Opioid Withdrawal: Symptoms, Risks, and Medical Detox

Opioids are a broad class of substances that include several prescription medications, including oxycodone, methadone, and morphine, as well as illegal drugs such as heroin, illicitly-manufactured fentanyl, and nitazenes.¹ People who use opioids, even those who take the medications as directed by a physician, should be aware of the potential risks and discomforts of dependence and opioid withdrawal.¹ Understanding withdrawal will help you know what to expect if you want to stop using opioids.

This article will help you understand:

• Symptoms of opioid withdrawal.
• How long opioid withdrawal lasts.
• Opioid withdrawal treatment.
• Opioid withdrawal medications.
• Continued treatment after opioid detox.

What Is Opioid Withdrawal?

Once dependence on opioids develops, you may experience withdrawal symptoms when you stop using the substance.² People who use opioids are at risk of developing significant opioid dependence. Dependence develops as a physiological adaptation to repeated or prolonged exposure to a drug.

Some degree of physiological dependence can develop after repeated use of opioids—whether it involves the use of illegal substances like heroin to get high or if you’re taking prescription opioids under a doctor’s supervision.^{2, 3}

Over time, as the body adapts to the presence of the drug, you may find yourself needing it to feel and function relatively normal.² When you stop taking the drug suddenly or use slows considerably, you can develop withdrawal symptoms as your body readjusts to functioning without the substance.²

People who are dependent on an opioid can experience significant discomfort and distress when they stop using the substance.⁴ Symptoms of opioid withdrawal are not typically medically dangerous, but they can be intensely uncomfortable and lead to needless suffering if not properly managed.⁴

Symptoms of Opioid Withdrawal

Opioid withdrawal often includes several characteristic symptoms that arise when a person abruptly stops or cuts down their opioid intake after a period of ongoing use.² Common signs and symptoms of opioid withdrawal include:

• Dysphoria (a sense of unease or unhappiness).⁵
• Anxiety.⁴
• Rapid pulse.⁴
• Elevated blood pressure.⁴
• Insomnia.⁵
• Nausea or vomiting.⁵
• Diarrhea.⁵
• Bone, joint, or muscle aches.⁵
• Teary eyes or runny nose.⁵
• Yawning.⁵
• Fever.⁵
• Chills and goosebumps.⁴
• Dilated pupils.
• Tremors.

Symptoms can cause significant distress and limit your ability to function at work, school, or home.⁵

Factors that Impact Opioid Withdrawal Symptoms

Withdrawal symptoms can range from mild to severe.² The severity and onset of symptoms you might experience depend on individual factors, such as:⁴

• The type of opioids used.
• How much you used.
• How frequently you used opioids.
• Physiological, psychological, and genetic influences.
• Other drugs or medications being used at the same time.

Opioid Withdrawal Timeline

The timeline for withdrawal can vary and it’s not easy to pinpoint an exact duration for how long your symptoms might last. The opioid withdrawal timeline can vary depending on whether you used a short- or long-acting opioid, the length you used it, the daily dose, and the interval between doses.^{4, 6}

From start to finish—or from symptom onset to symptom resolution—a general timeline for opioid withdrawal will take more time for relatively longer-acting opioids.⁵ Withdrawal symptoms associated with short-acting opioids, such as heroin, can start as soon as 6 to 12 hours after your last dose, peak in severity after 1 to 3 days, and then gradually subside over 5 to 7 days.⁵ Other examples of relatively short-acting opioids include:⁷

• Hydrocodone.
• Oxycodone.
• Morphine.
• Codeine.
• Fentanyl.

Withdrawal symptoms that arise after long-acting opioids are stopped, such as methadone, can start 2 to 4 days after the last dose, peak after 3 days, and then gradually subside over 3 weeks or longer.^{4, 5}

Medical Detox for Opioids

Medical detoxification involves a set of medical and psychosocial interventions designed to manage acute intoxication and keep you safe and comfortable as your body withdraws from opioids.⁴ One of the goals of detox is to return you to a medically stable state, which can help prepare you for further treatment.^{4, 8}

Supervised detox for opioids provides a safe, comfortable environment to undergo withdrawal without the distractions of everyday life while offering medical support and interventions in case of withdrawal complications.⁴

Supervised medical detox for opioids is especially important due to the potential for intense discomfort and suffering.⁴ The Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that hospitalization, or another form of 24-hour supervised medical care, will often be the preferred setting for detoxification from opioids.⁴

Important components of the detox process include:

• Evaluation. Everyone who enters detox receives a comprehensive evaluation. This is used to assess your overall physical and psychological health, determine your medical needs, test for the presence of opioids or other substances in your blood, screen for potential co-occurring psychiatric conditions (such as depression or bipolar disorder), and help guide the appropriate post-detox treatment placement.⁴
• Stabilization. This is the actual withdrawal and detox process where you receive support, care, and medication to help alleviate withdrawal symptoms and to keep you as safe and comfortable as possible.⁴
• Preparation for further treatment. You will receive assistance and support with finding and entering an appropriate addiction treatment center for your needs.⁴ It can be beneficial to continue treatment after detox to help address underlying issues and other concerns that may have led to or contributed to the addiction.^{4, 8}

Ongoing treatment after detox can help you regain control of your life and teach you new ways to live without the use of opioids.⁸ Treatment aims to promote positive recovery outcomes, help prevent relapse, and help you develop the skills you need to remain sober.⁴

Medications for Opioid Detox

Opioid withdrawal medications are a significant help to people attempting an opioid detox. They can help minimize or eliminate withdrawal symptoms and reduce cravings without the euphoria produced by the substance you originally used.⁹

Commonly used withdrawal medications include:

• Methadone is an opioid agonist, which minimizes withdrawal symptoms and reduces cravings because it acts fully on the same opioid receptors in the brain that are activated by opioids.⁹ Even though methadone activates these receptors when used at treatment doses, it doesn’t result in the rewarding high associated with misused opioids; however, if misused, it can have a risk of overdose itself.^{4, 10} It must be administered by certified opioid treatment programs.⁴ It may be taken orally as a liquid, tablet, or as a tablet for dispersion into an oral solution (i.e., diskette).¹⁰
• Buprenorphine is a medication known as a partial opioid agonist. As an opioid use disorder (OUD) treatment medication, it is sometimes preferred over methadone because it may have fewer side effects and a lower potential for misuse and overdose, and may be prescribed by specially-trained clinicians without the need to visit a specialized treatment clinic.^{4, 9} Similarly to methadone, buprenorphine blocks the effects of opioids, reduces cravings, and eases withdrawal symptoms.⁹ It is available as a tablet, orally dissolvable film, or an extended-release injection.¹¹
• Clonidine is not FDA-approved for opioid withdrawal but is sometimes used off-label during detox to reduce withdrawal symptoms.⁴ Doctors may use it because it doesn’t have the potential to cause intoxication and it is not reinforcing.⁴
• Lofexidine is an FDA-approved, non-opioid medication that can reduce physical withdrawal symptoms.¹²

Risks of Using Kratom for Opioid Withdrawal

While some people turn to kratom to help ease withdrawal, it is not FDA-approved for any medical purposes at this point in time and could be associated with some serious harmful health effects of its own. It’s important to be aware that using kratom can lead to additional health risks, as people have reported that they experience addiction and withdrawal symptoms from kratom use, but more research in this area is needed.¹³

Long-Term Medications for Opioid Addiction Recovery

Staying abstinent from opioids can be difficult once you’ve completed detox. If you have been diagnosed with opioid use disorder, the clinical diagnosis for opioid addiction, you should be aware that it is a chronic condition and is often treated with a combination of medication, counseling, and behavioral therapy.¹⁴

Medications are a cornerstone of OUD treatment. Sometimes referred to as medications for opioid use disorder (MOUD) or medication-assisted treatment (MAT), the medications that are used in the ongoing treatment of OUD after detox/stabilization can include:

• helps people sustain recovery by helping to reduce cravings and blocking the effects if opioid relapse occurs.¹⁰ SAMHSA says that the minimum length of time for methadone maintenance treatment can vary but should be at least 12 months, although some people may remain on the medication for longer periods or indefinitely.¹⁰
• can also help people remain in recovery, and avoid relapse, by diminishing cravings and other effects of physiological dependence on opioids.¹¹ It is sometimes used in a combination medication that also contains naloxone, known by the brand names Suboxone or Zubsolv.⁹ You can also stay on buprenorphine indefinitely if deemed appropriate for your situation.¹¹ Buprenorphine can be a more accessible option for people who are unable to go to a methadone clinic.¹¹
• is an opioid receptor agonist, which means it blocks the euphoric effects of opioids; you won’t feel the rewarding effects if you resume opioid use.^{9, 14} In this manner it may be used in the hope of decreasing opioid misuse and preventing relapse.¹⁴ It’s important to note that you need to be abstinent for a significant period of time before you begin taking naltrexone.¹⁴

Find Opioid Addiction Treatment Programs

If you are struggling with opioid misuse and want to stop, finding appropriate treatment is an important first stage of recovery. Reach out to a local rehab center today to get help.