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Opiates and synthetic opioids are some of the most addictive drugs in the world. Opiate withdrawal refers to the physical and mental symptoms a former user experiences when they stop taking opiates, typically after their body has become adjusted to taking a certain amount of the drug on a regular schedule.
Chronic opiate misuse can lead to physiological dependence, which means your body needs opiates to continue functioning normally. If you are dependent on opiates and suddenly quit using them, you’ll experience opiate withdrawal symptoms, which can be extremely distressing and uncomfortable. Opiate withdrawal is not typically life-threatening but the symptoms can be very severe and can occasionally have dangerous consequences. 1,2
This guide will cover everything you need to know about opiate withdrawal including signs & symptoms, the withdrawal timeline, and other substances & medications that may assist in the detoxification process. We’ll also look at the best ways to quit using opioids and some stats on how widespread opiate use is in America.
Jump to a section:
Opiate Withdrawal Statistics
Opiate Withdrawal Symptoms
The Opiate Withdrawal Process
Opiate Withdrawal Timeline
Can Opiate Withdrawal Kill You?
Medication-Assisted Detox
Does Alcohol Help With Opiate Withdrawal?
Is Gabapentin Effective?
Tips for Opioid Withdrawal
Opiate Withdrawal Statistics
The dangers of opiate withdrawal symptoms become more and more apparent with every passing year. According to the Centers for Disease Control and Prevention, opiate prescription drug abuse sent over 475,000 Americans to the emergency room in 2009, which represents a twofold increase within a five-year period (2005-2009). Heroin overdose incidents have also sent more than a few people to the emergency room.
Whether a person takes opiates for a couple of days or a couple of years, opiate withdrawal symptoms will develop in one form or another. For people who’ve used opiates for years, the risk of developing dangerous opiate withdrawal symptoms increases the longer a person uses. In effect, ongoing opiate use turns into opiate withdrawal syndrome when the body is deprived of the drug’s effects. In some cases, this shift or shock can have fatal consequences for the person who hasn’t used it for a while as well as for those who attempt to go “cold turkey.”
Learn more about opiate addiction statistics in the US.
Opiate Withdrawal Symptoms
If you take opiates or opioids exactly as prescribed, you can still become dependent on your medication. This is a normal physiological response and nothing to be concerned about. However, if you want to stop taking your pain medication, you’ll want to talk to your doctor first so they can create a tapering schedule for you so you can avoid opiate withdrawal symptoms.3
Otherwise, if you misuse opiates like heroin, the speed with which you develop a dependence will be much faster, and your opiate withdrawal symptoms will likely be more severe.
Opioid withdrawal symptoms have been likened to those of moderate to severe flu, including:2,4
- Bone pain
- Muscle aches
- Increased or lowered body temperature
- Anxiety
- Stress
- Weakness
- Insomnia
- Nausea
- Vomiting
- Diarrhea
- Chills
- Irritability
- Increased heart rate
- Depression
The Opiate Withdrawal Process
Opiates’ ability to take over the body’s chemical process accounts for why people experience opiate withdrawal symptoms when stopping or reducing drug use. In actuality, the body can become dependent on opiate effects in as little as a week’s time. The longer a person uses the more dependent the body becomes.
The opiate withdrawal process follows a certain sequence of effects or symptoms as the body attempts to reassume control over its own chemical processes. From the first day of not using, opiate withdrawal symptoms gradually increase in intensity. Feelings of fatigue and random muscle aches here and there eventually turn into irritability, mood swings, sweats, chills, stomach cramps, and diarrhea.
As the body adapts to the absence of opiates, it’s also in the process of expelling opiate materials and leftover drug toxins. Any of these symptoms can pose a danger for someone who’s used opiates for a long time.
Opiate Withdrawal Syndrome
Opiates act as central nervous depressants by slowing down almost every major system in the body. This means the body’s heart, respiratory, digestive, and even temperature control systems are all altered by ongoing opiate use. Dangerous opiate withdrawal symptoms result from the chemical imbalances set into motion once a person stops using.
Opiate withdrawal syndrome is a serious condition that can cause permanent heart and lung damage when opiate withdrawal symptoms take a bad turn. In effect, the body’s central nervous system undergoes a “reboot” that can potentially cause serious damage, especially when a person is in poor health.
Respiratory Distress
As the body becomes increasingly dependent on opiate effects, a person’s tolerance level for the drug also rises. Increased tolerance levels drive a person to consume more of the drug in order to experience the same “high” effects. Unfortunately, the body’s physical tolerance for opiates develops faster than its ability to withstand opiate withdrawal symptoms.
The need to ingest more of the drug greatly increases the likelihood a person will overdose. As opiates slow down body functions in general, overdose episodes can trigger respiratory distress to the point where a person can no longer breathe. Of all the possible opiate withdrawal symptoms, respiratory distress is not only the most dangerous – it can also be fatal.
Opiate Withdrawal Timeline: How Long Does It Last?
Opiate withdrawal symptoms are the result of discontinued use of an opiate after becoming physically dependent on the drug. The timeline of opiate withdrawal symptoms, though slightly different for each patient, generally coincides with the user’s drug use, frequency of drug use, and various other factors. Although withdrawal is not life-threatening, it can make remaining abstinent from opiate abuse very difficult to achieve.
Acute Withdrawal
Acute withdrawal symptoms can last for anywhere from a few days up to a few weeks depending on the type of drug that was used, the method of use, the frequency of use, the length of time the drug was used, and various other factors. Acute withdrawal symptoms may be treated using Clonidine which can greatly reduce the amount of time that a user experiences discomfort. Symptoms include:
- Muscle cramps
- Joint pain
- Twitching
- Mild nausea or vomiting
- Abdominal pain
- Diarrhea
- Elevated blood pressure
- Irritability
- Anxiety
The onset of symptoms will generally take place within 24 hours of the last dose, although it could take up to 48 hours for the symptoms to begin. As time progresses without the use of opiates, the timeline of opiate withdrawal symptoms will gradually peak and then begin to retract, allowing the user some relief. Unfortunately, this could take up to four weeks, depending on the type of drug that was used.
Protracted Withdrawal
Protracted withdrawal is defined as a set of symptoms that are much like those seen in acute withdrawal but which occur after the time period for which acute withdrawal is expected. The National Institute of Health found that people who are in recovery from heroin addiction or other forms of opiate addiction are likely to experience the following symptoms of protracted withdrawal, which can last months beyond the scope of acute withdrawal:
- Inability to focus on a task
- Sleep disturbances
- Anxiety
- Depression
- Fatigue
- Irritability
How Long Does Opiate Withdrawal Last?
Opiate withdrawal syndrome will generally begin around the time when the next habitual drug use would normally occur. The onset of withdrawal symptoms may begin within a few hours of the last opioid use.5 The exact onset of withdrawal symptoms does appear to vary depending on the specific opioid and amount of drug used.2 Most users will experience no more than 7 days of withdrawal from heroin, no more than 14 days of withdrawal from prescription painkillers, and no more than 28 days of withdrawal from methadone.
Heroin withdrawal appears to begin within 12 hours of last use, whereas fentanyl shows a withdrawal onset of 8-16 hours. Methadone withdrawal symptoms develop the latest, with a symptom onset of 30 hours—this is because methadone is a long-acting opioid, meaning its effects come on slower and last longer than others.2
Short-acting opioids, such as codeine and hydrocodone, appear to cause more severe symptoms, and long-acting opioids have a longer detox process.2 With short-acting opioids, withdrawal symptoms peak by 36-72 hours and resolve within 5 days.6 Longer-acting opioids such as fentanyl and morphine peak within 5-6 days, and withdrawal resolves within 14-21 days.6 When opioid withdrawal symptoms begin to appear, they develop in a predictable order, beginning with anxiety, drug cravings, and sweating.2,5
This anxiety is usually increased by the onset of sympathetic and central nervous system arousal, such as increased heart rate, irritability, and restlessness.5 Gastrointestinal distress and flu-like symptoms will begin following the anxiety and nervous system arousal, including nausea, vomiting, diarrhea, and shivering.5 The other symptoms may also develop at any point during the withdrawal process, with depression developing throughout the withdrawal period and possibly remaining after the detox is complete.2,5
Can You Die From Opiate Withdrawal?
Opiate withdrawal is not typically life-threatening, but the fear and severity of the withdrawal process can seem intimidating.2 Although death is unlikely, there is a risk of dehydration from vomiting and diarrhea. This can present complications, if untreated, as dehydration may lead to an elevated blood sodium level and potentially heart failure.7
Despite the low risk of life-threatening consequences, however, studies show that fear of the detox experience may deter some from seeking treatment. This fear may stem from those addicted, who feel most normal while using opioids, and the subsequent fear of how they feel without the drugs. Or, it may come from those using opioids to manage chronic pain conditions, and the fear of experiencing pain when the medication is discontinued.2
This apprehension is a large barrier to the successful treatment and recovery of those needing help, and one that can hopefully be overcome with the knowledge of and accessibility to medical support during the opiate detox process.2
Options, such as medication-assisted detox, are available to not only help manage opiate withdrawal symptoms but also assist those needing continued pain management once opioid use is discontinued. With the knowledge that medical support is available, more people may feel encouraged to begin their recovery process.2
Medication-Assisted Treatment (MAT) and Opiate Detox
Medical detox is a medically managed detoxification process. This is offered when opiate use is first discontinued, and the detox or withdrawal phase begins.8 Since this first stage of recovery is accompanied by uncomfortable withdrawal symptoms, medical and supportive care is available to help alleviate as much discomfort as possible.8
For detox to be considered medical, it must be done within a licensed medical facility, such as a hospital or free-standing detox facility, with clinical oversight from a doctor, nurse, and other support staff.8
During medical detox, the medical team will monitor your vitals, such as blood pressure and pulse, to ensure that you’re stable and tolerating withdrawal. Comfort supports may also be offered, such as water, food, and blankets.8 Medical staff will closely monitor all withdrawal symptoms and offer or increase medications if needed.9
Some of the most common medications used in MAT detox are the following:
Methadone
Methadone has been on the scene since the 1960s and is known to be an effective treatment for heroin addiction. It is administered by specialized methadone clinics and is intended for daily use. Methadone is taken in liquid form and the effects last for 24 to 36 hours. Opiate users can be slowly given smaller and smaller doses to stop using altogether, but often people either go on and off the medicine or use it continually. Using methadone protects you from health risks associated with injecting heroin, and is said to make you less depressed and generally more stable although it can have some negative side effects.
Buprenorphine
The newest medication used in opiate addiction treatment is buprenorphine. This drug relieves drug cravings by acting on the same receptors as the main opiates heroin and morphine. It does not, however, create the same intense high or the dangerous side effects that opiate abuse causes. Buprenorphine is a truly revolutionary opiate addiction treatment that helps to reduce cravings and change behavior of drug users, as it produces severe withdrawal symptoms when injected but no adverse effects when taken orally. Since 2002 physicians have been authorized to administer the medicine in their offices, thus it is often more accessible than methadone which can only be taken in special clinics. It is taken in tablet form three times a week.
Suboxone
Suboxone, another opiate addiction treatment, is a combination of buprenorphine and naloxone. The two have been combined to counteract the negative side effects that occur if buprenorphine is injected. Naloxone neutralizes the effects of injected drugs but does little when ingested under the tongue. For this reason, it is prescribed to higher-risk patients who are likely to inject the buprenorphine. Like buprenorphine, suboxone can be administered by physicians.
Naltrexone
An opioid receptor blocker, Naltrexone is effective in reversing the effects of a heroin overdose as it efficiently blocks the drug’s effects. It is also used to help curb the cravings in people who have already stopped using opiates. As an opiate addiction treatment, however, the medicine has shown poor performance. Its ability to effectively promote abstinence from drug use is weak because chronic opiate users do not usually adhere to treatment.
Medical Detox Side Effects
Opiate withdrawal medications may also be used to alleviate symptoms and cravings, including:1,9
- Buprenorphine: A partial opioid agonist medication that relieves withdrawal symptoms and cravings without causing a euphoric rush
- Methadone: A full opioid agonist medication that alleviates cravings and opiate withdrawal symptoms without causing a high
- Loperamide: Symptomatic treatment for diarrhea
- Promethazine: Symptomatic medication for nausea and vomiting
- Ibuprofen: Symptomatic treatment for pain
- Clonidine: Symptomatic, adjunctive care to reduce blood pressure and rapid heartbeat
Studies have also shown these opiate withdrawal medications to have a large safety profile.10 Since methadone and buprenorphine are opioids themselves, they can lead to dependence, so medical detox will entail a gradual tapering process to slowly wean you off of methadone or buprenorphine to avoid withdrawal from these medications.
This tapering process is shown to slow the opiate withdrawal symptoms, allowing for a more manageable experience that, in turn, increases success rates for those completing full opiate detoxification process.3 A successful detox sets the stage for a successful addiction treatment program, helping many achieve the sobriety and life they deserve.
If you are looking for an opiate medical detox program or addiction treatment program, we are here to help. Contact our helpline at
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Does Alcohol Help Opiate Withdrawal?
No, alcohol does not help opiate withdrawal. Although on the surface it might seem to alleviate the symptoms of withdrawal, it can be a very dangerous choice for treating opiate withdrawal. Some circles say that being drunk is a way to stop feeling the symptoms of opiate withdrawal but it also opens up a whole new set of problems. There are several reasons why you should not use alcohol to treat opiate withdrawal and several alternatives to try instead.
It might seem like a good idea because alcohol is known to relieve anxiety and calm the mind and body, but there are a lot of reasons why using alcohol for opiate withdrawal is an extremely bad idea.
Mixing Alcohol and Opiates can Kill you
Mixing alcohol and opiates can easily cause a fatal overdose. They both depress the respiratory system which causes you to stop breathing.
Opens the Door to Binge Drinking
At the very least opiate withdrawal lasts three to five days. If you drink to avoid all of the effects of opiate withdrawal, what you are doing is binge drinking and going on a bender (drinking until drunk every day).
According to the Centers for Disease Control, both of these types of drinking can lead to these serious health risks:
- Violence
- High-risk sexual activity
- Suicide
- Heart failure
- Stroke
When you binge drink or go on a bender you also put yourself at risk for Alcohol Withdrawal Syndrome. This deadly condition makes opiate withdrawal look pleasant.
Alcohol Causes Nausea and Vomiting in High Doses
Opiate withdrawal causes nausea and vomiting adding alcohol to the mix increases these symptoms. Using alcohol for opiate withdrawal makes these symptoms of opiate withdrawal worse.
Alcohol Dehydrates you
Both alcohol and opiate withdrawal can cause dehydration. Dehydration is a leading cause of hospitalization during opiate withdrawal. Do you really want to risk putting yourself in the hospital?
Alcohol can Damage the Immune System
Alcohol can decimate an immune system already ravaged by opiate abuse and withdrawal. This leaves you open to a variety of infections.
Alcohol can Give you a Hangover
Let’s face it, if you are using alcohol for opiate withdrawal there is a good chance you will drink too much of it. A hangover on top of opiate withdrawal will just make the opiate withdrawal worse.
Treating Opiate Withdrawal Without Using Alcohol
According to the Substance Abuse and Mental Health Services, medication-assisted treatment uses these medications to relieve opiate withdrawal symptoms:
During medication-assisted treatment, you can also receive treatment for an alcohol use disorder if that is the reason why you are considering using alcohol to relieve opiate withdrawal symptoms.
You will also receive the counseling that you need for your opiate addiction and to help you with the cravings many people get after opiate withdrawal.
Is Gabapentin an Effective Treatment for Opiate Withdrawal?
Recent studies have examined the effectiveness of gabapentin as a treatment for opiate withdrawal. In addition, some individuals have heard about the efficacy of the drug for treating withdrawal from opioids and choose to use this medication by dosing themselves without a doctor’s prescription, which is not recommended. It is important to understand just how effective gabapentin is in treating opiate withdrawal and how it can be safely used to do so.
Opioid Withdrawal Treatment
A study published in the Journal of Clinical Psychopharmacology evaluated the efficacy of gabapentin as a supplemental medication for those who were already on methadone for withdrawal treatment. The drug was used in an adjunctive capacity and administered to 27 patients. According to the study, “Add-on gabapentin with a dose of 1600 mg/d is effective in reducing some of the withdrawal symptoms in patients addicted to opiates undergoing methadone-assisted detoxification.”
This study is very important to note, and others like it have had similar results. However, gabapentin has not been studied enough as an opioid withdrawal treatment to be considered an approved treatment method for this syndrome. In addition, it has only been looked at in an adjunctive sense, not as a sole treatment for opioid withdrawal; therefore, it cannot be determined if gabapentin is a safe or effective treatment for this condition, especially when used on its own.
What Does This Mean for Those in Opioid Withdrawal?
In any case, individuals going through opioid withdrawal should not take gabapentin unless the drug is prescribed to them by a doctor. It may be helpful to take the medication as a supplemental treatment to a more established opioid withdrawal treatment option (namely methadone), but gabapentin is a prescription-only drug. Taking it without a doctor’s permission can be very dangerous.
The medication can cause seizures, severe withdrawal symptoms, and other problems if not taken properly. Its side effects can be intense and may include strange thoughts, memory problems, diarrhea, headache, and anxiety. When taken in high doses, it can cause euphoria, much in the same way that opioids do. When a person begins to abuse gabapentin––or take it in any way other than they were prescribed––they open themselves to the possibility of addiction again. This is especially dangerous to those in withdrawal who were recent opioid abusers.
Can I Take Gabapentin for Opioid Withdrawal?
You should only take this medication under a doctor’s care no matter why you are using it. And though it has not been officially indicated for the treatment of this syndrome, a doctor may prescribe you gabapentin as an opioid withdrawal treatment in addition to another medication. According to the Substance Abuse and Mental Health Services Administration, gabapentin is also being considered––and sometimes used––to treat alcohol withdrawal, so there is a strong possibility it could be effective for both syndromes under the right circumstances.
Tips for Managing Opiate Withdrawal
Now that you know how opiate detox and withdrawal works, here are 15 tips that can help manage this difficult process and get started on your path to a new life.
1. Take Over-the-Counter Painkillers for Muscle Pain
One of the most intense symptoms of opiate withdrawal is the muscle pain caused by the absence of the drug in the individual’s system. Opiates cause pain relief, and when they are no longer present in the body after a long time, the individual will often feel real or phantom pains in the muscles, bones, and joints. Taking over-the-counter drugs like aspirin, acetaminophen, and ibuprofen can help with these issues.
2. Take Medications for Diarrhea and Vomiting
Diarrhea, nausea, and vomiting are also common issues during opiate withdrawal. Constipation is “the most common and debilitating symptom” of opioid-induced bowel dysfunction, and withdrawal from the drug can cause the opposite effect (NCBI). If you take over-the-counter medications and follow the directions, you can ease these symptoms and make the withdrawal process much less intense.
3. Get Plenty of Sleep
Sleep is one of the most important aspects of helping you get through withdrawal. Whether you are in the first stages or the last, it is important that you get at least eight hours of sleep when you can. You will be feeling pains and also dealing with cramps, nausea, vomiting, diarrhea, and other issues, so whenever you can sleep you should.
4. Ease Back on Your Workload
Resting, staying hydrated, and taking it easy will help you get through withdrawal.
Whatever your responsibilities are, if there is a possibility that you can ease back on your workload or anything else that causes you stress, you should. You will already be having a difficult enough time dealing with your symptoms, and adding more stress to your day will only make your withdrawal syndrome more difficult.
5. Talk to Someone
Whether it is a friend, family member, your doctor, or individuals in a self-help group, talking to someone about what you are going through is important. Anxiety is one of the earliest symptoms of withdrawal which can make you want to start using again. If you can discuss these feelings with someone, it can help you avoid relapse.
6. Be Comfortable
If you are prepared to go through withdrawal, you should have a comfortable place in which to do so. If you are in your own home, make sure the room you’re going to spend the most time in has things to occupy your interests and a comfy place to rest.
7. Rest Up
Even if you are not sleeping, you should be resting. Exercise should be light and not strenuous. You should rest as much as possible because your body will be going through a lot and it is best not to put it through more if possible.
8. Taper Off the Drug
If you are doing withdrawal at home and you have the ability to, rather than going cold turkey, taper off the drug slowly. The VA suggests tapering amounts for methadone, morphine, and oxycodone, usually starting with decreasing the “dose by 20-50 percent per day” and then getting more specific from there.
9. Attend Detox
For severe withdrawal symptoms, detox can sometimes be extremely beneficial and even necessary. If you are considering attending formal detox for opiate withdrawal and you have been addicted to one or more opiates in the past, you should attend formal addiction treatment as well, as detox will not treat your addiction to opiates, just your withdrawal.
10. Don’t Go It Alone
Even if you decide not to attend formal detox, don’t go through withdrawal alone. Ask a friend or loved one to stay with you for a while and help you through this difficult time. One of the symptoms of withdrawal is usually some level of depression, and having a friend nearby could be very helpful in keeping you from feeling extremely low.
11. Drink Lots of Water
Drinking water and other liquids will help replenish and rehydrate your body during the episodes of vomiting and diarrhea. You will also sweat during withdrawal which can dehydrate you, so making sure to stock up on juices, sports drinks, and just water is very important.
12. Keep a Consistent Temperature in Your Home
You will likely go back and forth between getting goosebumps and chills and sweating profusely. Withdrawal from opiates feels similar to the flu which is why making sure that your home is consistent in temperature and that you are not somewhere too hot or too cold will be necessary to your comfort. Dress in loose-fitting clothes that are good for relaxing and keep blankets nearby.
13. Remember This is Temporary
Withdrawal can sometimes last a week or more and can be very painful and uncomfortable. Knowing that it is temporary and that you will soon be back to yourself again will help you resist the urge to start abusing the drugs again. As stated by the NLM, when someone who has been taking a drug for so long that the body depends on it suddenly stops, “the body needs time to recover, and withdrawal symptoms result.” Eventually, they will wear off.
14. Engage in Activities that Make You Happy
Whether this means watching your favorite show, playing a fun video game, or just spending comfortable time with those you love, try and lift your spirits by doing things that make you happy. Still be careful and take it easy with whatever activities you choose to participate in, and stay away from things like busy events and alcohol as it is a depressant and can cause you to become very upset or even relapse. Try for a calm state of contentment and comfort.
15. Reward Yourself
Choose something as a reward for getting through each day of withdrawal and give it to yourself. Whether this means a treat like chocolate or something small you’ve been wanting to buy yourself, it shouldn’t become too difficult or expensive to reward yourself this way if you think of small things that can be a prize for getting through each difficult day. Withdrawal is not easy, and only you will truly understand what you are going through in that moment. Reward and praise yourself for each day you make it through.
Resources
- Shah M, Huecker M. (2021). Opioid Withdrawal.Treasure Island. StatPearls Publishing.
- Pergolizzi, J. V., Raffa, R. B., & Rosenblatt, M. H. (2020). Opioid Withdrawal Symptoms, a Consequence of Chronic Opioid Use and Opioid Use Disorder: Current Understanding and Approaches to Management. Journal of Clinical Pharmacy and Therapeutics, 45(5), 892–903.
- Annely, L. Loes, D., Hanneke, R., Stan, Chudy, Alessandro, C. Bart, K., (2021). Effectiveness of non-opioid interventions to reduce opioid withdrawal symptoms in patients with chronic pain: a systematic review. Family Practice.
- Farrell, M. (1994). Opiate withdrawal. Addiction, 89(11), 1471-1475.
- Christine, C., Tracy, M., Devon W, Jacqueline F, Paul A. (2021). Emergency Physicians Ability to Recognize and Diagnose Opiate Use Disorder: A Qualitative Study. Cureus 13(9):e18216.
- Fareed, A., Stout, S., Casarella, J., Vayalapalli, S., Cox, J., & Drexler, K. (2011). Illicit Opioid Intoxication: Diagnosis and Treatment. Substance Abuse: Research and Treatment.
- Darke, S., Larney, S., & Farrell, M. (2017). Yes, people can die from opiate withdrawal. Addiction, 112(2), 199-200.
- Volkow, N. D. (2011). Principles of Drug Addiction Treatment: A Research-Based Guide (2nd Ed.). United States: DIANE Publishing Company.
- Veilleux, J. C., Colvin, P. J., Anderson, J., York, C., & Heinz, A. J. (2010). A review of opioid dependence treatment: pharmacological and psychosocial interventions to treat opioid addiction. Clinical Psychology Review, 30(2), 155-166.
- Saxon, A. J., Hser, Y. I., Woody, G., & Ling, W. (2013). Medication-assisted treatment for opioid addiction: methadone and buprenorphine. Journal of Food and Drug Analysis, 21(4), S69-S72.