The Three Stages of Opiate Withdrawal – Opioid Withdrawal Timeline

Individuals who abuse opioids such as heroin and prescription pain pills will find themselves in withdrawal when they try to discontinue using the the drug. They will experience the 3 stages of the opioid withdrawal timeline: the “acute” stage, the “peak” stage, and the “psychological stage”.

What Is An Opiate/Opioid?

An opiate is the term used to reference the original drugs derived from the opium poppy plant. While the term opioid is used to reference derivatives of opiates, made to be less habit forming. In the newest definition, opioid is now used to refer to the whole family of narcotic drugs including the illegal form, heroin.

Examples of opioid drugs include:

  • Oxycodone (OxyContin or Percocet)
  • Hydrocodone (Vicodin)
  • Hydromorphone (Dilaudid)
  • Codeine
  • Fentanyl
  • Methadone
  • Meperidine (Demerol)
  • Morphine
  • Heroin

This class of drug, typically prescribed to relieve and manage pain, can have serious addictive consequences. Opioids influence the body’s central nervous system to change the way pain is perceived and cause a euphoric effect.

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What Causes Opioid Withdrawal?

After as little as two weeks of abuse, the body can build up a tolerance to the effects opioids have. This causes the brain to think that it needs larger and larger doses of the drug to produce the same effect as the initial, smaller, dose. This tolerance can eventually lead to structural changes in the brain that can impact a person who may be trying to break their addiction to opioids.

In general, opioid withdrawal can be broken down into three main stages. Once an individual has completed all three stages of withdrawal there is significantly less of a chance for them to relapse and become addicted to opioids once more.

Once someone begins to lessen the dose or stop taking opioids altogether, withdrawal symptoms can start within as little as two hours of the last dose. Though opioid withdrawal isn’t considered to be life-threatening, it is extremely painful and difficult to accomplish by yourself.

Inpatient treatment for opioid addiction may be a good option for someone wanting a lasting separation from their addiction. This type of treatment ensures the highest likelihood of success to those looking to reclaim control of their lives from opioid addiction.

The Stages And Symptoms Of Opioid Withdrawal

Opioid withdrawal can be generalized into three stages. Individual withdrawal will be dependant on what substances were taken — whether they were short-acting, long-acting, or illegal type opioids, and the length of time they were abused.

Opioid withdrawal symptoms can range from mild to severe, depending on the level of dependence the person suffers from.

An individual’s level of dependence on opioids is influenced by:

  • The amount of time abusing the drug
  • Which opioid was abused
  • How large a dose was abused
  • Co-occurring mental health issues
  • Underlying medical conditions
  • Family history with drug dependence
  • Previous traumas
  • Lack of supportive networks

First Phase Of Opioid Withdrawal: Acute Withdrawal

The first phase of opioid withdrawal, also known as acute withdrawal, takes place anywhere from two to 24 hours from the last dose of opioids. It produces symptoms that often first come to mind when thinking about opioid withdrawal.

These symptoms can include:

  • Agitation
  • Watery eyes
  • Flu-like symptoms i.e. runny nose, chills, excessive sweating, and sore muscles
  • Frequent yawning
  • Nausea and vomiting

Second Stage Of Opioid Withdrawal: The “Peak” Stage

The second phase of opioid withdrawal occurs as the body tries to regain homeostasis after acute withdrawal. This stage is also known as the “peak” stage. It occurs between 48 to 72 hours after the last dose of opioids and is when symptoms are at their worst.

As the body works to be rid of all of the chemicals left behind by the abused opioid, it is common to experience:

  • Goosebumps on the skin
  • Cramping in large muscle groups, such as the abdomen
  • Diarrhea
  • Rapid heartbeat
  • High blood pressure
  • Dilated pupils and blurry vision
  • Mild, moderate, or extreme drug cravings

This second stage of “rebalancing” can last for up to two weeks but, typically, these uncomfortable symptoms will begin to subside within 72 hours.

Third Stage Of Opioid Withdrawal: The “Psychological” Stage

The third stage of opioid withdrawal is mostly psychological. This stage can last anywhere from a week to two months. In some cases, people who abused opioids for a long time report that, even though they have been clean for years, they still experience some of the following symptoms.

The symptoms experienced in the third stage of withdrawal can include:

  • Anxiety and depression
  • Restlessness
  • Insomnia

Though this is not the most painful stage of recovery, it is often the time when people in the process of recovering experience relapse. This is due to the extremely fragile mental state this stage produces. Many feel that, to escape the symptoms of this stage, returning to their opioid addiction is the only way to feel normal again.

It is important to note, again, that withdrawal symptoms are specific to the individual and the above list is not inclusive of all the symptoms that may occur. It is possible to experience symptoms not found in this article, which is why it is so important to consult a health professional when going through opioid withdrawal.

Opioid Withdrawal Complications

Opioid withdrawal symptoms can last for a wide range of time. In most cases, these symptoms are experienced for four to 10 days. However, if withdrawing from an extended release opioid, symptoms can last up to 21 days or even longer.

During the initial stage of withdrawal when diarrhea and vomiting are experienced, many people can suffer from loss of fluids and electrolytes. This loss can make the following stage of rebalancing more difficult. Additionally, severe diarrhea can cause irregularities in heartbeat, which can produce circulatory problems and possibly result in heart attack.

It is also possible to inhale vomit and other stomach content into the lungs during the initial stages of opioid withdrawal. This is medically known as aspiration, and can be a serious complication if it goes unnoticed. Aspiration can develop into pneumonia, which shows similar symptoms to that of opioid withdrawal, making it difficult to diagnose, if no one knows to look for it.

However, the largest complication of opioid withdrawal is returning to drug misuse. Most deadly overdoses occur in people who just gone through detox. Because withdrawal reduces a person’s tolerance to opioids, a much smaller dose could be toxic to a person who is used to taking more than recommended.

Treating Opioid Withdrawal

The research from the National Institute on Drug Abuse has provided significant evidence, over the last two decades, indicating that a high-quality, opioid addiction, treatment plan must address the following:

  • Medications such as buprenorphine (Suboxone), clonidine, and more
  • Behavioral interventions
  • Infectious disease identification and treatment
  • Screening and treatment of co-morbid psychiatric diseases
  • Overdose protection (naloxone)

Currently, there are very few places, aside from inpatient treatment facilities, that offer all of these components in conjunction with each other.

Withdrawing from opioids can be an unpleasant experience. In fact, many people choose to stay physically dependant on opioids in order to avoid going through withdrawal. This is why medication-assisted treatment (MAT), performed in an controlled environment is perhaps the best way to pursue opioid withdrawal.

A few of the approved medicines used in MAT include, Suboxone (buprenorphine), and Methadone. These medications are extended-release opioids that provide a low, consistent, dose of opioid chemicals to the receptors in the brain. This helps reduce the symptoms of withdrawal and craving for the desired opioid. These medications are far less likely to become addictive because they enter the brain at a slower rate.

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MAT have also begun to include the use of various therapy types for a holistic treatment process. This ensures that both medical and mental needs of the person undergoing treatment are met in a meaningful way. Some of the therapies provided in a treatment center could include:

  • Cognitive-behavioral therapy – therapy based on the feelings, thoughts, and beliefs about the substance and its effects on the individual.
  • Motivational interviewing – Is used to find what would motivate a person to change and go through recovery.
  • Contingency management – provides tangible rewards for remaining drug-free, and recovery-oriented to disway further use of the drug
  • Family therapy – works to educate family members regarding substance and use issues and improve relationships with the individual in recovery and their family

Medication-assisted treatment is found to be most effective when it is applied in this larger context. Opioid dependence and addiction are chronic medical disorders, and recurrences can happen. Long-term treatment is the most viable option to limit adverse effects of addiction and improve an individuals day-to-day life.


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