Opioid Withdrawal: Symptoms, Timeline & Treatment

The United States has an opioid crisis, with more than 10 million Americans age 12 or over admitting to past-year opioid abuse in a 2019 survey.¹ Widespread opioid use and abuse have left many Americans struggling with opioid dependence, which can lead to severe withdrawal symptoms upon quitting or cutting back on opioids.² Opioid withdrawal can be very uncomfortable, but medical detox can make the process safer and easier to bear.

The Difference Between Opioid Addiction and Dependence

Opioid addiction is not the same thing as physical dependence, though the latter is a common feature of many opioid addictions. More broadly, an addiction to opioids is a mental health condition characterized by certain changes in thoughts and behaviors, including a compulsion to continuing using these drugs despite an abundance of adverse consequences.^3,4

Developing physiological opioid dependence means that your body adapts to them in a way that could result in the onset of withdrawal symptoms should their use slow or stop.^5,6 Physical dependence commonly develops among those who use opioids and can occur among those who take their medications exactly as prescribed.³ It can take as little as a few weeks of regular opioid use to become dependent.

While physical dependence is one of the potential diagnostic signs of an opioid use disorder (opioid addiction), it doesn’t have to be present for such a diagnosis to be made.³ When present, however, the intensely unpleasant opioid withdrawal syndrome can make getting off of opioids without assistance very challenging.⁵ You can use the self-assessment below to see if criteria is met for dependence or addiction.

Opioid Withdrawal Symptoms

If you are physically dependent on opioids and stop taking them suddenly, you may experience several symptoms of withdrawal.⁷ Just how severe your symptoms will be is influenced by factors such as:^{2, 7}

• The particular opioid(s) you’ve been using.
• How long you’ve been using opioids and how regularly you use them.
• Your typical dose.
• Your general state of mental and physical health.

Symptoms of opioid withdrawal include:^2,3,4

• Restlessness and irritability.
• Depressed mood.
• Insomnia.
• Aching muscles/bones.
• Teary eyes.
• Runny nose.
• Yawning.
• Dilated pupils.
• Chills.
• Goosebumps.
• Fever.
• Sweating.
• Loss of appetite.
• Nausea and vomiting.
• Diarrhea.
• Increased blood pressure and heart rate.
• Strong cravings to use opioids.

Opioid Withdrawal Timeline

For relatively short-acting opioids like heroin, acute withdrawal symptoms can begin within 6–12 hours of the last dose, peak around day 1-3, and resolve within 5-7 days.⁴

For longer-acting opioids such as methadone, the withdrawal timeline is relatively longer. Withdrawal symptoms may not arise until about 2-4 days from the last dose, peak around day 3, and take as long as 3 weeks to subside.^4,7

Is Cold-Turkey Opioid Detox Safe?

Unlike withdrawal from certain other substances, including alcohol and benzodiazepines, opioid detox usually isn’t life-threatening.⁷ However, there are some noteworthy risks, such as:

• Dehydration. Excessive vomiting and diarrhea can result in dehydration and electrolyte imbalances. It can be difficult to rehydrate, especially if you are nauseated, so you may require intravenous fluids.⁸
• Cardiovascular issues. The raised blood pressure, heart rate, and body temperature that are associated with opioid withdrawal can aggravate underlying heart problems.⁷
• Increased pain sensitivity. Conditions that require pain management may worsen during detox. This is because withdrawal can decrease your threshold for experiencing pain (i.e., hyperalgesia) and such pain conditions may now require alternative management strategies.⁷
• Severe anxiety. Opioid withdrawal can worsen anxiety disorders, particularly those involving panic anxiety.⁷
• Relapse. The distressing physical and psychological symptoms, combined with cravings, can present challenges to early recovery efforts. Additionally, attempting to get clean in the same environment where you use opioids might further increase relapse risks.²

Benefits of Medical Detox for Opioids

You can receive medical support during detox in either an inpatient or an outpatient setting. Both forms of treatment provide the following benefits:

• Medical support and check-ins. Detoxing in a medical program means you’ll receive medications to help with withdrawal symptoms and the peace of mind knowing medical professionals are checking on your condition periodically.
• Medications to prevent relapse. Medical detox facilities, including AdCare, will offer the option of beginning medication-assisted treatment drugs (e.g., Suboxone or naltrexone) during detox.^7,9
• Entry point into treatment. Detox alone may not be sufficient to sustain long-term recovery from addiction, ⁷ but it is a great starting point. In a program that offers detox plus other levels of care (e.g., inpatient rehab), transitioning into further treatment can be as simple as switching rooms.

There may be some additional benefits to choosing an inpatient program. Detox at an accredited inpatient treatment facility can help facilitate close patient monitoring and any needed adjustments to care, as well as minimize relapse risks during the withdrawal process because you’ll have:

• 24/7 medical support. Doctors and nurses in medical detox programs monitor your condition throughout the day and night and provide all-day comfort care. Should a complication arise, staff can intervene immediately.⁷
• A drug-free environment. The temptation to use can be overwhelming during withdrawal. An inpatient environment helps to minimize your access to opioids.
• Therapeutic support. Many inpatient detox programs have counselors or therapists on hand to care for your psychological needs during withdrawal.⁷

What Happens During Opioid Detox?

When you start any professional opioid detox program, one of the first things to expect is a thorough assessment. Staff may perform an initial drug test, go over your history of drug use and withdrawal, and review any past attempts at treatment. They may also ask about:⁷

• Any physical or mental health issues you may have.
• Any family history of substance use or mental health disorders.
• Any medications you may be taking.
• Your current social situation (e.g., whether you have any issues at school or work, whether your living environment is safe and stable, and if you have any pending or current legal issues.

This information will be used to determine your treatment plan in detox and suggest a direction for future treatment.⁷

For many people, detox is only a first step in their treatment plan.^7,9 After you complete detox, you can be referred for additional treatment, such as inpatient or outpatient rehab.⁷ This can make it easier to stay focused on your goals and work toward long-term recovery.

As part of post-detox treatment, some of the medications used during withdrawal stabilization (e.g., buprenorphine) may be used in a medication-assisted treatment (MAT) approach—sometimes called maintenance therapy. This approach utilizes both medications and behavioral to support your recovery from opioid addiction.⁷