When people talk about opioid withdrawal, they are usually referring to “acute” withdrawal – the most severe withdrawal period of a few days after discontinuing opioids. However, some individuals experienced a “protracted” withdrawal characterized by less severe, chronic symptoms for the first few weeks or even months after discontinuing opioids.
For short-acting opioids, acute withdrawal typically takes 2 to 7 days. For long-acting opioids, this typically takes 5-14 days. These timelines vary significantly between individuals and are affected by the duration of use, dosage used, and specific type of opioid used.
Do Detox Times Vary by Opioid?
Yes, detox timelines vary depending on the opioid one takes. The most relevant factor is usually whether the drug is a short-acting opioid, which includes drugs like heroin and fentanyl, or a long-acting opioid, like methadone. These terms refer to the half-life of a given opioid. An opioid that takes longer to break down in the body is considered long acting, and one that spends less time in the body is considered short acting.
For short-acting opioids, withdrawal will typically begin between 8 and 24 hours of last use. The acute withdrawal phase, which is the type of withdrawal most people mean when they use the term withdrawal (where withdrawal symptoms are most intense) can be expected to last 2 to 7 days.
For long-acting opioids, withdrawal will typically begin somewhere between 12 and 48 hours after last use. The acute withdrawal phase will generally last much longer than with short-acting opioids, taking between 10 and 20 days to resolve.
“Acute” withdrawal is often followed by a protracted withdrawal phase that can last up to six months. This type of withdrawal is generally much less severe than that seen with the acute withdrawal phase.
During protracted withdrawal, a person will feel generally unwell and experience strong opioid cravings, but they will typically be able to function enough to perform important activities like work and go to school. However, because one will experience opioid cravings, it’s important to seek continued addiction treatment during this period to avoid relapse.
What Is the difference between withdrawal (dependence) and addiction?
Withdrawal occurs as the result of physical dependence on opioids, which is different but related to opioid use disorder. Drugs like opioids can cause changes to the brain over time with repeated use, with the brain adjusting to their presence. Opioids hijack reward circuitry in the brain over time. The brain becomes accustomed to the constant presence of opioids.  When opioids are abruptly discontinued, this causes a withdrawal syndrome.
Importantly, someone can be physically dependent on a drug, and thus go through withdrawal if they don’t take it regularly, even if they aren’t “addicted” to that drug. With opioids, this is often seen with people who are prescribed opioids to treat pain if they take them for a long period, even if they only take their drugs exactly as prescribed.
To be “addicted” to a drug, a person has to have behavior changes related to the way they use that drug. For example, using more of the drug than prescribed, spending lots of time thinking about their next dose, or even engaging in illicit activity to obtain more of the drug.
Factors That Impact the Length of Detoxing From Opioids
A few factors impact how long a person can expect withdrawal symptoms to last. The first is how long a person has been using opioids and how heavily they tend to use them. Generally speaking, a person who has been using opioids for a longer period at higher doses will have a longer period of withdrawal with more severe symptoms than one who engages in lighter use or for a shorter period of time.
Some factors that are less understood include a person’s genetics and general biology. Some people may experience longer or shorter periods of withdrawal compared to other individuals who otherwise engaged in identical amounts of opioid use. This may be due simply due to biologic or genetic differences between individuals and can be hard to predict.
How to Detox From Opioids
It’s best to first talk to a doctor or addiction treatment professional before trying to detox from opioids. These professionals can explain what to expect and the best way to detox from opioids for your situation.
If you have only been using opioids as medically prescribed for a sustained period, your doctor may prescribe a tapering schedule where you gradually reduce your dosage. If you have been misusing opioids, an addiction treatment professional may recommend medication assisted treatment (MAT).
While it is generally safe (albeit, unpleasant) to go “cold turkey” and discontinue opioids abruptly, it can have some disadvantages. First, it is well established that patients who attempt to discontinue opioids “cold turkey” have higher rates of relapse than those who either wean slowly or those who utilize evidence based treatments such as MAT. If you are at all concerned about returning to opioid use, it is best to speak to a medical professional or addiction specialist. They can help prepare you to stop opioid slowly (tapering) or even to use medications (MAT) to help with withdrawal and cravings.
Alternatives to Consider
These days, gold standard opioid addiction treatment is a combination of talk therapy like cognitive behavioral therapy and MAT options like methadone or Suboxone. Use of MAT either during the acute withdrawal period or even long term helps to treat symptoms and avoid the risk of relapse/return to use.
MAT has been shown to improve treatment outcomes, helping people to stay in addiction treatment and to increase the benefits they receive from that treatment. While no treatment option is right for every individual, most people suffering from OUD will benefit from MAT over simply the “cold turkey” detox approach.
There is a large and growing body of evidence supporting the use of these treatments, and telemedicine options make MAT more accessible and convenient than ever before.
If you’re unsure about whether this type of treatment is right for you but are interested, reach out to us here at Bicycle Health. We’re ready to answer any questions you have.
Medically Reviewed By Elena Hill, MD, MPH
Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More
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