Author: Tina Chang

Opiate Withdrawal: Signs, Symptoms, and Treatment

Quitting opiates isn’t easy and you should prepare yourself for withdrawal symptoms that will likely occur during your recovery. Understanding opiate withdrawal symptoms to expect can help you mentally prepare and get the right treatment you need.

In this article:

Common Opiate Withdrawal Symptoms
How Long Do Opiate Withdrawal Symptoms Last?
When Do Opiate Withdrawal Symptoms Occur?
Treatment for Opiate Withdrawal
What are Opiates?
How Do Opiates Work?
Commonly Used Opiate Drugs

Common Opiate Withdrawal Symptoms

Early withdrawal symptoms from opiates include:¹

Restlessness
Agitation/anxiety
Difficulty falling asleep or staying asleep (i.e., insomnia)
Muscle aches
Diarrhea
Vomiting
Leg movements
Cold flashes
Runny nose
Sweating
Excessive yawning

After these initial symptoms, you will enter the later stages of opiate withdrawal which include the following symptoms:¹

Nausea and vomiting
Abdominal cramping
Dilated pupils
Goosebumps
Diarrhea

Opiate withdrawal symptoms are uncomfortable and may even be painful but are generally not life-threatening.¹ However, it is always recommended to contact a healthcare provider to receive medical support when going through the withdrawal process.³

How Long Do Opiate Withdrawal Symptoms Last?

As there are many formulations of opiates and ways opiates may be used, the amount of time you experience withdrawal symptoms will differ. The type of opiate use, duration of use, dose taken, and time between doses all contribute to how you’ll experience withdrawal.¹

Shorter-acting opioids such as heroin usually have withdrawal symptoms that appear within the first 8-12 hours after last use. Peak withdrawal symptoms will occur within 1-3 days after last use, and withdrawal symptoms will usually cease after 7 days.⁶

Immediate-release formulations of opioid medications such as oxycodone, fentanyl, and hydrocodone have a slightly different timeline. Initial withdrawal symptoms may appear within 8-24 hours after the last use and withdrawal symptoms may last up to 10 days.⁷

Longer-acting opiates, such as methadone, and extended-release formulations of medications such as hydrocodone have a slightly longer timeline. Initial withdrawal symptoms may appear within 36 hours after last use and withdrawal symptoms may continue for up to 14 days or longer.⁶

When Do Opiate Withdrawal Symptoms Occur?

Symptoms of opiate withdrawal may appear anywhere between 12-72 hours since you last used the drug, depending on the opiate, however it’s important to note not everyone will experience withdrawal.⁶

Withdrawal symptoms from opiates usually only occur if you have been using the drug over a long period of time (longer than weeks or months), in a higher dose, or more frequently than advised by your physician, as you are at a higher risk for developing an addiction.³

How long it takes for you to become physically dependent on an opiate depends on how long you’ve been taking the drug, the method by which they you’ve been taking the drug, and which drug you’re using.⁴ In addition, factors such as your family history, genetic makeup, medical history, and mental health history all contribute to addiction risk.⁴

With continued opiate use and addiction, more of the drug is needed to experience the same effect (this is referred to as drug tolerance).

Generally, once you being to experience any signs of drug tolerance or physical dependence, you are at risk of experiencing opiate withdrawal symptoms once you stop taking the drug or take it in lower doses.⁴

If you’re seeking help for your opiate addiction, call 866-968-5444Who Answers? to speak with a treatment advisor who can help find the right program for you.

Treatment for Opiate Withdrawal

Going through opiate withdrawal can be uncomfortable and, in some cases, may be painful, but is usually not life threatening.¹ Regardless, going through the withdrawal process on your own can be very difficult and is generally not advised.⁴

The most common settings to go through opiate withdrawal in, include:¹

At home: Withdrawing from opiates at home often requires the use of medication and the presence of a support person to help navigate the withdrawal process. As withdrawal is uncomfortable, it is suggested that opiate withdrawal is done slowly and with the oversight and support of a healthcare professional.
At a detoxification center: There are certain facilities set up that are designed to help individuals go through the symptoms of opiate withdrawal. Talk to your healthcare provider or call 866-968-5444Who Answers? to learn more.
In a hospital: If your withdrawal symptoms feel severe, it is suggested to receive medical support in a hospital setting with access to around-the-clock care.

Medication for Opiate Withdrawal

No matter the setting, opiate withdrawal is often supported with the use of medications. Commonly used medications to treat withdrawal symptoms include¹:

Methadone: Methadone helps to relieve withdrawal symptoms and can aid in the detoxification process. In addition, methadone may be used as a long-term maintenance medication for those with a history of opioid dependence. After you feel stable after going through withdrawal and receiving methadone maintenance therapy, methadone dosage may be decreased slowly over a long period of time. However, you may end up staying on methadone for years or your whole life, depending on your treatment needs.
Buprenorphine: Buprenorphine helps to treat withdrawal from opiates and can help to shorten the length of the detoxification/withdrawal process. This medication may be used for long-term maintenance in a way similar to methadone, however, buprenorphine does have similar effects to opioids. As a result, this medication is often combined with naloxone to help prevent drug dependence and misuse.
Clonidine: Clonidine may be used to help reduce the symptoms commonly seen with withdrawal, such as anxiety, agitation, muscle aches, and cramping. However, this medication does not help to reduce opioid cravings.
Naltrexone: Naltrexone may be prescribed to help prevent relapse and may be given as a pill or as an injection. If there are still opioids in your bloodstream, receiving naltrexone treatment has the potential to send you into a sudden and severe withdrawal. As a result, it is important that you do not take opioids for at least 12-24 hours before beginning naltrexone treatment.
Other medications: Your provider may prescribe other medications to help treat symptoms of nausea and diarrhea, and to help improve quality of sleep while going through opiate withdrawal.

If you have struggled with multiple opioid withdrawal experiences, evidence suggests maintenance and long-term treatment with either methadone or buprenorphine is effective.¹

What Are Opiates?

Opiates are natural substances derived from the opium poppy plant are commonly used as a medication to treat pain, although there are illicit opiates such as heroin which are used recreationally. Opioids, on the other hand, are similar but are synthetic opium drugs (vs natural). Both terms, opiates, and opioids, are generally used interchangeably, although are technically slightly different.

Opiate medications, such as morphine and codeine, work by binding to specific receptors in your brain, spine, and gastrointestinal tract to mask the pain. In addition, opiates also alter your mood, which can create pleasurable effects such as euphoria and mental relaxation.⁴ Because of the ways, opiates bind to receptors throughout the body, they can slow your breathing and impact your gastrointestinal system, often resulting in undesirable effects such as constipation.³

How Do Opiates Work?

When you take an opiate drug, the brain releases a chemical referred to as dopamine which helps your brain reinforce pleasurable activities, such as exercise and spending time with friends. Reinforcing these behaviors motivate us to repeat them and, as a result, we continue behaving in the same way. The ways in which opioids and opiates influence dopamine in the brain is what makes these medications addictive.⁶

Commonly used opiates include street drugs such as heroin, and prescription drugs like codeine, hydrocodone (Vicodin), hydromorphone (Dilaudid), and oxycodone (Percocet or OxyContin).² Prescription opiates have a similar origin to heroin, and due to their euphoric effects are often sought out for non-medical purposes and recreational use.²

Use of all opiate drugs, whether prescribed or used recreationally, has the risk of physical and/or emotional dependence in addition to the risk of death from overdose.

Commonly Used Opiate Drugs

Name of Opioid	Common Street Names	Forms of Medication	Ways Medication is Taken
Codeine	Coties, Captain Cody, Schoolboy May be taken in soft drink or candy form, which is referred to as: Lean, Sizzurp, Purple Drank	Tablet, capsule, liquid	Injection Orally
Fentanyl	Apache, Blue Diamond, China White, Blonde May be mixed with heroin, which is referred to as Birria	Tablet placed on the tongue (known as sublingual tablet), film, lozenge	Injection Smoking Snorting
Hydrocodone or dihydrocodeinone (Vicodin)	Vikes, Veeks, Idiot Pills, Lemonade, Dones May be mixed with Valium and vodka and referred to as: Triple V	Capsule, tablet, or liquid form	Swallowing Snorting Injection
Hydromorphone (Dilaudid)	D, Dillies, K4, Needle Candy	Liquid form, suppository	Injection Inserting a capsule into the anal cavity (in suppository form)
Methadone	Amidone, Fizzies, Jungle Juice May be mixed with MDMA and referred to as Chocolate Chip Cookies	Tablet, liquid form	Swallowing Injection
Morphine	Dreamer, First Line, Joy Juice, Morpho	Tablet, capsule, liquid form, suppository	Injection Swallowing Smoking Inserting a capsule into the anal cavity (in suppository form)
Oxycodone (OxyContin, Percocet)	Oxy, Beans, Blues, Roxy, Percs	Capsules, tablet, liquid form	Swallowing Snorting Injection
Oxymorphone	Biscuits, Blue Heaven, Mrs. O	Tablet	Swallowing Snorting Injection
Heroin	Brown Sugar, Dope, H, Horse, Smack May be mixed with marijuana and referred to as: A-Bomb	White powder, brownish powder, black sticky substance (commonly known as black tar heroin)	Injection Smoking Snorting

This table outlines commonly known/used opiates. It is not an exhaustive list.

Quitting Opiates Safely

Quitting opioid use and going through the withdrawal process can be very uncomfortable and at times, painful. As a result, it is recommended to undergo the withdrawal process with oversight from a healthcare provider or in a treatment center. When seeking professional help, you can expect to receive the following treatment:¹

A provider may ask questions about history of opioid use, such as the type of opioid taken, over how much time, in what dose, and in what way the drug has been ingested.
A provider may complete a physical exam and ask further questions regarding medical history and history of drug use.
A urine or blood test may be collected to screen for drugs and confirm the presence of opiates in your system.
Other tests may be collected, depending on the provider’s concerns and the overall treatment goals. These may include:
- Liver function tests to determine how well your liver is functioning.
- CBC blood test to measure blood count, including red and white blood cell count.
- A chest x-ray to determine lung functioning.
- Testing for illnesses that are more common among those who use opiates, specifically those who use needles for drug injection. These illnesses include hepatitis C, HIV, and tuberculosis.

Treatment for opiate addiction often involves a combination of medication, counseling, and support.³ It is important to be honest with your healthcare provider regarding treatment goals so that a realistic treatment plan can be put into place.

After going through the opiate withdrawal/detoxification process, you may need emotional support to remain drug-free. There are many treatment options available, including (but not limited to):¹

Self-help groups, such as Narcotics Anonymous or SMART Recovery
Outpatient therapy
Intensive outpatient treatment, such as a day program at a local hospital
Longer-term inpatient treatment with access to around-the-clock support

Call 866-968-5444Who Answers? if you or a person you know is struggling with opiate abuse or addiction. Care is available and you are not alone.

References

U.S. National Library of Medicine. (2020, May). Opiate and opioid withdrawal, viewed November 2020.
National Institute on Drug Abuse. (2020, August). Commonly Used Drugs Chart, viewed November 2020.
Shah, M., & Huecker, M.R. (2020). Opioid Withdrawal. StatPearls Publishing.
Substance Abuse and Mental Health Services Administration. (2013). Opioid Overdose Prevention Toolkit: Opioid Use Disorder Facts, viewed November 2020.
Center for Disease Control and Prevention. (2020, March). Opioid Basics, viewed November 2020.
Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment, viewed November 2020.