Opiate Withdrawal Symptoms, Timeline, and Detox Treatment

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Chronic opiate misuse can lead to physiological dependence, which means your body needs opiates to continue functioning normally. If you are dependent on opiates and suddenly quit using them, you’ll experience opiate withdrawal symptoms, which can be extremely distressing and uncomfortable. Opiate withdrawal is not typically life-threatening but the symptoms can be very severe and can occasionally have dangerous consequences. However, help is available. Medical detox can help you safely and comfortably withdraw from opiates by providing you with around-the-clock medical oversight, care, and monitoring.^1,2

Opiate Withdrawal Symptoms

If you take opiates or opioids exactly as prescribed, you can still become dependent on your medication. This is a normal physiological response and nothing to be concerned about. However, if you want to stop taking your pain medication, you’ll want to talk to your doctor first so they can create a tapering schedule for you so you can avoid opiate withdrawal symptoms.³

Otherwise, if you misuse opiates like heroin, the speed with which you develop a dependence will be much faster, and your opiate withdrawal symptoms will likely be more severe.

Opioid withdrawal symptoms have been likened to those of a moderate to severe flu, including:^2,4

Bone pain
Muscle aches
Increased or lowered body temperature
Anxiety
Stress
Weakness
Insomnia
Nausea
Vomiting
Diarrhea
Chills
Irritability
Increased heart rate
Depression

Opiate Withdrawal Timeline: How Long Does It Last?

The onset of withdrawal symptoms may begin within a few hours of the last opioid use.⁵ The exact onset of withdrawal symptoms does appear to vary depending on the specific opioid and amount of drug used.²

Heroin withdrawal appears to begin within 12 hours of last use, whereas fentanyl shows a withdrawal onset of 8-16 hours. Methadone withdrawal symptoms develop the latest, with a symptom onset of 30 hours—this is because methadone is a long-acting opioid, meaning its effects come on slower and last longer than others.²

Short-acting opioids, such as codeine and hydrocodone, appear to cause more severe symptoms, and long-acting opioids have a longer detox process.² With short-acting opioids, withdrawal symptoms peak by 36-72 hours and resolve within 5 days.⁶

Longer-acting opioids such as fentanyl and morphine peak within 5-6 days, and withdrawal resolves within 14-21 days.⁶ When opioid withdrawal symptoms begin to appear, they develop in a predictable order, beginning with anxiety, drug cravings, and sweating.^2,5

This anxiety is usually increased by the onset of sympathetic and central nervous system arousal, such as increased heart rate, irritability, and restlessness.⁵

Gastrointestinal distress and flu-like symptoms will begin following the anxiety and nervous system arousal, including nausea, vomiting, diarrhea, and shivering.⁵

The other symptoms may also develop at any point during the withdrawal process, with depression developing throughout the withdrawal period and possibly remaining after the detox is complete.^2,5

Is Opiate Withdrawal Dangerous?

Opiate withdrawal is not typically life-threatening, but the fear and severity of the withdrawal process can seem intimidating.²

Although death is unlikely, there is a risk of dehydration from vomiting and diarrhea. This can present complications, if untreated, as dehydration may lead to an elevated blood sodium level and potentially heart failure.⁷

Despite the low risk of life-threatening consequences, however, studies show that fear of the detox experience may deter some from seeking treatment. This fear may stem from those addicted, who feel most normal while using opioids, and the subsequent fear of how they feel without the drugs. Or, it may come from those using opioids to manage chronic pain conditions, and the fear of experiencing pain when the medication is discontinued.²

This apprehension is a large barrier to the successful treatment and recovery of those needing help, and one that can hopefully be overcome with the knowledge of and accessibility to medical support during the opiate detox process.²

Options are available to not only help manage opiate withdrawal symptoms but also assist those needing continued pain management once opioid use is discontinued. With the knowledge that medical support is available, more people may feel encouraged to begin their recovery process.²

Detox Treatment

Medical detox is a medically managed detoxification process. This is offered when opiate use is first discontinued, and the detox or withdrawal phase begins.⁸

Since this first stage of recovery is accompanied by uncomfortable withdrawal symptoms, medical and supportive care are available to help alleviate as much discomfort as possible.⁸

For detox to be considered medical, it is done within a licensed medical facility, such as a hospital or free-standing detox facility, with clinical oversight from a doctor, nurse, and other support staff.⁸

During medical detox, the medical team will monitor your vitals, such as blood pressure and pulse, to ensure that you’re stable and tolerating withdrawal. Comfort supports may also be offered, such as water, food, and blankets.⁸

Medical staff will closely monitor all withdrawal symptoms and offer or increase medications if needed.⁹

Opiate withdrawal medications may also be used to alleviate symptoms and cravings, including:^1,9

Buprenorphine: A partial opioid agonist medication that relieves withdrawal symptoms and cravings without causing a euphoric rush
Methadone: A full opioid agonist medication that alleviates cravings and opiate withdrawal symptoms without causing a high
Loperamide: Symptomatic treatment for diarrhea
Promethazine: Symptomatic medication for nausea and vomiting
Ibuprofen: Symptomatic treatment for pain
Clonidine: Symptomatic, adjunctive care to reduce blood pressure and rapid heartbeat

Studies have also shown these opiate withdrawal medications to have a large safety profile.¹⁰ Since methadone and buprenorphine are opioids themselves, they can lead to dependence, so medical detox will entail a gradual tapering process to slowly wean you off of methadone or buprenorphine to avoid withdrawal from these medications.

This tapering process is shown to slow the opiate withdrawal symptoms, allowing for a more manageable experience that, in turn, increases success rates for those completing full opiate detoxification process.³

A successful detox sets the stage for a successful addiction treatment program, helping many achieve the sobriety and life they deserve.

If you are looking for an opiate medical detox program or addiction treatment program, we are here to help. Call our helpline at 800-926-9037 (Who Answers?) to speak to a knowledgeable treatment support specialist.

Resources

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Pergolizzi, J. V., Raffa, R. B., & Rosenblatt, M. H. (2020). Opioid Withdrawal Symptoms, a Consequence of Chronic Opioid Use and Opioid Use Disorder: Current Understanding and Approaches to Management. Journal of Clinical Pharmacy and Therapeutics, 45(5), 892–903.
Annely, L. Loes, D., Hanneke, R., Stan, Chudy, Alessandro, C. Bart, K., (2021). Effectiveness of non-opioid interventions to reduce opioid withdrawal symptoms in patients with chronic pain: a systematic review. Family Practice.
Farrell, M. (1994). Opiate withdrawal. Addiction, 89(11), 1471-1475.
Christine, C., Tracy, M., Devon W, Jacqueline F, Paul A. (2021). Emergency Physicians Ability to Recognize and Diagnose Opiate Use Disorder: A Qualitative Study. Cureus 13(9):e18216.
Fareed, A., Stout, S., Casarella, J., Vayalapalli, S., Cox, J., & Drexler, K. (2011). Illicit Opioid Intoxication: Diagnosis and Treatment. Substance Abuse: Research and Treatment.
Darke, S., Larney, S., & Farrell, M. (2017). Yes, people can die from opiate withdrawal. Addiction, 112(2), 199-200.
Volkow, N. D. (2011). Principles of Drug Addiction Treatment: A Research-Based Guide (2nd Ed.). United States: DIANE Publishing Company.
Veilleux, J. C., Colvin, P. J., Anderson, J., York, C., & Heinz, A. J. (2010). A review of opioid dependence treatment: pharmacological and psychosocial interventions to treat opioid addiction. Clinical Psychology Review, 30(2), 155-166.
Saxon, A. J., Hser, Y. I., Woody, G., & Ling, W. (2013). Medication-assisted treatment for opioid addiction: methadone and buprenorphine. Journal of Food and Drug Analysis, 21(4), S69-S72.