When you stop using an opiate or reduce the drug abruptly, you can get mild to severe withdrawal symptoms and signs lasting three to fourteen days. The onset and duration of the opiate withdrawal syndrome depends, in part, on how long your drug of choice affects your body after a dose, and the level of your physical dependence on it, according to Psychiatric Clinical Pathways.
Short Acting Opiates
Short acting opiates, such as heroin, morphine, and Vicodin (hydrocodone/acetaminophan), affect you for a shorter time after a dose than longer acting opiates, such as Oxycontin (oxycodone) or methadone. Withdrawal signs and symptoms begin six to eight hours after the last dose and get worse during the first three days, after which they lessen and subside by the end of about seven days.
According to the 2010 Massachusetts General Hospital Psychopharmacology and Neurotherapeutics, signs and symptoms during the first day of acute withdrawal of an opiate include:
- Irritability and restlessness
- Shakiness, hot and cold sweats, and goosebumps
- Runny nose, watery eyes, and dilated pupils
- Faster breathing and yawning
- Loss of appetite
- Drug craving
Days Two to Three
If untreated, during days two to three, the early symptoms of opiate withdrawal can worsen and more severe ones appear, including:
- Increased heart rate
- High blood pressure
Joint and muscle aches
- Nausea and vomiting
- Difficulty sleeping
Days Four to Seven
Symptoms, which peak by day three, begin to lessen by day four and subside by day seven. After that, your feelings of physical distress will continue to improve in the weeks and months following the last dose of your opiate.
Post Day Seven Resolution
After day seven, as your body readapts to being without your opiate of choice and the hormones that lead to physical dependence return to normal, the signs and symptoms of opiate withdrawal resolve. If you stay off your drug, you may still have a level of psychological dependence on it and crave it for weeks, months, or years later. This is because of the changes opiates imprint on your brain, according to the National Institute on Drug Abuse.
Longer Acting Opiates
Longer acting opiates affect you for more hours after the last dose than the shorter acting ones. The withdrawal signs and symptoms start later and last longer. For example:
- Oxycontin withdrawal signs and symptoms start eight to twelve hours after the last dose and last 10 to 14 days.
- For methadone, an even longer acting opiate, the withdrawal begins in one to three days, may persist for two to four weeks, and is milder.
The withdrawal signs and symptoms are the same as those of the shorter acting opiates. Day one symptoms may be similar in severity, but they will peak and then subside on a slower time course.
Tracking the Signs and Symptoms
Health care providers in various types of drug addiction treatment programs can use a documentation tool, such as the Clinical Opiate Withdrawal Scale (COWS), to document the daily progression of the opiate withdrawal signs and symptoms. You can download the COWS tool to track your withdrawal symptoms.
Drugs Can Help Opiate Withdrawal
According to the National Institutes of Health, drugs such as clonidine, methadone, and buprenorphine can decrease the severity of the withdrawal symptoms and shorten the duration. They make symptoms less distressing and easier to cope with than withdrawing cold turkey. Seek professional help if you find it difficult to manage opiate withdrawal on your own.