Opiate withdrawal symptoms

After the early phase, the stomach and gut take over. These later symptoms are the ones people dread most.

• Stomach cramps
• Nausea and vomiting
• Diarrhea
• Goosebumps and chills
• Wide (dilated) pupils

The National Institute on Drug Abuse (NIDA) also describes muscle and bone pain, cold flashes and leg movements you cannot control.

Hot and cold flushes are common, so you may be sweating one minute and shivering the next. None of this is pleasant. In a healthy adult, it is the body recalibrating, and it passes.

How strong the symptoms get depends on which opioid you took, how much and for how long. Two people stopping the same drug can have quite different weeks.

Symptoms from fentanyl are the same in kind, though many people find they come on faster.

Withdrawal is not only physical. For many people the mental symptoms are harder to sit through than the cramps.

Anxiety and restlessness

You may feel on edge, unable to settle, pacing or shifting in bed. This often starts early and can be at its worst at night.

Low mood

Feeling flat, hopeless or tearful is common during withdrawal and in the weeks after. SAMHSA notes that anxiety, depression and sleep problems can last for weeks or months after opioid withdrawal.

Cravings

Your body knows that one dose would end the misery, and it reminds you constantly. A craving is a symptom, the same as a cramp. It says nothing about your character.

If low mood or cravings carry on after the physical symptoms have gone, read about post-acute withdrawal.

Most withdrawal symptoms are miserable without being dangerous. A few are warning signs. Get medical help the same day, or go to an emergency room, if you notice any of these:

• You cannot keep fluids down. Ongoing vomiting and diarrhea can cause dehydration and upset the balance of salts in your body.
• Signs of dehydration. Dizziness when you stand, a very dry mouth, confusion, a racing heart, or passing very little urine.
• Trouble breathing or chest pain. Vomit breathed into the lungs can cause a lung infection.
• You are pregnant. The CDC says quickly stopping opioids in pregnancy is not recommended because of the risk to the pregnancy.
• You have another serious health condition. Withdrawal puts extra strain on a body that is already unwell.
• Thoughts of suicide or self-harm. Call or text 988 at any hour.

Call 911 if someone is not breathing or cannot be woken. That is not withdrawal. It may be an overdose, and it can happen when someone returns to use after their tolerance has dropped. Learn the signs on the overdose risk page.

People often feel they should tough it out. There is no medal for that, and there is a real cost.

Untreated symptoms are a common reason people go back to opioids partway through. Going back after a few days without is when overdose risk rises, because tolerance has already started to fall.

A prescriber can treat withdrawal directly with buprenorphine or methadone, or ease individual symptoms with medicines such as lofexidine or clonidine. The page on easing withdrawal symptoms explains what each option does.

If you are not sure where to start, SAMHSA’s National Helpline at 1-800-662-4357 gives free, confidential referrals around the clock. You can also search the treatment directory for providers in your state.

For how all the pieces fit together, go back to the main guide to opiate withdrawal.