How Long Does Opioid Withdrawal Last? Timeline, Symptoms, and Treatment

Opioid withdrawal may not be life-threatening in the way that alcohol or benzodiazepine withdrawal is, but it is still difficult to manage.[1]

It’s an experience that is uncomfortable enough to cause relapse in those who face it without support and, for many, is the reason they can’t bring themselves to quit. If you are currently using opioids and are worried about withdrawal, it is only natural to wonder how long the process will be. 

This article provides information on the opioid withdrawal timeline, possible symptoms that may occur during withdrawal, and available treatment options to assist with managing withdrawal.

What Are Some of the Common Symptoms of Opioid Withdrawal?

Regular opioid use causes the body and brain to adapt to its presence. Once opioid use stops, your brain and body will need some time to adjust to functioning without it, which is where all the unpleasant symptoms associated with withdrawal and detox originate.

Early Stage Symptoms 

The symptoms of early-stage withdrawal can begin within hours of the last dose, with timing depending in part on whether the opioid is short-acting or long-acting.[2] Many people report symptoms consistent with a severe case of the flu, including:

• Anxiety
• Restlessness
• Yawning
• Runny or watery eyes
• Runny nose
• Sweating
• Muscle pain or aches
• Chills
• Insomnia

Later Stage Symptoms of Opiate Withdrawal

As withdrawal progresses, the intensity of the physical symptoms may increase. Some examples of later stage symptoms of opiate withdrawal include:

• Nausea
• Vomiting
• Diarrhea
• Abdominal cramps
• Goose bumps
• Dilated pupils
• Rapid heartbeat
• Elevated blood pressure
• Intense opioid cravings

How Long Does Opioid Withdrawal Typically Last?

Usually around 7–14 days.[3] However, there are many variables that affect the timeline, such as the type of opioid that was used, whether the drug is short-acting or long-acting, how long you have been using it, what your average dosage has been, and how well your metabolism works.

Withdrawal From Short-Acting Opioids

Short-acting drugs such as oxycodone, hydrocodone, and heroin are metabolized faster than those that are long-acting ones. As a result, when someone takes a short-acting drug, their withdrawal symptoms will appear earlier and may be more severe.

Withdrawal from illicit fentanyl can be harder to predict because illegally manufactured fentanyl products may vary in potency and may contain other substances. As a result, the onset, severity, and duration of withdrawal symptoms can differ from person to person. 

Timeline

• Onset: 6–24 hours after the last dose
• Peak: Day 2–3
• Improved: Days 5–10

Withdrawal From Long-Acting Opioids

Long-acting opioids like methadone and other extended-release formulas are in the system much longer. When a person stops taking a long-acting opioid, withdrawal symptoms start later and will take longer to subside.

Timeline

• Onset: 24–48 hours after the last dose
• Peak: Day 3–5
• Duration: 10–20 days or longer

Opioid Withdrawal Timeline by Stage

Stage 1: Withdrawal begins. The flu-like symptoms such as restlessness, yawning, and runny nose are usually one of the first things people notice in withdrawal. 

Stage 2: Peak withdrawal. This is often the most physically difficult stage. Sleep is disrupted, gastrointestinal symptoms worsen, and cravings can be extremely strong.

Stage 3: Your body adjusts. Physical symptoms start to improve. Stomach issues decrease. Appetite returns. Energy levels increase.

Stage 4: Recovery. Your physical symptoms may resolve by this time; however, you may experience post-withdrawal symptoms referred to as Post Acute Withdrawal Syndrome (PAWS), which can include poor sleep quality, anxiety, depression, low motivation, and cravings. These can last up to several months.[4] Unlike acute withdrawal, PAWS tends to come and go in waves rather than following a predictable schedule, and it typically responds well to continued treatment and support.

What Factors Determine How Long Opiate Withdrawal Lasts?

There are many factors that affect withdrawal, including:

• The type of opioid being used
• If the opioid is short-acting or long-acting
• How much was taken daily
• How long and how often the opioid has been used
• Overall health
• Age
• If multiple substances like alcohol or benzodiazepines are involved
• Previous withdrawal experience

The onset, duration, and severity of opioid withdrawal can vary based on the opioid involved, duration and amount of use, dosing interval, and physiological, genetic, and psychological factors.[5] 

How Does Medical Detox Work?

A medical detox means that your physical and mental health symptoms are clinically monitored throughout the detoxification process. Doctors will monitor your vitals, provide medicine to help with nausea and other symptoms, and keep you as comfortable as possible. For severe dependency, they may use medication-assisted treatment (MAT),  which includes FDA-approved medications that can include:

• Suboxone (buprenorphine): Typically prescribed to replace an opioid that is taken orally.
• Methadone: Methadone is also taken orally, usually once a day.
• Naltrexone: Naltrexone is prescribed to prevent relapse by blocking opioids from producing euphoria, typically started after detox is complete.

Methadone and buprenorphine can reduce withdrawal symptoms and cravings and help people remain in treatment. Naltrexone works differently by blocking opioid receptors and can reduce cravings after an appropriate opioid-free period.[6] 

Withdrawal-Specific Treatments

In addition to MAT, there are a variety of medications that can assist in treating specific withdrawal symptoms:

• Clonidine can help alleviate anxiety, sweating, and restlessness.
• Antiemetics can help manage nausea and stomach upset.
• Anti-diarrheal medications can help manage gastrointestinal problems.
• Non-steroidal anti-inflammatories (NSAIDs) can aid in reducing muscle pain.
• Sleep aids can be used if necessary to help an individual get sufficient rest.

Supportive Care During Withdrawal

Doctors also provide supportive care:

• Hydration
• Electrolyte replacement
• Nutrition
• Light exercise (such as walking)
• Sleep hygiene
• Emotional support from loved ones, counselors, or peer support groups

Should You Attempt to Detox From Opioids at Home?

At-home detoxification is possible for some. However, it is usually not the safest method for opioid detox, especially for those who:

• Have a severe opioid addiction
• Using multiple substances
• Are managing other health problems
• Are pregnant
• Have experienced numerous relapses in the past

A medical detoxification will provide continuous supervision, prescription medication to reduce the severity of withdrawal symptoms, and timely medical intervention when complications develop. 

When Do I Need to Seek Medical Attention?

There are certain symptoms of opioid withdrawal that require immediate medical assistance. Please seek immediate help if you or a loved one experiences:

• Unable to keep down liquids
• Chest pain
• Suicidal ideation
• Pregnancy complications
• Uncontrolled medical issues
• Psychiatric disorders

You can contact the Suicide and Crisis Lifeline by dialing or texting 988 at any hour of the day, every single day, should you experience suicidal ideation.

Take the Next Step 

Opioid withdrawal is daunting, but it is temporary. The majority of physical symptoms subside within 1–2 weeks, and emotional symptoms diminish over time.

There are several medications available to assist with withdrawal, including buprenorphine and methadone. After completing detoxification, continued care has been shown to increase an individual’s likelihood of achieving sustained recovery. Detoxification is the beginning step toward recovery and not the end result.

If you or someone you love is struggling with opioid use, Marietta Springs provides PHP, IOP, and outpatient addiction treatment, including care for co-occurring mental health conditions. If detox is needed first, we can help coordinate placement with a trusted detox provider before transitioning into treatment. Reach out today to speak with an admissions specialist and learn what the next stage of recovery could look like for you.