often used in combination with naloxone (e.g., Suboxone).
Naltrexone
It blocks opioid effects and helps prevent the high associated with relapse. It is usually started after detox is complete and can be part of ongoing treatment to prevent relapse.
These drugs bind to opioid receptors and reduce withdrawal symptoms without eliciting euphoria in people with opioid dependency.
Other supportive medications may include:
Clonidine for opioid withdrawal
Clonidine is used primarily in the inpatient setting. It can help reduce the intensity of withdrawal symptoms. Clonidine works by calming the nervous system and is often used in combination with other treatments. It is especially good at easing anxiety, restlessness, sweating, and muscle aches.
Benzodiazepines for Opioid Withdrawal
Benzodiazepines are not typically used for opioid withdrawal. But studies show that two out of five people seeking detox for opioid use disorder had used benzodiazepines in the prior month. These medications act as sedatives, calming the brain and nervous system, which may give them relief during withdrawal. Benzodiazepines can be dangerous when combined with opioids, and they are not approved for opioid withdrawal. It’s best to speak with your healthcare provider if you want to come off of opioids.
Cannabidiol for Opioid Withdrawal
Cannabidiol (CBD), a non-psychoactive compound in cannabis, shows promise in easing opioid withdrawal symptoms. Research suggests it may reduce anxiety, nausea, insomnia, and pain, making withdrawal more manageable. A 2021 study found that CBD could lower opioid cravings and even help reduce opioid use in individuals with chronic pain.
Despite its potential, CBD is not yet approved for opioid withdrawal, and more research is needed to confirm its safety, effectiveness, and optimal dosages. While it may complement traditional treatments, CBD should only be used under medical supervision as part of a comprehensive withdrawal and recovery plan.
Trazodone for Opioid Withdrawal
Insomnia is one of the most common symptoms of opioid detox and withdrawal. Trazodone is often prescribed to help people with insomnia, and it may be used to help you get some sleep. It is usually taken at bedtime to minimize daytime drowsiness. Trazodone is considered safe and effective but should only be used as prescribed.
Vitamin C for Opioid Withdrawal
Vitamin C (ascorbic acid, AA) has been studied for its potential to reduce opioid consumption as well as help with withdrawal. However, it is not approved for either of these conditions. More research is needed to determine if it is safe or effective.
However, unlike other medications, it’s safe, affordable, and easy to find. Ask your healthcare provider first if it’s OK for you to take, but most people can add Vitamin C to their medication regimen.
Gabapentin For Opioid Withdrawal
Gabapentin is an anticonvulsant medication commonly used to treat nerve pain and seizures. Like Vitamin C, gabapentin has been studied as a potential treatment for opioid withdrawal. But more research is needed first. Gabapentin is a prescription medication and should only be used as instructed by your healthcare provider.
Kratom for Opioid Withdrawal
Kratom is an herbal extract from the leaves of a tropical tree native to Southeast Asia. In Asia, people use kratom in small amounts to reduce tiredness or attempt to self-treat opioid withdrawal.
However, kratom is not FDA-approved and can cause side effects. While researchers have studied kratom for managing withdrawal symptoms, the evidence shows that it may not help with addiction. Instead, using kratom could lead to dependency and withdrawal symptoms of its own.
Opioid Detox at Home
It’s best to only attempt opioid detoxification under medical care. Many people can still stay at home while going through detoxification, but your healthcare team can help reduce withdrawal symptoms and work with you to create a long-term plan for you to break free from opioid addiction.
If you are going through opioid detox at home, make sure to gather supplies like over-the-counter painkillers (like aspirin, ibuprofen, or acetaminophen), anti-diarrhea medicine (e.g., Loperamide (Imodium)), and electrolyte drinks to stay hydrated.
In addition to medications, some home remedies, such as staying hydrated, getting plenty of rest, and eating a balanced diet, can ease the withdrawal process. Light activities like stretching or walking can also help you relax and reduce stress. If you experience severe symptoms like rapid heartbeat, high fever, or hallucinations, seek immediate medical attention.
Remember, home detox carries risks such as dehydration, electrolyte imbalance, and relapse. Therefore, it is also important to have family or friends around for support and to know when to get medical help if things get difficult to manage.
Once detox is over, keep up the recovery with therapy, support groups, and taking care of your mental health. Detoxing at home can be challenging, but with the right help, you can make it possible. If the withdrawal process gets too hard, don’t hesitate to reach out for professional help. Your health and safety are the top priority. Recovery is possible, and you have the strength to overcome it.
Inpatient Rehabilitation
Inpatient facilities provide 24/7 medical and psychological care. These programs are ideal for people with severe addiction or co-occurring mental health disorders. They provide structured schedules, group therapy, and access to medical care.
Outpatient Programs
Outpatient programs allow you to receive treatment along with your daily tasks. These programs are for those with milder opioid dependence. They may include counseling sessions, medication management, and support groups.
Counseling and Therapy
Behavioral therapies and counseling address the psychological aspects of opioid addiction. They help people address the underlying causes of opioid use disorder (OUD) and develop coping skills to control triggers and manage cravings. These approaches include:
- Cognitive behavioral therapy (CBT)
- Motivational interviewing (MI)
- Contingency management (i.e., provides incentives for maintaining sobriety, such as vouchers or prizes for negative drug tests)
Support Groups
Several groups, like Narcotics Anonymous (NA) or SMART Recovery, offer a community-based approach. These groups introduce you to people who have firsthand experience with what you’re going through. They can share recovery tips and support you in overcoming challenges.
What Can I Expect From an Opioid Detox Center?
Overcoming opioid addiction isn’t easy, but a professional detox center can make the process smoother and faster. At a detox facility, trained doctors, nurses, therapists, and addiction specialists work together to support you every step of the way.
The detox process generally begins with an in-depth assessment. You’ll be asked about your drug use history, how long you’ve been using it, how often, and in what amounts. This information helps your doctor to create a treatment plan according to your needs.
In a detox program, you’ll have 24/7 medical care to help manage withdrawal symptoms, which can last up to two weeks. Medical staff may use medications to ease discomfort, reduce cravings, and prevent complications. They may prescribe methadone, buprenorphine, or naltrexone to manage cravings and reduce relapse risk. Behavioral therapies, such as cognitive-behavioral therapy (CBT), are often integrated into the detox process.
Detox centers also provide a supportive space where your daily needs, such as meals and medication schedules, are handled for you.
While detox focuses on the physical aspects of withdrawal, many detox centers also provide emotional support through counseling or therapy sessions. To make detox more manageable, you can bring activities to keep your mind occupied, like crafts, books, or journals. These small comforts can help you stay distracted from withdrawal symptoms and feel more at ease.
Detox is the first step in recovery. Before you leave, the staff will help you plan for the next phase of treatment, such as inpatient rehab, outpatient therapy, or support groups, to ensure ongoing progress. A smooth transition from detox to further treatment is essential for long-term recovery.
Contact us today to learn more about medically supervised detoxification treatment.
Frequently Asked Questions
Does alcohol help with opiate withdrawal?
No, alcohol can make withdrawal worse. It can cause dehydration and interact dangerously with detox medications. Do not ever attempt to treat opioid withdrawal with alcohol.
Does Suboxone help with opiate withdrawal?
Yes, Suboxone (buprenorphine/naloxone) reduces cravings and discomfort by acting on opioid receptors. It is used in medication-assisted treatment (MAT) programs under medical supervision to support long-term recovery.
Can you take ketamine for opiate withdrawal?
Ketamine, an anesthetic and pain reliever, is not a standard treatment for opioid withdrawal. It is also a prescription medication that should only be used under the supervision of your healthcare provider.
Is Lyrica effective for opiate withdrawal?
Lyrica (pregabalin) is an anticonvulsant and pain medication. It may help with anxiety and insomnia but isn’t approved for opioid withdrawal. It also carries its own risks of dependence and is a controlled substance.
Is hydroxyzine used for opiate withdrawal?
Hydroxyzine is an antihistamine with sedative properties. It may help with anxiety and sleep issues but doesn’t directly treat withdrawal symptoms. Your doctor can decide if hydroxyzine is a good choice for your withdrawal management plan.
Is tramadol used for opiate withdrawal?
Tramadol is a prescription opioid that is not used for opioid withdrawal. It is also a controlled substance and has a risk of dependence and abuse. Do not use tramadol unless directed by your healthcare provider.
Is baclofen effective for opiate withdrawal?
Baclofen is a muscle relaxant not typically used for opioid withdrawal. It is also a prescription-only medication. Do not use baclofen unless your healthcare provider prescribes it for you.
Are detox drinks for opiates enough?
No, detox drinks are not enough to manage opioid withdrawal effectively. While they may help with hydration or provide nutrients, they do not address the severe physical and psychological symptoms of withdrawal. These products often make unsubstantiated claims and are expensive. Talk to your healthcare provider before using any detox drinks.
What is opiate rapid detox?
This controversial approach uses anesthesia to speed up withdrawal. While it may shorten the duration of acute withdrawal, it carries significant risks and does not address the long-term aspects of recovery. Healthcare experts generally recommend a more gradual detox for safer, more sustainable results.
Can you take loperamide for opiate withdrawal?
Loperamide can help with diarrhea but does not address other aspects of opioid withdrawal. It’s best to speak with your healthcare provider before using any OTC or prescription medications, including loperamide.
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