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Opiate withdrawal timeline

A day-by-day look at what usually happens after the last dose, and how the clock differs for heroin, pain pills and methadone.

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Updated October 2026. Sources are linked on this page.

Illustration of a person resting on a sofa under a green blanket, with a friend sitting nearby

The short answer

When it starts
Usually 8 to 24 hours after the last dose of a short-acting opioid, and 12 to 48 hours after methadone.
When it peaks
For heroin, the worst symptoms tend to come between 24 and 48 hours after the last dose.
When it eases
Short-acting opioids take about 4 to 10 days in all; methadone can take 10 to 20 days.

What decides how fast withdrawal moves

The clock is set mainly by how quickly the opioid leaves your body. Heroin and immediate-release pills such as oxycodone are short-acting. Methadone is long-acting.

World Health Organization clinical guidelines give these ranges. With short-acting opioids, symptoms begin 8 to 24 hours after the last dose and last 4 to 10 days. With long-acting opioids such as methadone, they begin 12 to 48 hours after the last dose and last 10 to 20 days.

MedlinePlus gives a similar picture: symptoms usually start within 12 hours of the last heroin dose and within 30 hours of the last methadone dose.

These are ranges, not promises. How much you have been taking, for how long, and your general health all move the numbers. For the bigger picture, start with the guide to opiate withdrawal.

The four stages after a short-acting opioid


  1. Hours 8 to 24: it begins

    Anxiety, yawning, runny nose, watery eyes, sweating and aching muscles.


  2. Days 1 to 3: the peak

    Cramps, nausea, vomiting, diarrhea, goosebumps and very little sleep.


  3. Days 4 to 10: it eases

    Physical symptoms fade a little each day. Tiredness and low mood linger.


  4. The weeks after

    Sleep, mood and cravings settle slowly. Tolerance is now much lower.

The second stage is the hardest. The National Institute on Drug Abuse (NIDA) says major heroin withdrawal symptoms peak 24 to 48 hours after the last dose and subside after about a week.

The stages blend into each other. Many people have one good hour followed by a bad one, especially at night. For what each symptom is and which ones need a doctor, see withdrawal symptoms.

How the timeline changes with methadone

Methadone stays in the body much longer than heroin or oxycodone. That is what makes it useful as a treatment, and it also stretches withdrawal out.

Symptoms tend to start later, around 12 to 48 hours after the last dose. They build more slowly and can go on for 10 to 20 days.

People often describe it as less sharp but more wearing. The long run of poor sleep and low energy is what grinds people down.

If you take methadone or buprenorphine as treatment, please do not stop it on your own. Stopping suddenly brings withdrawal and a high risk of returning to use. If you want to come off, your prescriber can plan it with you.

Why your own experience may not match the chart

Published timelines were built around heroin, pain pills and methadone. Real life is messier.

  • Fentanyl. Researchers think fentanyl can build up in body fat with regular use and leave slowly, so timing is less predictable. See fentanyl withdrawal.
  • Extended-release pills. Tablets designed to release slowly can behave more like a long-acting opioid, so withdrawal may start later and last longer.
  • What is really in the supply. Street drugs are often mixed. NIDA notes that fentanyl is commonly mixed with heroin and other drugs, and people often do not know.
  • Your health. Other illnesses, poor nutrition and lack of sleep can make each stage feel longer.

If you are on day 6 and still feel terrible, that does not mean something has gone wrong. It may mean your timeline is at the longer end, and it is a good reason to ask a clinician for help.

How treatment shortens the hard part

The timeline above describes withdrawal with no medical help. With treatment, it looks very different.

Buprenorphine and methadone relieve withdrawal symptoms and cravings. Non-opioid medicines such as lofexidine or clonidine can ease symptoms for people who are stopping opioids altogether.

A prescriber decides which fits you and when to start. The page on what eases withdrawal explains the options, and medication treatment covers staying on them longer term.

You can look for a provider in your state through the treatment directory.

What to know once the last stage is over

Finishing withdrawal feels like the finish line. Medically, it is the riskiest point.

Your tolerance has fallen, so the amount you used before can now cause an overdose. WHO guidelines advise that everyone who has withdrawn from opioids be told about this risk.

Keep naloxone where you and the people around you can reach it. Call 911 if someone is not breathing or cannot be woken.

Sleep problems, low mood and cravings can continue for weeks or months. That stretch is covered in post-acute withdrawal.

For a crisis or thoughts of suicide, call or text 988. SAMHSA’s National Helpline, 1-800-662-4357, offers free referrals 24 hours a day.

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Questions people ask us

What day of opiate withdrawal is the worst?

For short-acting opioids such as heroin, the worst symptoms usually come between 24 and 48 hours after the last dose, which is day two or three for most people. With methadone the peak arrives later and is more drawn out. Medical treatment can blunt the peak considerably.

How long until I feel normal again?

The main physical symptoms of short-acting opioid withdrawal usually pass in 4 to 10 days. Feeling like yourself takes longer. Sleep, energy and mood often take weeks or months to settle. That slower stretch is common and does not mean you are doing anything wrong.

Does withdrawal from pain pills follow the same timeline as heroin?

Broadly, yes, for immediate-release pills such as oxycodone or hydrocodone. They are short-acting, so symptoms tend to start 8 to 24 hours after the last dose and last 4 to 10 days. Extended-release tablets leave the body more slowly, so withdrawal may begin later.

Can I speed up withdrawal?

There is no safe way to make your body clear opioids faster. What you can change is how hard it feels and how safe it is. Medicines from a prescriber relieve symptoms, and medically supervised detox adds monitoring and fluids if you need them.

Sources

This page is general information, not medical advice. Talk with a clinician about your own situation.

Need help right now?

Someone is not breathing: call 911 Crisis or thoughts of suicide: call or text 988 Free treatment referral, 24/7: 1-800-662-4357 (SAMHSA National Helpline)