Most opioid withdrawal runs its course in about a week, and knowing the order things arrive in makes that week easier to plan around. This guide follows the whole arc: what withdrawal feels like, how detox is assessed and managed, the signs that need urgent help, and what lowers the overdose risk once the physical symptoms settle.
Key Points About Opioid Withdrawal and Detox
- Vomiting and diarrhea are the part that can hurt you: untreated, they cause dehydration, though withdrawal itself rarely kills.
- Overdose risk peaks after detox, when tolerance falls and a dose the body once handled can now cause an overdose.
- Buprenorphine, methadone and lofexidine ease withdrawal, and buprenorphine or methadone can continue as longer-term treatment.
- Buprenorphine started too early can trigger precipitated withdrawal, so clinicians time the first dose, especially after fentanyl use.
- Detox is a first step: medication and counseling afterward are what reduce the risk of relapse and overdose.
- Alcohol does not ease withdrawal, and drinking before returning to opioids can cause a fatal overdose.
Opioid Withdrawal Symptoms
Opioid withdrawal behaves like a heavy bout of flu. Anxiety and aching muscles and bones arrive alongside sweating, a dripping nose, stomach cramps, vomiting and diarrhea. Restlessness and broken sleep tend to come first, with stomach trouble, dilated pupils and goosebumps later.
Early symptoms
The early ones include agitation and anxiety, watery eyes, a runny nose, sweating, yawning, muscle aches and trouble sleeping.
Later symptoms
Stomach cramps and diarrhea join dilated pupils, goosebumps, nausea and vomiting. A fast heart rate, higher blood pressure and chills can also occur.
Emotional symptoms
Strong cravings sit underneath all of it, and they explain a good share of why people start using again while withdrawal is still running. Cravings, irritability, low mood and trouble concentrating belong to withdrawal too, lingering after the physical symptoms fade.
Is it the flu or opioid withdrawal?
The two overlap, so a few differences are worth knowing.
| Clue | Flu | Opioid withdrawal |
|---|---|---|
| When it starts | Begins 1 to 4 days after contact with the virus | Hours after the last opioid dose |
| Fever | Common, often high | Seldom, and mild if at all; chills and sweating are frequent |
| Cough, sore throat | Common | Not typical |
| Runny nose, watery eyes | Common | Common |
| Muscle aches | Common | Common |
| Dilated pupils, goosebumps, frequent yawning | Not typical | Common |
| Strong craving for opioids | No | Common |
Taking opioids exactly as a prescription directs can still lead to physical dependence and withdrawal, and that alone does not mean someone has opioid addiction. If opioids are treating your pain, raise it with the prescriber who wrote the prescription before you quit: the FDA warns that stopping abruptly brings serious withdrawal and uncontrolled pain, so a slower taper is safer.
Opioid Withdrawal Timeline: How Long Does It Last?
Heroin and immediate-release oxycodone are short-acting: withdrawal usually begins within roughly 12 hours of the last dose. Symptoms peak in 1 to 3 days and ease over about 7 to 10 days. Long-acting opioids such as methadone start later, up to about 36 hours, peak near days 3 to 4 and can run 14 days or more. Sleep, mood and cravings can stay unsettled for weeks or months after symptoms fade.
| Phase | Timing | What may happen |
|---|---|---|
| Early withdrawal | About 12 hours after the last heroin dose; about 30 hours after methadone; up to 36 hours for long-acting opioids | Restlessness, yawning, anxiety, poor sleep, runny nose, watery eyes, sweating, body aches |
| Peak withdrawal | 1-3 days after the last short-acting dose; 72-96 hours with a long-acting opioid | Vomiting, diarrhea, cramps, goosebumps, dilated pupils, fast heartbeat, dehydration risk |
| Easing of acute symptoms | About 7-10 days total for short-acting opioids; 14 days or more for long-acting ones | Physical symptoms fade; sleep and mood recover |
| Protracted symptoms | Weeks to months | Lower well-being, strong cravings |
| After withdrawal | Days to weeks after detox | Tolerance has dropped, so a once-usual dose can cause an overdose |
Timing varies by opioid.
| Type | Examples | Onset | Length |
|---|---|---|---|
| Short-acting | Heroin; immediate-release oxycodone, hydrocodone, morphine | About 12 hours (heroin) | About 7-10 days |
| Long-acting | Methadone; extended-release opioids | About 30-36 hours | 14 days or more |
| Illegally made fentanyl | Fentanyl powder or counterfeit pills | Less predictable | Can be longer or uneven |
Fentanyl withdrawal can be harder to predict
Illegally made fentanyl does not keep that clock: it can stay in the body longer, so withdrawal may arrive unevenly and drag on.
Buprenorphine taken less than about 48 hours after fentanyl use can set off precipitated withdrawal, the intense start of symptoms. Clinicians now adjust how buprenorphine is started for people who use fentanyl.
Xylazine and medetomidine can complicate withdrawal
Sedatives in the illegal fentanyl supply carry withdrawal of their own. Medetomidine can bring on a severe withdrawal syndrome needing hospital care. Xylazine brings a separate syndrome too, described in xylazine withdrawal. Tramadol and kratom have withdrawal timelines too: tramadol withdrawal and kratom withdrawal.
Can You Die From Opioid Withdrawal?
Opioid withdrawal rarely kills on its own, but it can. Vomiting and diarrhea cause dehydration and electrolyte problems when untreated. The danger comes afterward: tolerance falls fast, and a dose once handled can now cause an overdose. Most opioid overdose deaths follow a recent detox.
Dehydration can raise blood sodium and, rarely, heart failure. Pregnancy, older age and heart, kidney or mental health conditions call for medical care during withdrawal: the American College of Obstetricians and Gynecologists (ACOG) and SAMHSA warn against stopping opioids alone in pregnancy, favoring buprenorphine or methadone over detox.
Get help right away if you or someone with you:
- cannot hold fluids down, or vomits or has diarrhea that will not stop
- feels dizzy or confused, or barely urinating
- has chest pain, a fast heartbeat or fainting
- talks about suicide: call or text 988
- is barely breathing, has pinpoint pupils or cannot be woken: give naloxone, call 911
54,045
U.S. opioid overdose deaths in 2024, CDC final
44,564
U.S. opioid overdose deaths in 2025, CDC provisional
Naloxone reverses opioid overdoses, including fentanyl, and will not harm someone not overdosing. Narcan nasal spray went over the counter in 2023, and other sprays followed. Keep naloxone at home during and after detox.
Opioid Detox: What to Expect
Detox, which clinicians also call withdrawal management, is medical care that keeps a person safe and as comfortable as possible while the body adjusts to going without opioids. It starts with an assessment of how severe the withdrawal is, often using the Clinical Opiate Withdrawal Scale (COWS), and continues with medicines such as buprenorphine, methadone or lofexidine that ease symptoms. It is a first step rather than a full treatment: medication and counseling that follow reduce the risk of relapse and overdose.
Where opioid detox happens
Detox takes one of three shapes: medical detox in a hospital or residential unit, inpatient care with staff around the clock, or an outpatient program where a clinician prescribes medicine and checks in often. Inpatient care is the usual setting for heavy fentanyl use, for alcohol or benzodiazepines used alongside opioids, in pregnancy, or with serious medical or mental health conditions.
How withdrawal is measured: the COWS scale
Wesson and Ling built COWS in 2003 to score 11 signs: resting pulse, sweating, restlessness, pupil size, stomach upset, tremor, goosebumps, yawning, bone or joint aches, a runny nose or tearing, and anxiety or irritability. A higher total means more severe withdrawal.
| COWS score | Withdrawal level |
|---|---|
| 5-12 | Mild |
| 13-24 | Moderate |
| 25-36 | Moderately severe |
| More than 36 | Severe |
Medications used during opioid detox
Each option:
| Medication | How it helps | Good to know |
|---|---|---|
| Buprenorphine (alone or with naloxone, as in Suboxone) | Partial agonist: eases withdrawal and cravings, can shorten detox | Starts once withdrawal is under way; can continue long term |
| Methadone | Full agonist: prevents withdrawal and cravings | Through certified opioid treatment programs, often long term |
| Lofexidine (Lucemyra) | Non-opioid that eases symptoms; FDA approved in 2018 | Eases symptoms but does not treat opioid use disorder; blood pressure and heart rate may fall |
| Clonidine | Eases anxiety, sweating, runny nose, cramps, agitation | Off-label; can lower blood pressure |
| Symptom relief | Eases nausea, diarrhea, aches, poor sleep | Follow label directions; very high loperamide (Imodium) doses can harm the heart |
| Naltrexone (after detox) | Blocks opioid effects, which can help prevent a return to use | After 7 to 10 days with no opioids; monthly injection form |
Buprenorphine and methadone differ in how they are started and monitored, and buprenorphine vs. methadone compares them.
Buprenorphine and precipitated withdrawal
Buprenorphine attaches to opioid receptors more tightly than most opioids but switches them on only partly. Given while fentanyl or heroin still occupies those receptors, it can displace that opioid and trigger what clinicians call precipitated withdrawal, a sudden, intense bout. So the first dose waits until withdrawal is clearly under way, often checked with COWS.
Fentanyl clears the body slowly, which makes the timing harder: with regular use, withdrawal rises and falls unevenly. Clinicians may start very small doses while the person keeps taking their own opioid, the low-dose start, or give 8 mg or more once withdrawal begins, a high-dose start. Buprenorphine labeling sets no maximum daily dose, the FDA has clarified, because high tolerance can leave some people needing more than 24 mg. A prescriber can time that first dose.
Can you detox from opioids at home?
Withdrawal on its own is rarely dangerous, but doing it without help is hard, and it brings real risks: symptoms drive many people back to using, and overdose risk climbs as tolerance falls. Many people can manage withdrawal at home when a clinician prescribes buprenorphine and checks in often, including by telehealth. Supervision matters most for someone who uses fentanyl heavily, also drinks or takes benzodiazepines or xylazine, is pregnant, or has heart, kidney or mental health conditions. If you are supporting a family member, helping a loved one with addiction covers what helps.
After detox: why the next step matters
Overdose risk peaks in the weeks after detox, since tolerance falls fast and a dose once handled can now be too much. Continuing medication lowers it: a large study of overdose survivors found 59% fewer opioid overdose deaths over the next year among people taking methadone, and 38% fewer among people taking buprenorphine, a 2018 report in the Annals of Internal Medicine noted. Have naloxone nearby, and make sure the people around you can use it.
Most people do better when detox leads into ongoing care: medication-assisted treatment that continues buprenorphine or methadone, counseling, and a residential or outpatient program. Medicaid and private insurance commonly pay for detox and treatment, so check how to pay for rehab before you call.
What Helps With Opioid Withdrawal?
Care does the most: with a clinician’s guidance, buprenorphine, methadone, lofexidine and clonidine make withdrawal easier. At home, fluids and rest help. Alcohol, kratom or a borrowed prescription makes withdrawal worse.
Comfort steps that help:
- Sip water and fluids that carry electrolytes, especially when vomiting or diarrhea sets in.
- Rest, and lighten your schedule the first week if you can.
- Take over-the-counter pain, nausea or diarrhea medicine as directed.
- Eat small, bland meals when you can.
- Have someone check on you, and clear opioids from home.
- Keep naloxone where others can find it.
Does Alcohol Help Opioid Withdrawal?
No. Alcohol may blunt the discomfort, yet drinking makes withdrawal more dangerous. Alcohol and opioids both slow breathing, so drinking and then returning to opioids can cause a fatal overdose. Alcohol also worsens dehydration and nausea and can cause alcohol withdrawal seizures. If alcohol is involved, tell the detox team.
Gabapentin, Clonidine and Kratom
A study tested gabapentin as an add-on to methadone-assisted detox. Gabapentin is not approved for opioid withdrawal, and the FDA warns mixing it with opioids can cause serious breathing problems. It is prescription only.
Clonidine is a blood pressure medicine used off-label for withdrawal. It is prescription only and can lower blood pressure.
No use of Kratom has FDA approval, and the FDA warns that it can lead to addiction and its own withdrawal.
Opioid Withdrawal FAQs
How long does opioid withdrawal last?
For heroin and other short-acting opioids, withdrawal lasts about 7 to 10 days, and days 1 to 3 are usually the hardest. Methadone and other long-acting opioids run 14 days or more. Sleep trouble, low mood and cravings can outlast both.
What helps with opioid withdrawal?
Medication does most of the work: buprenorphine, methadone, lofexidine or clonidine, prescribed and adjusted by a clinician. Fluids, rest and over-the-counter medicines, taken as the label directs, ease the day to day symptoms.
What should you give someone for opioid withdrawal vs. an overdose?
For withdrawal, a person needs medical care, fluids, and medication a clinician prescribes, such as buprenorphine or lofexidine. Naloxone will not ease withdrawal, and it can deepen the symptoms. Treat slow or stopped breathing, pinpoint pupils and a person who cannot be woken as an overdose: give naloxone at once and call 911.
Can you die from opioid withdrawal?
Rarely. The main danger is dehydration from vomiting and diarrhea that goes untreated, which can disturb the body’s electrolytes. The greater danger arrives when tolerance has dropped after withdrawal, since a dose the body once handled can now cause an overdose.
What is precipitated withdrawal?
Sudden, intense withdrawal that follows buprenorphine or naltrexone taken while fentanyl, heroin or another full opioid is still active. Buprenorphine grips opioid receptors tightly and switches them on only partly, so it can push the other opioid off and set symptoms off at once. Clinicians time the first dose during medical detox to keep that from happening.
What is a COWS score?
A COWS score comes from the Clinical Opiate Withdrawal Scale, which grades 11 signs and adds them into one number. A total of 5-12 counts as mild, 13-24 as moderate, 25-36 as moderately severe, and above 36 as severe. Clinicians read that number to judge how hard the withdrawal is and whether treatment is working.
Does alcohol help opioid withdrawal?
No. Opioids slow breathing, and alcohol does too, so a drink followed by a return to opioid use can be deadly. Alcohol also makes dehydration worse.
Can I take gabapentin or kratom for opioid withdrawal?
Not on your own. Gabapentin is not approved for opioid withdrawal, and the FDA warns that combining it with opioids can cause serious breathing problems. Kratom is in the same position: no approved use, and it can bring dependence and withdrawal of its own.
Why is fentanyl withdrawal different?
Fentanyl lingers longer than clinicians expect with regular use, so the withdrawal it brings may climb and ease unevenly instead of following a steady curve. That unevenness is why a first buprenorphine dose needs extra care.
What happens after opioid detox?
Ongoing medication, counseling and a program, whether inpatient or outpatient, carry most people past detox. Overdose risk is highest in the weeks that follow, so keeping naloxone on hand matters, and the people around you should know how to give it.
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Courtney Myers, MS
Courtney Myers is a professional writer and editor in North Carolina. She holds an MS in Technical Communication from N.C. State University and has worked in digital marketing for more than 15 years. While she has written content across a variety of industry verticals, she…
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