Timeline for Opioid Withdrawal: The Three Stages of Withdrawal Explained

M.M., a 24-year-old man, was involved in a car accident three years ago and had a significant whiplash injury.

12/23/20226 min read

M.M., a 24-year-old man, was involved in a car accident three years ago and had a significant whiplash injury. To address his neck discomfort, his doctor recommended oxycodone for several months. M.M began getting oxycodone "on the street" after his doctor unexpectedly withdrew the medicine.

He discovered that it not only relieved his pain but also boosted his mood, and he'd "pop a pill" whenever he felt down or anxious. He switched to heroin (laced with fentanyl) since it was less expensive than oxycodone and allowed him to feel the effects sooner. M.M. went over 12 hours without heroin after calling his normal dealer and being unable to reach him. He began to feel awful—shaky, anxious, his muscles began to ache, and his nose began to run.

J.R., a 56-year-old man, recently injured his back at work while lifting cement blocks. For the agony, his doctor prescribed Vicodin. J.R.'s back discomfort worsened once he returned to work and resumed heavy lifting, so he began taking extra medications for a few days in a row. He ran out of vicodin early toward the end of the month, and after a few days without it, he began to feel nauseated, vomiting, going to the bathroom with diarrhea, and experiencing severe stomach cramps.

L.D. is a 42-year-old post-office worker who is married with two young children. She has been in recovery for almost ten years and takes buprenorphine/naloxone (Suboxone) every day to help her feel "normal" so she can work and care for her children. Her family chose to go camping during her children's spring vacation.

Her backpack was flung open while she was setting up camp, spilling her prescriptions, including her buprenorphine/naloxone (Suboxone). Two days later, as her family prepared to leave, she began to have flu-like symptoms, including body aches, chills with "gooseflesh" skin, and nausea. These people were all going through drug withdrawal.

What Exactly is Opioid Withdrawal and Why Does it Occur?

Opioid withdrawal is a normal physiological process that can happen to anyone whose body has become accustomed to having opiates in their bloodstream at all times of the day. Consider this: suppose that you have neurological opioid receptors all over your body.

Most people's opioid receptors are triggered on occasion when they do something nice, such as eat a piece of cake, have sex, or go for a run and get a 'runner's high.' Again, for the most part, these receptors are devoid of information and are only activated on rare occasions.

However, if you take an opioid like oxycodone or illicit opioids like fentanyl every day for more than 5 days, your body becomes accustomed to having your opioid receptors stimulated all of the time.

If you stop taking opioids suddenly or lose access to them, your brain's opioid receptors become "naked," and you experience the polar opposite of that happy/"high" feeling, which is known as opioid withdrawal. Body aches, chills, GI symptoms such stomach cramps, nausea, vomiting, diarrhea, and anxiety and tremulousness are all common symptoms of opiate withdrawal, according to patients.

Opioid Withdrawal Symptoms
  • Restlessness
  • a lot of yawning

  • Pupils that are bigger

  • a stuffy nose

  • Aches in the body

  • Tremors/twitching

  • Sweating or chills

  • Are you worried or irritable?

  • Your skin has "goose pimples" on it.

  • Constipation, nausea, vomiting, or diarrhea

How Quickly Can You Experience Opioid Withdrawal?

The duration of opioid withdrawal symptoms is determined on the type of opioid used. Some opioids have a shorter half-life and hence leave the body sooner, causing opioid withdrawal symptoms to appear sooner. Others have a longer half-life, causing opioid withdrawal to develop later. How soon after the last opioid dose was taken might withdrawal symptoms appear: Heroin, Percocet, Oxycodone, Vicodin, and Dilaudid are examples of short-acting opioids.

  • 10 to 12 hours later
    Fentanyl, Oxycontin, MS Contin are examples of long-acting opioids.

  • After a 24-hour period
    Methadone is an opioid with a very long half-life.

  • 48-72 hours later

Is it Dangerous to Stop Using Opioids?
"Opioid withdrawal is clearly UNCOMFORTABLE— no one loves to feel like they have the flu," says Dr. Brian Clear, Chief Medical Officer of Suboxone Clinic, a tele-health firm that helps patients with opioid addiction by offering evidence-based MAT (medication for addiction treatment). However, it is not lethal.

Opioid withdrawal will not kill patients." Additionally, it is required to go through a brief period of opioid withdrawal in order to begin life-saving opioid addiction treatments such as buprenorphine/naloxone (Suboxone), methadone, and naltrexone (AKA Vivitrol). If your body is acclimated to taking oxycodone or fentanyl, for example, you should wait until you experience withdrawal symptoms before starting therapy medications. If you start taking treatment medications (like Suboxone) too soon, you may have precipitated withdrawal, which is a faster, more severe form of withdrawal.

Dr. Clear describes how Suboxone clinic uses these ideas to help patients get started on buprenorphine/naloxone (Suboxone). "When you come to Suboxone clinic to start Suboxone, we ask you what was the last opioid you took and when you took it. We utilize this information to predict when you will experience withdrawal symptoms. We'll start you on Suboxone once you've had at least three of these symptoms, which will help you feel better." Many individuals are anxious about the time period between taking their final opioid and initiating opioid addiction treatment.

So, what are the options? Doctors frequently prescribe "comfort" drugs to assist patients cope with symptoms such as anxiety, nausea and vomiting, diarrhea, stomach cramps, and body pains during the withdrawal period. Dr. Clear discusses how Suboxone clinic employs Clinical Support Specialists to assist patients who are beginning buprenorphine/naloxone treatment (Suboxone). "When patients are getting ready to start Suboxone and are having withdrawal symptoms, our team is available to make sure they're doing good, understand the plan made with their practitioner, and are on track to a successful start."

Is it Really Worth It to Go Through This?

Certainly! We know that abstinence-only regimens are ineffective for the majority of patients. This implies that if someone wants to detox and get off opioids like oxycodone and fentanyl but does not start medication for opioid addiction therapy, their chances of relapsing and dying from an overdose are quite high—up to 90% of patients will relapse after 3 months of not taking medication.

Read more about the typical myths about treatment to discover more about the effectiveness of drugs to treat opioid addiction. Dr. Clear discusses the several advantages of beginning opioid addiction treatment with drugs. "Here at Suboxone clinic, we've seen outstanding rates of success, and we know they're consistent with national trends, indicating that one month after starting buprenorphine, 97 percent of patients are still taking their medications, and six months later, 56 percent of patients are still taking their medications."

That implies people stay in recovery for considerably longer than if they detoxed first and then started buprenorphine."

Is There a Chance of Relapse?

Patients frequently inquire if they must take opioid addiction treatment drugs such as buprenorphine/naloxone (Suboxone) for the rest of their life. "We know that stopping these medications puts you at a high risk of relapse." I tell my patients that if things are going well for them—they're working, fulfilling their responsibilities, developing meaningful relationships with their friends and family, and taking better care of their health—like going to doctor's appointments, getting back into exercising, and eating healthy—no there's rush or need to get off these medications."

But What if I Decide to Leave? What's the Best Way to Taper?

Because buprenorphine/naloxone (Suboxone) is a partial opioid agonist, which means it only partially stimulates opioid receptors, discontinuing it too quickly can result in opioid withdrawal symptoms. "Of course, if patients absolutely want to be off Suboxone, we work with them to properly taper off these drugs, but it takes a long time—usually at least 6 months—and is generally not recommended."

Patients who want to get off buprenorphine/naloxone (Suboxone) should construct a long-term plan with their prescribing doctors. This entails a moderate tapering approach with frequent check-ins to determine how the tapering process is reducing withdrawal symptoms. Dr. Clear also recommends using this "checklist" to determine whether or not a patient is ready.

"The more questions you can honestly say 'YES,' the more likely you are to be able to go off Suboxone and maintain your recovery," he continues. Consider that each 'NO' response signifies an area where you will most likely need to improve in order to have a successful taper and recovery."

  1. Have you stopped using illegal substances like heroin/fentanyl, cocaine, or speed?

  2. Do you believe you can deal with difficult situations without the use of drugs?

  3. Do you have a job or are you enrolled in school?

  4. Are you avoiding touch with users and engaging in illicit activities?

  5. Have you gotten rid of your "job" or "outfit"?

  6. Are you comfortable in a neighborhood where there aren't many drugs?

  7. Do you have a healthy family relationship?

  8. Do you get out with folks that aren't users?

  9. Do you have any friends or family members who could assist you with a taper?

  10. Have you gone to any counseling sessions that have been beneficial to you?

  11. Is your counselor confident that you're ready to taper?

Dr. Clear emphasizes the need of assisting patients who are addicted to opioids. "We know this is a life-long condition, and people who use scientifically-proven therapy drugs like Suboxone do well in recovery. "There's no need to rush, and I normally advise against going off Suboxone due to the significant risk of relapse."