Key takeaways:

  • Opioid withdrawal symptoms are one of the main reasons people relapse when attempting to stop and are one of the criteria for measuring addiction
  • The symptoms of opioid withdrawal are similar to that of a terrible case of the flu and include aches, chills, and gastrointestinal upset
  • Many forms of medication are available for people in recovery from opioid addiction that can help manage cravings and ease or prevent withdrawals

Opioid withdrawal symptoms can be extremely uncomfortable and will often require medically assisted treatment to overcome safely.

Opioid withdrawal

Opioid painkillers (also often referred to interchangeably with opiate painkillers) cover a wide range of prescription medications used to treat those suffering from mild to severe pain. These include drugs such as Codeine, Morphine, Tramadol, and Oxycodone. When taken in the recommended dosage, they can alleviate chronic pain such as arthritis and help those recovering from surgery or physical trauma. Opioids are also the main component of certain illicit substances such as heroin.

When someone abuses opioid painkillers, taking more than the recommended dose or for longer than intended, there is a chance they will develop a physical dependence on the substance.

When someone abuses opioids, they can effectively rewire the pleasure receptors in the brain and cause a tolerance to the substance to build. This mechanism gives rise to dependence when the person abusing requires more of the substance to feel its effect or, in many cases, to feel normal.

When a person has developed a physical dependence on opioid painkillers, they will often experience uncomfortable or painful symptoms when they stop using the drug completely (also known as cold turkey) for some time. Opioid withdrawal symptoms are one of the main reasons people relapse when attempting to stop and are one of the criteria for measuring addiction [3].

Withdrawal symptoms from opioid drugs can be highly uncomfortable, and some may experience pain and other health problems. These symptoms are often flu-like, with vomiting, nausea, muscle aches, and shivers being common. To ensure that opioid withdrawal is handled safely and effectively, it is always advised that someone completes a medically assisted detox. From here, trained rehab professionals can create ongoing treatment programs and develop a plan for long-term recovery.

Get help during covid-19

Get help during Covid-19

At Recovered, we recognize the impact COVID-19 has had and the continued challenges it poses to getting advice and treatment for substance use disorders. SAMHSA has a wealth of information and resources to assist providers, individuals, communities, and states during this difficult time and is ready to help in any way possible.

Speak to SAMSHA

Symptoms of opiate withdrawal

Most people experiencing opioid withdrawal will begin to feel symptoms within the first 8-24 hours after their last dose, and sometimes even sooner [1].

The symptoms of opioid withdrawal are similar to that of a terrible case of the flu and include aches, chills, and gastrointestinal upset. The most intense period occurs during the first few days, and most of the physical withdrawals are complete within one week [1, 2]. The exception is that people who take long-acting synthetic opioids like Suboxone can experience prolonged withdrawal that lasts for two weeks or sometimes longer [1].

The longer someone has had an opioid use disorder, how it was abused (e.g., intravenously), and the amount taken each time all affect how dependent a person is and how severe their withdrawals will be. Therefore, someone with a relatively short history of opioid abuse may only encounter mild symptoms. Those taking the drug in large doses for months or years will likely experience the most severe form of withdrawal. External risk factors, such as mental health issues or previous opioid addiction, can also affect withdrawal symptoms.

Not everyone will experience the same symptoms during withdrawal from opioids, but here are some of the most commonly reported withdrawal symptoms [1]:

  • Nausea, cramping, diarrhea, or other gastrointestinal problems
  • Sweats, fever, or hot and cold chills
  • Watery discharge from eyes/ runny nose
  • Muscle, bone, headaches, or body aches
  • Sore or tense muscles or muscle spasms
  • Increased heart rate, blood pressure, and respiration
  • Yawning, feeling tired but not being able to sleep
  • Restless legs, feeling unable to sit still
  • Anxiety, irritability, or mood problems

These symptoms can be mild, moderate, or severe, depending on how many symptoms are reported. While these symptoms may not be directly life-threatening, they cause a lot of discomfort and distress to a person and make it hard to function.

While the physical withdrawals are usually gone within a week, some people develop Post-Acute Withdrawal Syndrome (PAWS), which can last up to a year or, in some cases, longer. PAWS symptoms are often more psychological and include mood problems, drug cravings, fatigue, trouble concentrating, and cognitive impairments.

Most people report PAWS symptoms are milder and ‘come and go’ throughout this period. While these effects on mood and behavior can last for months after the initial period of opioid withdrawal, the longer the person remains drug-free, the more these symptoms will start to dissipate.

Opioid withdrawal timeline

As outlined above, the length of time and severity of heroin withdrawal depends on several factors, including:

  • The period of opioid abuse
  • The number of opioid painkillers taken per dose
  • Frequency of abuse
  • Method of abuse (intravenous, inhaled, snorted)
  • The type of opioid used (i.e., heroin or synthetic opioids)

Days 1-7 - Symptoms usually present within 8-24 hours of the last use. The first few days of opioid withdrawal can be difficult. Most people reported flu-like symptoms, including nausea, vomiting, cramps, aches, hot and cold chills, sweating, and insomnia [1, 2].

Days 7-10 - At this point, most people report that the most intense withdrawal symptoms have tapered off. Mild symptoms like occasional chills, aches, cramping, or insomnia sometimes persist [1, 2].

PAWS - For those with a long history of opioid painkiller abuse or who used large doses, PAWS may persist for months after acute withdrawal signs have faded. These can include depression, insomnia, hypersensitivity, fatigue, mood swings, anxiety, and irritability [1].

Medications used in opioid detox

Many forms of medication are available for people in recovery from opioid addiction that can help manage cravings and ease or prevent withdrawals. These medications are often recommended to people who want to stop using opioids because they are safe and effective [1]:

  • Methadone: A low-strength opiate that takes longer than heroin to take effect, methadone is a common medication used in heroin detox and long-term recovery.
  • Buprenorphine: Another commonly prescribed drug that helps opioid withdrawal symptoms and prevents withdrawals, and helps manage cravings.
  • Naltrexone: A medication that blocks the opioid receptors in the brain. Over time it can reduce cravings and works best with opioid painkiller abusers who have already completed detox.
  • Suboxone: A combination of buprenorphine and naltrexone, Suboxone relieves withdrawal pains such as muscle aches and abdominal cramps and inhibits the effects of opioids on the brain.
  • Clonidine: A medication that can help to ease many of the physical symptoms associated with heroin and other opioid withdrawals.

Treatment for opioid addiction

Medication is not recommended as a stand-alone treatment for recovery from addiction to opioid painkillers or heroin. According to best practice guidelines, these medications should only be prescribed and other forms of treatment, including inpatient or outpatient rehab or group or individual counseling [4].

Inpatient rehab centers provide round-the-clock care and professional medical supervision to help with the detox and withdrawal process. This level of care is recommended for people with more severe addictions. Outpatient treatment programs offer addiction treatment in facilities or office-based settings and may meet the needs of people with less severe addictions.

These treatments help people in recovery address the root causes of their addiction while also learning ways to manage cravings and prevent relapse. If you or someone you love is struggling with an opioid painkiller, the best thing to do is reach out to an addiction treatment center. Setting up an appointment with a licensed addiction specialist can help you determine which treatment is best for you.