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Opioid Withdrawal: Symptoms To Look Out For And Withdrawal Timeline

Last Updated: January 14, 2022

Reviewed by Michael Espelin APRN

In recent years there has been an increase in the cases of opioid withdrawal in various parts of the world, especially in the United States. Opioid medications considered as one of the pain drugs, when abruptly discontinued often lead to severe health issues. According to The American Journal on Addictions, this drug termination is associated with opioid use disorder (OUD) and this can be a lifetime issue with a prevalence rate of 35%. Furthermore, symptoms of opioid withdrawal can be extreme and may require the care of a qualified medical professional. Sudden termination from opioids always entails a large number of side effects which progressively deteriorates into both physical and mental incapacitation. There are many ways on how to taper off opioids, and in all cases, it requires the assistance of health care professionals.

Reasons Of Getting Off Opioids

Understanding how to get off opioids requires a comprehensive study on how the drug works and what opioids side effects are common. The drug alters the activities of the CNS, causing increased opioid tolerance and dependency. If this drug is so addictive, then why do people use opioids for pain? The prevalence of abuse and addiction to this drug is mainly among students and adults who may have indulged in the substance as a recreational drug.

The prevalent use of the drug and resultant opioids national epidemic statistics shows a high level of dependency in millions of people from various regions of the United States and beyond. Reports showed an exponential growth in neonatal opioid withdrawal syndrome. Due to the high rate of opioid overdose, and dependency, many people are seeking the best options on how to get rid of their addiction.

A man consults with a doctor regarding opioid withdrawal symptoms.

Opioid Withdrawal Symptoms

An opioid withdrawal comes with various complications because the body has adjusted to the high levels of this medication in the system. Schedule II opioids such as Hydrocodone, Methadone, and Oxycodone present with severe symptoms of opioid withdrawal. Despite that other opioids were classified as Schedule III, it is not easier to withdraw from them. A person may begin to experience opioid withdrawal symptoms just a few hours after the last indulgence. However, take note that symptoms of opioid withdrawal may be experienced at different periods depending on the mechanism of action of the drug. For short-acting opiates, termination symptoms may occur within 6-12 hours after the last dose while for the longer-acting opiates, drug termination symptoms may appear 24-72 hours after the last dose. Additionally, signs are differentiated into early and late opioid withdrawal symptoms.

The Initial or Early Symptoms Include:

  • Frequent muscular ache and pain as well as stomach cramps
  • Palpitations and lacrimation with levels of insensitivity to light
  • Inability to sleep
  • Anxiety, agitation, mood swings, and hypertension
  • Frequent yawning
  • Feverish conditions and running nose

On the Other Hand, Late Opioid Withdrawal Symptoms May Include the Following Conditions:

  • High craving for the drug
  • Vomiting and nausea
  • Recurrent diarrhea
  • Depression and moodiness
  • Cramping of the stomach
  • Goosebumps

The symptoms and side effects of opioid withdrawal can last for weeks, depending on the severity of the addiction. The opiates vs opioids withdrawal symptoms are similar and uncomfortable but unlikely to lead to death. However, termination from opioids can be even fatal if the individual quits cold turkey. As stated in the National Council for Mental Well-Being, 14,000 people have died due to the use of opioids. This means that self-harm or relapse leading to overdose can occur without the aid of a medical professional, according to the National Center for Health Statistics. In case of overdose, seek emergency medical care as soon as possible.

Opioid Withdrawal Timeline: How Long Does Opioid Withdrawal Last?

According to the US World Health Organization National Institute on Drug Abuse, the opioid withdrawal timeline is a schedule of physical symptoms that can last through a particular period depending on the severity of addiction to the substance. So, how long does it take to detox from opioids, and how long does opioid withdrawal last? The termination period varies from one patient to the other; however, the good part is that the timeline acts as a guide for those who are going through the withdrawal process, that there is an end to these phases and endurance is what counts. The opioid withdrawal timeline can be categorized into three phases, which will be discussed in the information below:

Phase One

According to a study of medical doctors from the United States, the first stage begins immediately when the amount of substance that was usually taken is reduced or stopped completely. This stage occurs within the range of 12 to 36 hours after the last fix. Symptoms of this stage can last from 3 to 5 days, hitting their peak about 70 hours into drug cessation.

The First Phase May Present With Symptoms Listed in the Information Below:

  • Agitation, irritation, mood swings
  • Vomiting and nausea
  • Stomach cramps
  • Inability to sleep

In the same study, based on 5 participants, it was reported that 4 of them were able to wean off the opioids completely, without recurrence of cessation symptoms. This means that there would still be a chance to experience cessation again. Therefore, considering a medical drug intervention would be of great help to avoid cessation relapse.

Phase Two

According to a study published in the Journal of Addiction, many users, especially long-term users or those with substance abuse disorder, battle with the second phase and often end up reverting to using the substance. The chemical known as endorphins are produced in the brain, and they are responsible for regulating a person’s mood and behavior. These medications completely deplete the number of endorphins in the brain, so during the second phase, the brain begins to re-manufacture endorphins. The downside to this process is that it comes with the most distressing feeling of depression.

The Dominant Characteristics of This Phase Are Listed in the Information Below:

  • Dilated pupils
  • Muscular cramps
  • Depression
  • Fever
  • Goosebumps
  • Insomnia

In the same study, it was reported that this phase can last for about two weeks or more. But, with the help of opioid detox, those who want to wean off opioids may gain full abstinence especially when they enroll in inpatient or outpatient rehabilitation.

A man speaks with a medical worker in a hospital.

Phase Three

Milder symptoms are expected during the third phase of the opioid withdrawal timeline, especially when a detox treatment is already started during this period. The duration of this stage largely hinges on the physical and mental condition of the individual and may last for two months or more depending on levels of opioid tolerance and dependency. This particular phase comes with symptoms that are more psychological than physical. Take a look at the information below:

  • Irritability and restlessness
  • Inability to sleep
  • Depression
  • Anxiety

Some individuals experience extended phase three periods while some can skip this phase depending on the peculiarity of their abuse and addiction, and method of healing. A rehab center is often recommended for faster and safer healing.

Opioid Withdrawal Medication

There are various processes of opioid detox, and the duration varies from one person to another. Some rehab facilities may suggest forms of medical therapies such as rapid detoxification for inpatients or office-based opioid withdrawal treatment for outpatients. According to medical doctors from Germany,  rapid opioid detox is known to be based on the use of anesthesia and other medication to mitigate the cessation symptoms experienced by the patient. This process of sedation may seem like a safe option to evade symptoms felt during prolonged tapering processes. However, this method is unorthodox and may present complications as there is no evidence to support its efficacy. According to the National Academies of Sciences, Engineering, and Medicine, drugs for OUD can save lives but cessation medications treat different cessation symptoms of opioids abuse and addiction. Some treat physical cessation symptoms and some drugs treat the altered mental state due to opioid withdrawal.

Some Opioid Withdrawal Treatment Drugs for Treating Physical Termination Symptoms Include:

From the list above, Buprenorphine is said to be the best opioid withdrawal medication for severe opioid withdrawal. According to a study published in the American Medical Association Journal of Ethics, the drug Buprenorphine is most suitable for inpatient opioid withdrawal treatment.

Moving On, Some of the Opioid Withdrawal Treatment Drugs That Treat Mental Cessation Symptoms Include:

An opioid withdrawal medication may be obtained by prescription. Because of this, it is understandable that only a medical doctor can prescribe the most suitable opioid withdrawal medication for a patient.

Seeking Help From Medical Professionals For A Safe Opioid Withdrawal

Cessation symptoms from opioids are often systemic and come with a lot of physical and mental trauma. Some may suggest various programs and medications inclusive of pain relievers, aromatherapy, exercises, and many others, however, when experiencing signs of opioid withdrawal on abstinence, the first line of action should be to adopt the opiate tapering method.

The opioid withdrawal scale continues to tip as more and more people are seeking professional help for their addiction through inpatient and outpatient programs. It is necessary to seek the counsel of a health care professional as self-medication is dangerous, and so is quitting cold turkey.

Medical doctors can recommend the best detox therapy for various levels of abuse and addiction. Professional opioid use disorder treatment comes with medication therapy, cognitive behavioral therapy, twelve-step programs, peer support groups, counseling, and follow-ups to prevent relapse.

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Page Sources

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  2. Hensel, M., & Kox, W. J. (2000). Safety, efficacy, and long‐term results of a modified version of rapid opiate detoxification under general anaesthesia: a prospective study in methadone, heroin, codeine and morphine addicts. Acta anaesthesiologica scandinavica, 44(3), 326-333.
  3. Kosten, T. R., & Baxter, L. E. (2019). Effective management of opioid withdrawal symptoms: a gateway to opioid dependence treatment. The American journal on addictions, 28(2), 55-62.
  4. Miller, N. S. (2004). Treatment of Dependence on Opiate Medications. AMA Journal of Ethics, 6(1), 22-26.
  5. Miser, A. W., Chayt, K. J., Sandlund, J. T., Cohen, P. S., Dothage, J. A., & Miser, J. S. (1986). Narcotic withdrawal syndrome in young adults after the therapeutic use of opiates. American journal of diseases of children, 140(6), 603-604.
  6. National Academies of Sciences, Engineering, and Medicine. (2019). Medications for opioid use disorder save lives. National Academies Press.
  7. Understanding the Epidemic | CDC’s Response to the Opioid Overdose Epidemic | Centers for Disease Control and Prevention. (2021, March 17). CDC. https://www.cdc.gov/opioids/basics/epidemic.html
  8. World Health Organization. (2009). Training manual for clinical guidelines for withdrawal management and treatment of drug dependence in closed settings. Manila: WHO Regional Office for the Western Pacific.

Published on: September 17th, 2019

Updated on: January 14th, 2022

About Author

Peter J. Grinspoon, MD

Dr. Peter Grinspoon is an experienced physician with long-term clinical practice experience. As a former analgesic addict, Dr. Grinspoon knows precisely how important it is to provide patients with effective treatment and support. Medical writing for him is the way to communicate with people and inform them about their health.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.