The opioid withdrawal timeline varies from person to person. It can depend on overall health and the type of opioid used. However, symptoms can appear as soon as a person misses their next opioid dose and typically follow a three-stage progression.
Opioid withdrawal can be painful and potentially dangerous. It occurs when a person with opioid use disorder abruptly stops using opioids.
Withdrawal can also happen to people who take long-term opioids for pain as their doctor prescribes, but there are differences between the two. This article focuses on opioid withdrawal in people with opioid use disorder.
This article also describes opioid withdrawal by stage and provides information on when to contact a doctor and the dangers of opioid use disorder.
A person typically begins experiencing cravings for opioids shortly after they stop taking them and usually around the time they would have taken their next dose.
The half-life of a drug can help predict when these cravings will begin. The half-life of a drug is the period of time it takes the body to eliminate half a dose of it.
Most opioids have a short half-life of just a few hours. For example, oxycodone’s half-life is
Cravings generally worsen over several hours. Some symptoms that a person might experience include:
- anxiety
- an intense desire to take more opioids to feel normal
- frustration
- a preoccupation with opioids
- physical symptoms that may steadily worsen,
such as :- runny nose or eyes
- yawning
- sensitivity to light
- insomnia
At this stage, a person may still be able to manage their withdrawal symptoms with distraction, support, or doing something else that leads to pleasure.
However, some people may require treatment during this stage.
Opioid withdrawal symptoms
With most drugs, withdrawal symptoms are the most intense a day or so after a person stops using. However, extended-release drugs and long-acting opioids may have a later peak, at around 30–72 hours after a person stops using them.
At this peak stage, a person may feel very sick. Some common symptoms include:
- mood changes
- anxiety
- depression and feelings of hopelessness
- intense drug cravings
- a strong belief that one needs the drug
- diarrhea, vomiting, and constipation
- a rapid heart rate
- increases in blood pressure
- difficulty sleeping
- feeling cold or hot
- sweating
- flu-like symptoms
This stage of withdrawal is typically the most powerful. It is the time when a person is at higher risk of relapse. A person may be unable to distract themselves or think about anything else. They may also be so sick that they cannot get out of bed.
The American Society of Addiction Medicine (ASAM) recommends using medication to treat the symptoms of opioid withdrawal.
Methadone treatment
A 2013 review evaluated relapse after short-term methadone use for detoxification and found high rates of relapse. However, overall relapse rates were lower in people who sought methadone treatment, used methadone for an extended period, and gradually tapered their dosage under the guidance of a medical professional.
For most people, symptoms gradually reduce within
However, opioid use disorders, including opioid addiction, are chronic medical conditions. Without treatment, a person may still experience mild withdrawal symptoms for months or years after stopping opioid use. This may increase their risk of relapse.
It is important for a person to seek ongoing support and address any factors that initially caused them to misuse opioids. Such factors might include chronic pain, depression, anxiety, or trauma.
Some options for treating opioid use disorder include:
- taking medications for opioid use disorder as prescribed by a doctor
- getting support from friends and family
- pursuing psychotherapy
- treating any underlying health conditions, including mental health conditions
- joining an addiction support group
The type of opioid a person uses can influence the timeline of withdrawal.
According to the ASAM, short-acting or immediate-release opioids may cause withdrawal symptoms within 8–12 hours after the discontinuation of use. The peak of withdrawal symptoms may occur within 48–72 hours, and symptoms may clear within 7–10 days.
Long-acting or extended-release opioids may take 1–3 days to cause withdrawal symptoms after discontinuation. The peak of symptoms may occur 3–8 days after the last dose. Withdrawal symptoms may persist for several weeks after the discontinuation of use.
Short-acting opioids may include:
- oxycodone
- codeine
- hydrocodone
- morphine
- fentanyl that is illegally manufactured
Long-acting opioids include:
- methadone
- prescription fentanyl
- buprenorphine
Prescription opioids can be helpful medications for people with chronic pain but only when used as prescribed by a doctor.
The risks associated with opioid use
- addiction
- accidental overdose
- fatigue
- constipation
- nausea
- vomiting
- abdominal pain
- serious heart health issues
- breathing issues
- allergic reactions
- pregnancy complications, including opioid dependence in a newborn
Opioid use disorder is a medical condition that causes changes in the body and brain. It is not a moral failing or something that a person can simply choose to overcome.
Instead, a person needs professional treatment. Many people find that they need a combination of treatments to get the best results.
Some options include:
- taking medications such as methadone to treat withdrawal symptoms followed by medications such as methadone or buprenorphine to treat opioid use disorder
- receiving treatment for chronic pain or any other underlying medical conditions
- trying psychotherapy to help one understand their addiction, identify management strategies, and navigate the challenges of recovery
- joining support groups, such as Narcotics Anonymous
- getting treatment for any underlying mental health issues
- seeking education about addiction
There are various organizations that can help provide support to people with opioid use disorder. They can help people find support groups and treatment.
These organizations include:
Anyone who thinks that they may have opioid use disorder should contact a doctor. A person is more likely to have a positive outcome with ongoing support and professional treatment.
Experts recommend people speak with a healthcare professional if:
- their withdrawal symptoms suddenly worsen
- they start using opioids again
- they take a different dose of withdrawal medication than their doctor recommended
A person needs to go to the emergency room if they lose consciousness, experience chest pain, or are pregnant and feel very sick.
The intense symptoms of opioid withdrawal are typically short term. However, it is possible that mild symptoms will linger. They may become bothersome without treatment.
Having the right medical support can make it easier and improve the chances of a positive outcome.
People who think they may have opioid use disorder or who may be at risk of opioid withdrawal are encouraged to contact a doctor immediately for treatment and support.