Opiate withdrawal

The answer depends mostly on which opioid you have been taking. Short-acting opioids leave the body quickly, so withdrawal comes on fast and is over sooner. Long-acting opioids leave slowly, so it starts later and lasts longer.

The ranges below come from World Health Organization clinical guidelines. They are averages. Your own experience may be shorter, longer, lighter or harder.

For a day-by-day picture, see the withdrawal timeline.

Early on, people usually notice anxiety, restlessness, aching muscles, sweating, a runny nose, watery eyes, yawning and trouble sleeping.

Later come stomach cramps, nausea, vomiting, diarrhea, goosebumps and wide pupils. Cravings can be strong the whole way through. The page on withdrawal symptoms goes through each one and what it means.

It can differ by drug

Withdrawal from fentanyl does not always follow the usual pattern, and starting treatment can take more care. Read more about fentanyl withdrawal.

If you use heroin, there is a separate guide to heroin withdrawal, including what it means that much of the heroin sold today also contains fentanyl.

The most effective help is medical. You do not have to get through withdrawal on grit alone, and most people do better when they do not try.

• Buprenorphine and methadone. These are opioid medicines that relieve withdrawal and cravings. The National Institute on Drug Abuse (NIDA) reports that people treated with either one are less likely to overdose or die than people who get no treatment.
• Lofexidine and clonidine. These are not opioids. A prescriber can use them to take the edge off symptoms such as sweating, cramps and anxiety.
• Other comfort medicines. A clinician can also treat nausea, diarrhea and sleeplessness.

This site does not give doses or home taper plans. Those decisions belong with a prescriber who knows your health and what you have been taking.

Fluids, rest, plain food and a person nearby also make a real difference. The guide to easing withdrawal symptoms covers both the medical and the at-home side.

Where treatment happens

Many people picture a locked ward. Most withdrawal treatment is nothing like that. Buprenorphine is often prescribed at an ordinary office visit or by video, and you take it at home. Methadone is given at opioid treatment programs that you visit.

Some people are better off in a hospital or detox unit for a few days, for example if they have other health problems or are also stopping alcohol or sedatives. A clinician can tell you which fits.

If cost is what is stopping you

Worry about money keeps a lot of people from asking. Medicaid, private insurance and state-funded programs pay for much of this care, and a provider’s front desk can usually tell you what you would owe before you commit to anything.

When you want to see who offers this near you, the treatment directory lists providers by state.

For an otherwise healthy adult, opioid withdrawal is rarely life-threatening. It can become dangerous in a few situations.

• Dehydration. Days of vomiting and diarrhea can drain your body of fluid and salts. Get medical help if you cannot keep liquids down, feel faint or confused, or have almost stopped passing urine.
• Pregnancy. The CDC says stopping opioids quickly during pregnancy is not recommended. It can lead to preterm labor, fetal distress or miscarriage. Talk to a prescriber before changing anything.
• Other health conditions. A serious illness makes withdrawal harder on the body. If you have one, talk to a clinician before you stop.
• Thoughts of suicide. Withdrawal can bring very dark moods. Call or text 988 at any hour.

Call 911 if someone is not breathing or cannot be woken. For free, confidential referral to treatment at any time of day, SAMHSA’s National Helpline is 1-800-662-4357.

If you are sitting with someone in withdrawal

Keep fluids within reach and the room calm. Do not argue about the future today. Watch for the warning signs above, and keep naloxone in the house in case they use again once it is over.

Here is the part many people are not told. Once withdrawal is over, your tolerance has dropped. An amount your body handled a few weeks ago can now stop your breathing.

MedlinePlus states it plainly: most opioid overdose deaths happen in people who have just been through detox. This is the main reason that stopping suddenly on your own is riskier than it looks. The page on quitting cold turkey explains the risks and the safer routes.

Getting through withdrawal is also not the same as being treated. Poor sleep, low mood and cravings can linger for weeks or months, which is covered in post-acute withdrawal.

So withdrawal is best seen as a starting point. Staying on medication afterwards protects you during the months when a return to use is most dangerous.