Opioid addiction, whether from prescription medications, heroin, or powerful synthetic drugs like fentanyl, is one of the most difficult challenges to overcome. One reason many people struggle to quit is opioid withdrawal, a process that can feel absolutely unbearable without support.
In this article, we’ll break down the physical and emotional symptoms of opioid withdrawal, explain the timeline of what to expect, and highlight how Medication-Assisted Treatment (MAT) can provide relief and a path toward recovery.
What Causes Opioid Withdrawal?
Opioid withdrawal happens when someone who is dependent on opioids suddenly stops or reduces their use.
Opioids, like fentanyl, heroin, or oxycodone, bind to receptors in your brain that regulate pain, pleasure, and other functions. Over time, your brain becomes more dependent on opioids to function normally.
When you stop using opioids, your brain goes into overdrive, triggering a wide range of withdrawal symptoms as it attempts to restore balance. These symptoms can vary in severity depending on the drug, dosage, and length of use.
Recognizing Opioid Withdrawal Symptoms
Opioid withdrawal can feel like the worst flu you’ve ever had, amplified by intense emotional and physical cravings.
Here’s what to watch for.
Physical Symptoms
- Flu-like symptoms: Runny nose, watery eyes, and yawning.
- Sweating and chills: Sudden hot or cold flashes that leave you drenched or shivering.
- Muscle aches: Severe pain or cramping, especially in the legs and back.
- Nausea and vomiting: Digestive distress, including diarrhea and stomach pain.
- Rapid heart rate and high blood pressure: Caused by the body’s heightened state of alertness.
Emotional and Psychological Symptoms
- Severe cravings: A powerful, almost uncontrollable urge to use opioids again.
- Anxiety and irritability: Restlessness, panic, or agitation.
- Depression: Feeling hopeless, sad, or detached.
- Insomnia: Difficulty sleeping, often with fatigue and restlessness.
These emotional and psychological opioid withdrawal symptoms can be overwhelming, but they’re a normal response to withdrawal. You can manage them with the proper treatment, too. But first, let’s see a rough timeline of opioid withdrawal symptoms.
The Opioid Withdrawal Timeline: What to Expect
As we learned before, opioid withdrawal can be an intense and distressing experience, both physically and emotionally.
For many, the process feels like a severe case of the flu but with the added challenge of overwhelming cravings and emotional turmoil.
Understanding the timeline of opioid withdrawal symptoms can help you or a loved one prepare for what’s ahead—and highlight why professional support is so crucial during this time.
Stage 1: Early Withdrawal Symptoms (6–24 Hours After Last Dose)
Withdrawal symptoms often begin as soon as opioids start leaving the body. This happens within 6 to 24 hours of the last dose, depending on the type of opioid used. Short-acting opioids like heroin tend to trigger symptoms faster than long-acting drugs like fentanyl patches or methadone.
Common Early Symptoms of Opioid Withdrawal:
- Muscle aches and joint pain (often one of the first signs).
- Restlessness and anxiety.
- Sweating and chills.
- Runny nose and excessive yawning.
- Trouble sleeping or insomnia.
These early opioid withdrawal symptoms, though uncomfortable, signal the start of the detox process. Without opioids, your brain begins adjusting to the lack of these substances that previously helped suppress pain signals and other natural body functions.
Stage 2: Peak Withdrawal Symptoms (24–72 Hours After Last Dose)
The next stage is often the most intense.
Symptoms peak within 2 to 3 days and may feel overwhelming for individuals detoxing from opioids. This is the stage of withdrawal that leads many to relapse without proper support.
Common Peak Symptoms of Opioid Withdrawal:
- Nausea, vomiting, diarrhea, and abdominal cramps.
- Rapid heartbeat and high blood pressure.
- Dilated pupils and blurry vision.
- Severe sweating and chills (“cold turkey”).
- Intense cravings for opioids.
- Mood swings, including irritability, depression, or anger.
During this stage, the body is trying to “reset” itself after being dependent on opioids to regulate pain and emotions.
For example, diarrhea and sweating occur because opioids slow down the digestive system and other autonomic functions, and withdrawal causes those systems to suddenly go into overdrive.
Stage 3: Late Withdrawal Symptoms (4–10 Days After Last Dose)
As acute symptoms begin to subside, emotional and mental symptoms may become more pronounced.
By day 4 to day 10, physical discomfort may lessen, but individuals often feel exhausted, emotionally unstable, and overwhelmed.
Common Late Symptoms of Opioid Withdrawal:
- Persistent fatigue and muscle weakness.
- Depression, anxiety, or feelings of hopelessness.
- Cravings that come and go.
- Trouble sleeping or vivid, unsettling dreams.
While the worst of the physical symptoms are usually over by this stage, the psychological toll remains significant. Emotional symptoms are a result of the brain struggling to regulate dopamine and serotonin levels without opioids.
Stage 4: Post-Acute Withdrawal Symptoms (PAWS)
For many, withdrawal doesn’t end after the first 10 days.
Post-Acute Withdrawal Syndrome (PAWS) refers to lingering emotional and psychological symptoms that can persist for weeks or even months after quitting opioids.
Common PAWS Symptoms:
- Difficulty concentrating or “brain fog.”
- Mood swings and irritability.
- Sleep disturbances or insomnia.
- Persistent cravings, especially in stressful situations.
While PAWS isn’t as physically intense as earlier stages, it can be one of the most challenging recovery phases. Many people relapse during this time because they believe they’ve already gotten through the worst.
Why Professional Support Is Essential During Opioid Withdrawal
Opioid withdrawal is more than just uncomfortable—it can be dangerous if you don’t manage it properly.
Severe dehydration, complications from underlying health conditions, and the intense mental strain of withdrawal all highlight the importance of seeking medical guidance.
One of the most effective tools for managing withdrawal is Medication-Assisted Treatment (MAT). Medications like Suboxone (buprenorphine/naloxone) can:
- Ease physical symptoms like nausea and pain.
- Reduce cravings by partially activating opioid receptors.
- Prevent relapse by blocking the euphoric effects of opioids.
At QuickMD, we offer fast, affordable access to MAT with same-day telemedicine appointments. Our experienced providers can help create a personalized treatment plan, ensuring you or your loved one can detox safely and comfortably.
Withdrawal Symptoms by Drug Type: Fentanyl, Heroin, and Prescription Opioids
While all opioids can cause withdrawal, the symptoms and severity can vary depending on the specific drug. Factors like potency, how long the drug stays in the body, and how frequently it’s used all play a role.
Here’s a breakdown of what withdrawal looks like for fentanyl, heroin, and prescription opioids and why some drugs cause more intense symptoms than others.
Fentanyl Withdrawal Symptoms
Fentanyl is one of the most potent opioids available, and withdrawal from it can be particularly severe. Because fentanyl is so much stronger than morphine and acts quickly, it leads to a higher risk of dependency and a more intense withdrawal process.
Common Symptoms of Fentanyl Withdrawal:
- Extreme restlessness and agitation.
- Rapid heartbeat and profuse sweating.
- Severe muscle aches and joint pain.
- Persistent nausea, vomiting, and diarrhea.
- Difficulty sleeping and extreme fatigue.
What Makes Fentanyl Withdrawal Unique?
Fentanyl’s short half-life—meaning how quickly it leaves the body—causes withdrawal symptoms to set in faster, often within 6–12 hours after the last dose. However, the intensity of symptoms may be greater because the brain becomes highly dependent on fentanyl’s potent effects.
As you now know, many people describe fentanyl withdrawal as feeling like the “worst flu of their life” combined with uncontrollable cravings.
Heroin Withdrawal Symptoms
Heroin is a short-acting opioid, meaning withdrawal symptoms tend to develop quickly, usually within 6–12 hours of the last dose. While heroin withdrawal isn’t life-threatening, it can feel unbearable without proper treatment, leading many to relapse just to stop the symptoms.
Common Symptoms of Heroin Withdrawal:
- Severe muscle cramping and body aches.
- Watery eyes and runny nose.
- Nausea, vomiting, and abdominal cramping.
- Intense cravings for heroin.
- Anxiety, depression, and feelings of hopelessness.
What Makes Heroin Withdrawal Unique?
Heroin’s rapid onset and short duration create a rollercoaster effect, where the brain cycles between euphoria and withdrawal more frequently. This constant up-and-down can make cravings particularly strong during withdrawal.
Additionally, the psychological symptoms, such as anxiety and restlessness, are often more severe or pronounced compared to prescription opioids.
Prescription Opioid Withdrawal Symptoms
Prescription opioids, such as oxycodone (OxyContin), hydrocodone (Vicodin), or morphine, often manage pain.
While these medications can be safe with a doctor’s guidance, long-term use or misuse can lead to dependency and withdrawal symptoms similar to those of heroin or fentanyl.
Common Symptoms of Prescription Opioid Withdrawal:
- Flu-like symptoms: chills, sweating, and fever.
- Generalized body pain and muscle aches.
- Digestive issues, including nausea, vomiting, and diarrhea.
- Insomnia and difficulty concentrating.
- Mood swings, anxiety, and irritability.
What Makes Prescription Opioid Withdrawal Unique?
The timeline and intensity of withdrawal symptoms depend on the specific medication. For example:
- Short-acting opioids like hydrocodone or oxycodone may cause symptoms within 8–12 hours of the last dose.
- Long-acting opioids like methadone or extended-release formulations may take up to 36 hours before symptoms begin.
The perception of safety around prescription opioids often leads to unintentional dependency. Many people don’t realize they’re at risk until they try to stop and experience withdrawal.
Why Does Withdrawal Vary by Drug Type?
- Potency and Half-Life:
Fentanyl’s extreme potency and short half-life cause faster, more severe withdrawal compared to drugs like methadone, which has a longer half-life and more gradual symptoms. - Frequency and Duration of Use:
Someone using heroin multiple times a day will likely experience withdrawal differently than someone taking a single dose of a prescription opioid daily. - Illicit vs. Prescription Use:
Illicit drugs like heroin and fentanyl often come with additional risks, such as unknown dosages and contaminants, which can intensify withdrawal symptoms.
Understanding these differences is essential for tailoring treatment plans to each individual’s needs.
The Role of Medication-Assisted Treatment (MAT)
Withdrawal symptoms, regardless of the opioid type, can be debilitating and difficult to manage alone.
That’s where Medication-Assisted Treatment (MAT) comes in. MAT combines FDA-approved medications with counseling and behavioral therapy to ease withdrawal symptoms and support recovery.
How MAT Helps
- Suboxone (Buprenorphine/Naloxone): Reduces cravings and withdrawal symptoms by partially activating opioid receptors without creating a high.
- Methadone: A long-acting opioid that prevents withdrawal while reducing cravings over time.
- Naltrexone: Blocks opioid receptors entirely, preventing relapse by stopping the euphoric effects of opioids.
At QuickMD, we offer same-day access to MAT through telemedicine appointments. Our experienced providers can prescribe medications like Suboxone, which can help stabilize your body and mind during the withdrawal process—all from the comfort of your home.
Moving Forward: Seeking Support for Opioid Withdrawal
Whether it’s fentanyl, heroin, or prescription opioids, withdrawal is one of the most challenging parts of overcoming addiction. But it’s also the first step toward recovery.
With professional treatment, medication-assisted therapy, and a strong support system, you or your loved one can safely navigate the withdrawal process and begin the journey to a healthier life.
If you’re ready to take that step, QuickMD is here to help. Schedule a confidential telemedicine consultation today to connect with compassionate addiction treatment providers. Visit our addiction treatment page to learn more.
Recovery is hard, but it’s possible—and it starts with reaching out.
