When someone regularly uses opioids, over time, their body becomes less sensitive to their effects. The person will need larger and larger doses of opioids to achieve the same effect, this is known as “tolerance”. The drug will eventually change brain receptors to become dependent on the consistent presence of opioids in order to maintain a chemical balance. After this point, the person will likely experience opioid withdrawal if they stop taking the drug.
Going through opioid withdrawal can be very uncomfortable and terrifying, as can watching someone you care about go through that experience. Knowing what to expect from opioid withdrawal can offer some assurance during the process.
Opioid withdrawal timeline
It’s common sense to view withdrawal as a process, but you might still be wondering, “How long does opioid withdrawal last?” In general, opioid withdrawal can be broken up into three stages: early withdrawal, peak withdrawal, and late withdrawal. From start to finish, the opioid withdrawal timeline varies from a few days to a week or more, depending on the type of opioid drug the patient used (for instance, short-acting or long-acting opioids and the route of administration, swallowing or injecting, which can impact drug elimination rates), among other factors.
Early Withdrawal
Everyone experiences opioid withdrawal differently, but symptoms will usually appear within the first 24 hours after you stop using opioids or drastically reduce your dose. Early symptoms you may notice include:
- Anxiety
- Trouble sleeping
- Restlessness
- Muscle aches and pains
- Teary eyes
- Sweating
- Runny nose
- Fever and chills
- Nausea
It’s easy to confuse some of these symptoms for illnesses like a bad cold or flu, which is why some people don’t even realize that they’re dependent on opioids. People can also experience a wide range in intensity of these symptoms depending on how healthy they are, their level of hydration, what other drugs they use, and the amount of time they’ve been using opioids.
Peak Withdrawal
The early opioid withdrawal symptoms are generally the easiest to manage with medication and other support. Around 24 to 72 hours after the last opioid dose, peak withdrawal will typically hit. This stage of opioid withdrawal is the most dangerous and uncomfortable and can include the following symptoms:
- Depression
- Nausea and vomiting
- Diarrhea
- Panic attacks
- Cramps
- Fatigue
- Enlarged pupils
- Muscle aches and back pain
Patients should seek medical assistance if their symptoms become unmanageable. In addition to the symptoms from early withdrawal, the symptoms of peak opioid withdrawal can cause intense drug cravings.
Though opioid withdrawal is not generally life-threatening, untreated diarrhea and vomiting during this stage can lead to dehydration, confused mental state, or even heart failure. Patients detoxing without medical oversight during these days of opioid withdrawal are at increased risk. A clinician may use various scales-such as the Clinical Opiate Withdrawal Scale (COWS)–to rate and monitor the change in a patient’s opioid withdrawal symptoms over time.
Late Withdrawal
The final stage of opioid withdrawal is the late withdrawal stage, which typically begins 72 hours after the last opioid use. Some of the most common symptoms of withdrawal in this stage are:
- Fatigue
- Depression
- Irritability
- Insomnia
- Anxiety
Typically 3-5 days after the last opioid use, the patient should notice a significant decrease in withdrawal symptoms. Some opioids will remain in your system longer than others. Heroin, for example, leaves your system faster and produces withdrawal symptoms over a shorter period (2-4 days) than a long-acting opioid, like fentanyl that can cause withdrawal symptoms to emerge and peak later but last for a week or longer.
How to manage opioid withdrawal
It’s not always possible to prevent opioid withdrawal. If you or a loved one is going through opioid withdrawal, try these tips to reduce risks and discomfort:
- Use non-opioid drugs as needed to treat opioid withdrawal symptoms: Imodium® may help with diarrhea, for instance, and you can use nonsteroidal anti-inflammatory drugs (NSAIDs) like Motrin® and Advil® to address general pain and muscle aches.
- Anxiety and restlessness: Clonazepam and clonidine can be prescribed by your doctor and are a useful medication combination for reducing anxiety and restlessness, in part by calming the central nervous system that revs up during withdrawal.
- Drink extra fluids: Common opioid withdrawal symptoms become more severe in people who are dehydrated. Moreover, vomiting and diarrhea can leave patients even more dehydrated. Make sure to drink extra water or sports drinks (like pedialyte–salt is much more important than sugar for rehydration) to replace the fluids and electrolytes you lose. Being well hydrated will also allow you to better tolerate the prescribed medications.
- Distract yourself: During opioid withdrawal, particularly peak withdrawal, it can be difficult to think about anything other than opioids. Try to get your mind off them with other activities, like watching movies or going for a walk, if it’s physically safe to do so.
- Seek support from loved ones: The support of trusted friends or family members can be invaluable for patients going through opioid withdrawal. Don’t be afraid to talk to loved ones about your recovery or ask someone to check in on you.
- Consider professional counseling: Professional counseling isn’t something everyone is open to, but it can be a source of invaluable support during the treatment of opioid withdrawal and recovery. Consider getting in touch with a counselor who specializes in opioid dependency treatment.
These strategies can help make opioid withdrawal symptoms more manageable while you wait for them to subside.
How Suboxone can help
Suboxone (buprenorphine/naloxone) is a medication that helps manage withdrawal, prevent opioid cravings, and protect against relapse and overdose. It is long-acting, providing stable, low-level stimulation of opioid receptors in the brain without producing a high when taken as prescribed, even when taken in large doses. Many people find transformative life stability by taking Suboxone on a daily basis.
Experts do not recommend that you attempt withdrawal from opioid use unless you plan to transition to medication maintenance with a medication like Suboxone (buprenorphine) otherwise you are at a significantly increased risk of overdose.
Managing opioid dependency
Medications can reduce the symptoms of opioid withdrawal and aid in your recovery. The Centers for Disease Control and Prevention (CDC) and other federal agencies recognize medication-assisted treatment (MAT) as an effective treatment option for opioid dependency.
Ophelia makes MAT available to patients across the country through a private, personalized approach with high-quality real-time care. If you or a loved one is struggling with opioid dependency, contact Ophelia for support.
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