Opiate dependence is characterized by withdrawal symptoms that set in when opioid use suddenly stops. The opiate withdrawal timeline depends on several factors. The type of opioid and body chemistry impact the length and severity of withdrawal symptoms.
Withdrawal from opiates can be excruciatingly painful and uncomfortable, making it difficult to begin the journey toward sobriety. Interventions such as medical detox help reduce the opiate withdrawal timeline.
After detox, a medication-assisted treatment program (MAT) can assist with lasting sobriety as part of a comprehensive treatment plan. Reducing the opiate withdrawal timeline can be the first step in successful treatment for opiate addiction.
The Opiate Withdrawal Timeline
Depending on the type of opiate abused, including heroin, short-acting prescription opiates, or long-acting prescription opiates, the opiate withdrawal timeline typically starts between eight and 30 hours after the last dose and lasts between four and 10 days. For some people, the opiate withdrawal timeline will be shorter, while for others, it can last as long as a month or more.
The opiate withdrawal timeline depends on factors such as:
amountof opiates in your system at the time of detox.
- The length and severity of the dependence.
- The general state of physical and mental health.
- Genetics and biology.
- Whether you opt for medical detox or withdraw on your own.
The opiate withdrawal timeline can vary based upon the type of opiate from which a person is withdrawing. Withdrawal from heroin, which is a short-acting opiate, tends to begin within eight to 12 hours of the last dose of the drug. Withdrawal symptoms reach their peak within 36 to 72 hours and then decline significantly after about five days. 1
Withdrawal from a short-acting opiate, such as oxycodone, begins later, within 24 to 36 hours following the last dose. Symptoms peak in about 4 to 6 days and can persist for several weeks.
More mild withdrawal symptoms, such as fatigue, a depressed or irritable mood, and sleep disturbances can continue for months after opiate use ceases.
Reducing the opiate withdrawal symptoms can therefore play a critical role in maintaining lasting sobriety
Early symptoms beginning at the start of the withdrawal period may include:
- Psychological and behavioral effects, such as anxiety and/or agitation
- Sleep difficulties and yawning
- Muscular aches and pains
- Runny nose
- Excessive sweating
After these symptoms peak within the timeframes described above, the later symptoms in the opiate withdrawal timeline appear: 2
- Enlarged pupils
- Nausea and Vomiting
- Gastrointestinal discomfort, cramping, and diarrhea
These symptoms of opiate withdrawal can be intense and produce a debilitating level of discomfort. Fortunately, reducing the opiate withdrawal can make unpleasant symptoms more manageable.
Professionally administered medications to reduce the severity of withdrawal symptoms and shorten the time it takes to detox.
Those who try to detox from opiates on their own frequently relapse to end the discomfort of withdrawal.
Medical detox also involves emotional support and can include complementary therapies like massage or restorative yoga to reduce stress.
Services for Reducing the Opiate Withdrawal Timeline
Withdrawal from an opiate use disorder involves uncomfortable side effects, but there are services available for reducing the opiate withdrawal. Medical detox is medically supervised withdrawal. It involves a variety of medications that are administered as needed to reduce the severity of withdrawal symptoms and shorten the time it takes to detox. A medical detox program is the first step in the withdrawal process, and this type of program should be followed by ongoing treatment services, including medication-assisted treatment (MAT).
Medications and methods used to reduce the withdrawal timeline include:
- Opioid Agonists
- Non-Opioid Agonists
- Opioid Antagonist
- Partial Agonists and Antagonists
- Tapering Medications
Buprenorphine is one of a few medications commonly used during opiate detox. Buprenorphine is a semi-synthetic opiate, and a partial opioid agonist, which means that while it can produce the euphoric and respiratory depressing effects of opiates, the effects are far smaller than full agonists like heroin and opioid painkillers. Buprenorphine attaches to opioid receptors to reduce the intensity of opiate withdrawal, help normalize brain function and shorten the opiate withdrawal timeline.
Other medications used during opiate detox can treat symptoms like nausea, vomiting, abdominal cramps, diarrhea and feelings of agitation and anxiety. Cravings are intense during withdrawal, and while some medications can reduce their severity during withdrawal, cravings can last for weeks or months after detox and can make long-term recovery difficult.
Why Medical Detox is Essential for Opiate Withdrawal
Many people who try to detox from opiates on their own turn back to using very quickly, if only to end the discomfort of withdrawal. People in severe withdrawal can quickly become dangerously dehydrated as a result of severe vomiting and diarrhea.
In addition to reducing the severity of withdrawal symptoms and shortening the opiate withdrawal timeline, medical detox provides emotional support during withdrawal.
Medical Detox versus MAT
While medical detox programs and MAT may sound similar, they are actually distinct pieces of the recovery process. Medical detox programs involve medically supervised withdrawal from opiates, with medications being used to make withdrawal more manageable by reducing the opiate withdrawal. The goal of medical detox is to rid the body of opiates so that ongoing treatment can begin. Detox programs tend to be short in duration, lasting from a few days to a week.
MAT programs, on the other hand, are ongoing and can last for as long as several years. The aim of medication-assisted treatment is to help a person control cravings and achieve lasting sobriety from opiates. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), people who are receiving MAT must also undergo counseling, per Federal regulations.3 MAT is just one piece of a comprehensive treatment plan for an opiate use disorder.
Goal: rid the body of opiates so that ongoing treatment can begin
Duration: a few days to a week
Goal: help a person control cravings and achieve lasting sobriety from opiates
Duration: up to several years
How Medications are Helpful for Reducing Opiate Withdrawal Symptoms
Medications used for both medical detox and MAT can be effective for reducing the opiate withdrawal. For example, SAMHSA reports that medications such as buprenorphine and methadone can reduce the painful withdrawal symptoms that occur when stopping opiate use.3
Medications can also assist beyond the initial medical detox phase, as they are effective for reducing the opiate withdrawal symptoms that persist after the body is cleared of illicit opiates. For example, a person can feel anxious, depressed, or irritable for months after discontinuing opiate use, but methadone and buprenorphine can reduce opiate cravings and stabilize brain activity so that people in recovery do not turn to drugs to treat these lasting psychological side effects.
These medications tend to be most effective when combined with psychological interventions, such as counseling. Through counseling and psychoeducation, people recovering from opiate addiction can learn strategies for preventing relapse and coping with stressors. They can also begin to resolve underlying issues, such as trauma, abuse, or mental health conditions that have contributed to the opiate use disorder. While medications are effective for reducing the opiate withdrawal by lessening physical symptoms, they cannot cure the addiction or treat co-occurring emotional and psychological issues on their own.
How are Medications Helpful?
Reduce painful withdrawal symptoms from stopping opiate use
Reduce opiate cravings and stabilize brain activity
Allows people to focus on true recovery by processing underlying issues such as trauma, abuse, or mental health conditions
Medication-Assisted Treatment After Detox
According to the Substance Abuse and Mental Health Services Administration, medication-assisted treatment, or MAT, is the current gold standard for treating opiate dependence and addiction. Medication-assisted treatment involves medications that prevent withdrawal while helping to normalize brain function and block cravings for opiates.
Medication-assisted treatment enables individuals to focus on addressing the issues behind the addiction and can be taken for weeks, months or even years to effectively manage the addiction and help prevent relapse.
Medication is just one component of MAT. The other component is counseling, which is central to ending an addiction to opiates. The combination of medication and therapy helps addicted individuals address a variety of issues behind the addiction and develop essential coping skills for handling relapse triggers.
Detox is Not Addiction Treatment
If you choose to detox from opiates rather than opt for medication-assisted treatment, it’s important to understand that detox is not addiction treatment and does very little to address the critical issues behind the compulsive drug abuse. According to the National Institute on Drug Abuse’s Principles of Effective Treatment, addiction is far more complex than physical dependence. It requires comprehensive treatment that involves a variety of therapies to help people end their addiction for the long-term, restore function to their lives and find purpose and meaning in a life free of substance abuse.
Interesting Facts About Medications Used for Opiate Withdrawal
Researchers interested in reducing the opiate withdrawal have conducted numerous studies to assess the medications used in detox and MAT. A 2017 report in Dialogues in Clinical Neuroscience, showed significant findings.4
Statistics on Effectiveness of MAT
In one study, 74 percent of people who received methadone stayed in treatment, compared to 46 percent of those who took buprenorphine.
There is evidence that buprenorphine doses exceeding 32 milligrams per day are linked to greater treatment retention.
A review of 21 studies indicates that buprenorphine doses of 16 to 32 milligrams per day are more effective for retaining people in treatment than daily doses of less than 16 milligrams are.
Benefits of MAT
SAMHSA reports additional facts pertaining to MAT and states there is evidence of numerous benefits associated with this approach:3
- Reduction in illegal opiate use and criminal activity
- Better survival rates
- Greater likelihood of obtaining and keeping a job
- Fewer problems among babies born to women with a history of opiate abuse
- Potential reduction in the risk of HIV or hepatitis C
Medications for MAT
The National Institute on Drug Abuse (NIDA) has also discussed facts pertaining to MAT:5
Methadone can reduce the rate at which people test positive for opiates by 33 percent.
Buprenorphine can lower opiate use by about 14 percent compared to placebo and make treatment retention 1.82 times more likely.
In a study comparing patients who took 16 milligrams of buprenorphine per day to those who detoxed for six days with buprenorphine and then received a placebo, only 25 percent of those taking buprenorphine on an ongoing basis failed to stay in treatment, whereas 100 percent of those in the placebo group were unsuccessful.
While buprenorphine and methadone have received much of the attention for their success with reducing the opiate withdrawal, there are other medications used to treat opiate use disorders.
According to SAMHSA, naltrexone, which is available via pill and injection, works by blocking the brain’s opiate receptors. This medication is also known to lessen drug cravings.3 Unlike with buprenorphine and methadone, naltrexone is not used during the medical detox process and is instead reserved for MAT after a person completes detox.6
Also noteworthy is the fact that in 2018, the Federal government approved lofexidine for treating the physical symptoms of opiate withdrawal. This medication acts differently than buprenorphine and methadone do, because it is not an opioid, but it can be effective for reducing the opiate withdrawal through its ability to prevent the efflux of norepinephrine, which stimulates the nervous system.6
Using Medications Through Detox and MAT
Based upon the research, medications can be helpful during both the detoxification and ongoing treatment phases for opiate use disorders. When used in medical detox, medications can be effective for reducing the opiate withdrawal and making painful symptoms such as abdominal cramping and muscle aches more tolerable. When used on an ongoing basis in MAT, they can help to control the lasting symptoms associated with opiate cessation, as they make cravings and psychological distress more manageable.
Medications can play a critical role in a comprehensive opiate treatment program that also includes counseling, support groups, and social services. Treatment professionals can work with people in recovery to determine what medications are most effective for reducing the opiate withdrawal and contributing to lasting sobriety.