If you’re considering stopping opioids, you’ve likely asked yourself how long opioid withdrawal lasts and what to expect during the detox process. Your body’s response to discontinuing opioids can vary based on the type of opioid, dose, and duration of use. Understanding the opioid withdrawal timeline and the factors that influence its length can help you prepare mentally and physically for each phase.
Opioid withdrawal involves distinct stages, including early, peak, and late phases, with symptoms ranging from mild discomfort to severe physical and psychological distress. By familiarizing yourself with common withdrawal symptoms and evidence-based treatment options, you can make informed decisions about whether to attempt an at-home detox or seek professional medical supervision.
Understanding opioid withdrawal
Timeline of withdrawal stages
Early stage timing
Withdrawal from fast-acting opioids such as oxycodone or heroin typically begins within 6 to 12 hours after your last dose [1]. You may notice anxiety, runny nose, sweating, and mild aches. If you’ve been using slow-release opioids like Buprenorphine/Naltrexone, symptoms often start 1 to 3 days after cessation, with a gentler onset but potentially longer duration [1].
Peak stage duration
Symptoms usually peak around days 2 to 3, presenting the most intense physical and psychological discomfort. During this period you might experience severe muscle aches, nausea, insomnia, and cravings. For short-acting opioids, peak symptoms generally resolve within 5 to 7 days, whereas long-acting opioids can keep you in peak intensity for up to 10 days or more [2].
Late stage timeline
After the peak phase, acute physical symptoms begin to subside. For short-acting opioids, most physical discomfort ends by days 7 to 10. If you’ve been using long-acting opioids such as Buprenorphine/Naltrexone, lingering aches, insomnia, and dysphoria may persist for 2 to 4 weeks [3].
Factors affecting duration
Several variables influence how long opioid withdrawal lasts in your case:
- Type of opioid: fast-acting versus slow-release
- Dosage: higher daily intake often lengthens the timeline
- Duration of use: chronic use can intensify and prolong symptoms
- Metabolism and genetics: individual differences in liver enzymes
- Co-occurring health conditions: mental health disorders or other substance use
- Tapering strategy: gradual reduction versus sudden stop [1]
Early withdrawal symptoms
Short-acting opioid symptoms
If you’ve taken heroin or oxycodone, early withdrawal may include:
- Restlessness and anxiety
- Teary eyes or runny nose
- Muscle aches and joint pain
- Sweating and chills
- Gastrointestinal upset (nausea, vomiting, diarrhea)
For a more detailed checklist, see early signs of opioid withdrawal.
Long-acting opioid symptoms
Withdrawal from Buprenorphine/Naltrexone or extended-release formulations often presents:
- Mild to moderate muscle aches
- Fatigue and lethargy
- Irritability and mood swings
- Sleep disturbances (insomnia or vivid dreams)
Because these symptoms develop more slowly, you may underestimate their severity until peak stage.
Peak withdrawal phase
Symptom intensity risks
During peak withdrawal you face the highest risk of dehydration, electrolyte imbalance, and severe psychological distress such as panic attacks. Cravings can become overwhelming, increasing the risk of relapse. Close monitoring of vital signs and mental status is critical at this point.
Assessing severity with COWS
The Clinical Opioid Withdrawal Scale (COWS) helps health professionals measure symptom severity on a 0–47 point scale, with categories from mild (5–12) to severe (>37). Regular COWS assessments guide treatment decisions and dosing adjustments for medications like Buprenorphine/Naltrexone or buprenorphine [4].
Late withdrawal phase
Late-stage symptoms
Once peak symptoms ease, you may still experience:
- Dysphoria or low mood
- Cravings that come in waves
- Sleep disturbances and fatigue
- Mild aches and restlessness
These can last several weeks, especially after long-term opioid use.
Post-acute withdrawal syndrome
Post-acute withdrawal syndrome (PAWS) refers to psychological and emotional symptoms that persist for weeks to months after acute withdrawal. You might notice:
- Anxiety or panic attacks
- Mood swings and irritability
- Trouble concentrating
- Sleep disturbances
PAWS can increase relapse risk without proper support [5].
Medical management options
Medication-assisted treatment
Medication-assisted treatment (MAT) combines FDA-approved drugs with counseling to ease withdrawal and reduce cravings.
Buprenorphine timing guidelines
Begin buprenorphine 12 to 18 hours after your last dose of short-acting opioids or 24 to 48 hours after long-acting opioids to avoid precipitated withdrawal [4].
Buprenorphine/Naltrexone dosing protocols
Initial withdrawal dosing often starts at 10 mg orally or intravenously every 4 to 6 hours if symptoms persist, with total daily doses rarely exceeding 40 mg. Maintenance dosing typically begins around day 3 of treatment [4].
Lofexidine hydrochloride use
Lofexidine hydrochloride, approved in May 2018, is the first non-opioid medication for acute opioid withdrawal symptom management. It reduces sympathetic activity and can be used up to 14 days [4].
Symptomatic pharmacotherapy
Alongside MAT, symptom-specific medications may include:
- Loperamide for diarrhea
- Promethazine for nausea and vomiting
- Ibuprofen or acetaminophen for muscle aches
- Clonidine to reduce hypertension, sweating, and hot flashes
These are typically administered during the acute phase, up to two weeks [4]. For guidance on when to seek medical care, review withdrawal symptoms that require medical care.
At-home detox risks
Dangers of unsupervised detox
Attempting to detox without medical supervision can lead to:
- Severe dehydration and electrolyte imbalance
- Dangerous fluctuations in blood pressure or heart rate
- Unmanaged panic attacks or suicidal thoughts
- Increased risk of relapse due to intense cravings
For more on why professional support matters, see why you should not detox at home.
Signs you need detox
You should consider professional medical detox if you experience:
- Inability to keep fluids down
- Chest pain or rapid heartbeat
- Severe agitation or hallucinations
- Persistent vomiting or diarrhea leading to dehydration
See signs you need medical detox and when detox is not enough for more detail.
When to seek help
Severe withdrawal warning signs
Seek immediate medical attention if you notice:
- Extreme confusion or disorientation
- Severe chest pain or respiratory distress
- Seizures or convulsions
- Profuse sweating with very high blood pressure
Refer to severe withdrawal warning signs and danger signs during drug withdrawal.
Unmanaged withdrawal complications
Without proper intervention, withdrawal can result in complications such as:
- Cardiac arrhythmias
- Kidney or liver injury from dehydration
- Severe malnutrition
- Self-harm or suicidal ideation
Learn more at unmanaged withdrawal complications.
Planning a safe withdrawal
Tapering strategies
Gradual tapering under medical supervision reduces the intensity and duration of withdrawal symptoms. Your provider may create a day-by-day or week-by-week dose reduction plan based on your opioid type, dosage, and length of use [1].
Supportive therapies and resources
In addition to medications and tapering, you can bolster recovery with:
- Behavioral therapies such as cognitive behavioral therapy
- Peer support groups or 12-step programs
- Nutritional counseling for electrolyte balance
- Regular exercise and mindfulness practices
Engaging in comprehensive care increases your chances of a safe, lasting recovery.
By understanding how long opioid withdrawal lasts, recognizing warning signs, and exploring medical management options, you can navigate detox more safely and reduce the risk of complications. Whether you choose a supervised detox program or out-patient support, planning and professional guidance are key to a successful withdrawal and long-term recovery.
