Opioid Withdrawal & Timelines

Opioid withdrawal symptoms can be dangerous. Severe diarrhea and vomiting can lead to life-threatening dehydration and heart failure. Untreated withdrawal can also lead to cravings and drug relapse.

Don’t try moving through opioid withdrawal alone. Talk with a treatment team about how to get sober safely and comfortably. A detox program can ensure you complete the process without facing life-threatening complications.

How Long Does Opiate Withdrawal Last?

The amount of time opiate withdrawal can take varies, but the World Health Organization suggests doctors expect a duration of 4 to 10 days for short-acting opioids, like heroin, and 10 to 20 days for long-lasting opioids, such as methadone.

These symptoms typically begin within 8 to 24 hours after cessation of use with short-acting opioids (like heroin) and 12 to 48 hours after cessation with long-acting opioids (like methadone).

Symptoms of Opioid Withdrawal

While you may not want to, it is strongly recommended that you seek expert help while undergoing detox.

Opioid withdrawal is usually described as “flu-like,” with common symptoms like these:

• Agitation
• Anxiety
• Increased tearing
• Insomnia
• Muscle aches
• Runny nose
• Sweating
• Yawning

Late-stage withdrawal symptoms are typically worse and include the following:

• Abdominal cramping
• Diarrhea
• Nausea and vomiting
• Piloerection (goosebumps)
• Pupillary dilation

Generally speaking, symptoms will slowly worsen once a person stops taking opioids. They will hit a peak and then begin to taper off.

Opiate Withdrawal Timeline

Short-Acting Opioids

Short-acting opioids include the following drugs:

• Heroin
• Codeine
• Hydrocodone
• Oxycodone (immediate-release)
• Oxymorphone (immediate-release)
• Morphine

Long-Acting Opioids

Long-acting opioids include the following drugs:

• Methadone
• Hydrocodone (extended-release)
• Oxycodone (controlled-release)
• Oxymorphone (extended-release)

Factors That Affect Opiate Withdrawal

One of the biggest factors affecting the severity of withdrawal is the length of time a person has been using opioids and in what dosages.

Generally speaking, people who have used opioids longer or in higher amounts have a harder time during the detox process. This means the people who often experience the most discomfort are those who have intentionally abused opioids over multiple years.

As a result, people with longstanding or high-dose opioid addictions need additional support during the withdrawal process.

How to Safely Detox From Opioids

Opioid withdrawal can be significantly uncomfortable, and in severe cases, it can be life-threatening.

The most dangerous symptoms associated with withdrawal are vomiting and diarrhea. These symptoms, if untreated and severe, can cause three life-threatening results, which cascade into each other:

• Dehydration
• Hypernatraemia (elevated blood sodium level) 
• Heart failure

Fortunately, addiction treatment professionals understand these risks, and reputable treatment facilities will be well-equipped to help a person undergo withdrawal safely. They can help to ease withdrawal symptoms with medications and make sure a patient stays generally hydrated.

In an addiction treatment program, medical detox will begin the recovery process. The bulk of treatment will then take place in therapy, where the underlying issues that led to opiate abuse are addressed.

Risks of At-Home Opioid Withdrawal

While you may not want to, it is strongly recommended that you seek expert help while undergoing detox. Medical professionals can ensure you stay safe during the opioid withdrawal process, and they can make the process much more comfortable for you.

If you cannot access a treatment facility while undergoing withdrawal, make sure to prioritize hydration. You lose water not only through vomiting and diarrhea but also through sweating.

If you develop severe withdrawal symptoms, or you’re so uncomfortable that you think you might relapse to drugs, visit a hospital or urgent care center. Many people get treatment for opioid withdrawal in these settings, accessing the medications they need to stay safe. 

Tell the doctors what drugs you’ve been taking and the symptoms you’re experiencing. With their help, you’ll feel better.

Post-Acute Withdrawal Syndrome (PAWS)

People who have detoxed from opioids and gone through acute withdrawal may experience lingering symptoms for up to one year—these are called post-acute or protracted withdrawal symptoms and may include:

• Depression
• Anxiety
• Panic
• Irritability
• Learning, memory, or problem-solving issues
• Sleep problems
• Apathy
• Opioid cravings
• Increased stress sensitivity

Not everybody will experience PAWS, and these symptoms can also come and go and fluctuate in severity. If you’re experiencing post-acute withdrawal symptoms, you’ll want to make sure to receive therapy and support during this difficult time.

Medications Used to Treat Opiate Withdrawal

Medication-assisted treatment (MAT) is considered an evidence-based therapy for people with opioid use disorder. Organizations like the Centers for Disease Control and Prevention say increasing access to MAT is crucial.

Some people are introduced to MAT when they enter opioid detox programs. The following medications are often used:

Methadone

Methadone is a full opioid agonist, meaning it attaches fully to the same receptors used by drugs like heroin and oxycodone. Doses of methadone can ease withdrawal symptoms and associated cravings.

In a detox center, doctors offer doses ranging from 10 mg to greater than 100 mg. Researchers say that even these high doses don’t lead to sedation or respiratory distress. Instead, the medication helps people feel more comfortable.

Buprenorphine

Buprenorphine is a partial opioid agonist, meaning it latches loosely to opioid receptors. It also has a ceiling effect, which means that very high doses rarely cause problems like sedation or slow breathing.

Buprenorphine can cause withdrawal when it’s given too close to a dose of a strong opioid. In most detox programs, people must develop mild opioid withdrawal symptoms (like shivering) before they start buprenorphine.

While dosing rates can vary, experts say most people need at least 8 mg of the medication to get relief, and it can be provided at doses as large as 32 mg.

Clonidine

Clonidine is a medication that can treat many of the flu-like symptoms caused by withdrawal, reducing anxiety, agitation, muscle aches, and more. It is often used in combination with other medications that treat nausea, diarrhea, and sleep problems.

Lucemyra

In 2018, the U.S. Food and Drug Administration approved Lucemyra (lofexidine hydrochloride) for opioid withdrawal symptoms. This medication can lessen the severity of symptoms (like diarrhea), ensuring that people move through the process safely. However, it can’t prevent all opioid withdrawal symptoms. The medication also can’t block drug cravings.

Lucemyra is only approved for treatment lasting 14 days or less. Experts don’t consider it a treatment for opioid use disorder, but it can help ease some of the real dangers caused by sudden withdrawal.

Getting Help With Opiate Withdrawal

Ultimately, the best path forward for opiate detox is to get professional assistance.

Relapse is highly likely for those who attempt opiate detox on their own. When withdrawal symptoms get intense, it’s simply too easy to return to opioid use.

With the right help and a good support system, you can effectively get through opiate withdrawal and embrace life in recovery. Reach out for that help today.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More