How long does it take to get over opiate withdrawal? The time period involved to completely recover from opiate withdrawal depends on a number of factors: The individual, the opioid or opiate involved, the dose taken and length of time it was taken and whether or not the withdrawal is medication-assisted. Technically, an opiate is a narcotic substance naturally present in the opium poppy and directly derived from it. Two examples would be morphine and codeine. An opioid is s drug with narcotic effects, such as analgesia, sedation and euphoria, that may or may not be derived from the opium poppy. Some opioids are completely synthetic; others are semi-synthetic or natural.
Buprenorphine, oxycodone and hydrocodone are semi-synthetic, created by altering the natural opium alkaloid thebaine. Methadone and fentanyl are examples of synthetic opioids. Neither one is derived from the opium plant and both are made in a lab from chemical building blocks called precursors. Kratom is a good example of a natural opioid not derived from opium but still having dose-related narcotic effects. Kratom is a tree in the coffee family native to Southeast Asia. Its leaves yield the partial agonist opioids mitragynine and 7-hydroxymitragynine.
This article will use the term opioid or opioids to discuss opiate withdrawal. This will cover the withdrawal process collectively, regardless of the actual opioid substance used. Although some withdrawal symptoms may not be experienced by everyone and others can vary, there is still a predictable syndrome produced by unmedicated opioid withdrawal:
- Flu-like symptoms
- Cold sweats and feeling hot and cold
- Severe stomach pain
- Muscle and bone pain
- Depression and extreme fatigue
- Drug cravings
- Restless leg syndrome
Opioid Withdrawal Timeline
The onset of the withdrawal symptoms can vary because some opioids are longer-acting than others. Generally speaking, except for methadone and buprenorphine, which can take several days for symptoms to appear, withdrawal symptoms will first appear about 12 to 18 hours after the last dose. Heroin’s withdrawal may begin sooner than that, perhaps as soon as 6 hours. This is probably because it’s shorter-acting than most opioids.
Symptoms start in because the opioid molecules are dropping off the brain’s opioid receptors, the mu, the delta and the kappa receptors. The brain has become used to these receptors being occupied by the opioid drug of choice and can no longer function normally without the presence of the opioid. For example, the brain has grown extra receptors and stopped production of its own natural opioids called endorphins. The experience of withdrawal is all about the brain struggling to regain normal function.
The withdrawal process typically begins with anxiety and drug cravings. Cravings for sugar may also be present, and these can persist throughout and beyond other symptoms. Anorexia appears, nausea sets in and severe stomach pain starts. Vomiting may begin at this point, followed by diarrhea so severe that dehydration can occur. Back, head and body pain may be present. Insomnia begins almost immediately and will typically be one of the very last symptoms to subside. In fact, sleep disturbances from opioid withdrawal can persist for months.
As the syndrome progresses, restless leg syndrome, usually much worse at night, can become so severe that even sitting still is impossible. Diarrhea and insomnia rob the person of any other kind of rest. Medication for anxiety may help to ease some symptoms, but tranquilizers will not ease the misery of opioid withdrawal, which has only three remedies: Medication, more opioids or time.
The Timeline Continues
Unmedicated opioid withdrawal follows these rough estimated times:
- Acute withdrawal: seven to ten days
- Easing of most symptoms: seven days to two weeks
- Continuation of some symptoms: two to six weeks
- PAWS: some symptoms may be experienced for many months
PAWS stands for post-acute withdrawal syndrome. This generally means that extreme fatigue, insomnia and restless leg syndrome can persist for up to a year, although it’s more typically limited to about 90 days after acute withdrawal has ended. Not everyone will get PAWS.
It’s possible with get through opioid withdrawal without all the misery with Suboxone. It will ease withdrawal symptoms, and can be slowly withdrawn over time if the person wishes to be drug-free.