Important: Medical Supervision Strongly Recommended
- •While opioid withdrawal is rarely life-threatening, it can be extremely uncomfortable
- •Medical supervision provides medication that significantly reduces discomfort and cravings
- •Severe dehydration from vomiting and diarrhea can occur without proper care
- •Post-detox overdose risk is HIGH due to reduced tolerance - this is when most overdoses happen
- •Medication-Assisted Treatment (MAT) dramatically improves success rates and saves lives
Understanding Opioid Withdrawal
When someone who has developed physical dependence on opioids stops or significantly reduces their use, their body goes through withdrawal. This happens because the brain has adapted to the presence of opioids and needs time to return to normal functioning.
Opioid withdrawal is often described as feeling like "the worst flu you've ever had." While the symptoms are very uncomfortable and challenging, they are rarely medically dangerous for otherwise healthy individuals. However, medical supervision is still strongly recommended because:
- Medications can dramatically reduce discomfort and cravings
- Medical staff can prevent and treat dehydration
- Professional support reduces the risk of relapse
- Medication-Assisted Treatment (MAT) improves long-term outcomes
- The risk of overdose is highest immediately after detox due to reduced tolerance
Withdrawal Timeline: Fast-Acting Opioids
Examples: Heroin, fentanyl, oxycodone (Percocet, OxyContin), hydrocodone (Vicodin, Norco), immediate-release morphine
Fast-Acting Opioid Withdrawal Timeline
Withdrawal Begins (Fast-Acting Opioids)
moderate- Anxiety and restlessness
- Muscle aches beginning
- Watery eyes and runny nose
- Yawning and sweating
- Early cravings
For heroin, fentanyl, oxycodone, hydrocodone, immediate-release morphine
Peak Symptoms (Fast-Acting)
severe- Intense muscle and bone pain
- Severe nausea, vomiting, diarrhea
- Hot and cold flashes
- Goosebumps and chills
- Elevated heart rate and blood pressure
- Severe insomnia
- Intense drug cravings
- Agitation and irritability
This is when symptoms are most uncomfortable. Medical support and MAT can significantly reduce discomfort.
Acute Symptoms Resolve
mild- Physical symptoms gradually improve
- Fatigue and low energy
- Mood swings
- Continued cravings
- Sleep disturbances
Withdrawal Timeline: Long-Acting Opioids
Examples: Methadone, extended-release morphine, extended-release oxycodone, fentanyl patches
Long-Acting Opioid Withdrawal Timeline
Delayed Onset (Long-Acting Opioids)
mild- Mild anxiety
- Early muscle aches
- Restlessness beginning
- Yawning and sweating
For methadone, extended-release formulations. Symptoms develop more slowly.
Peak Symptoms (Long-Acting)
severe- Severe muscle and joint pain
- Nausea, vomiting, diarrhea
- Sweating and chills
- Insomnia
- Elevated heart rate
- Intense cravings
- Irritability and agitation
Extended Withdrawal Period
moderate- Lingering physical discomfort
- Fatigue
- Mood disturbances
- Sleep problems
- Continued cravings
Long-acting opioids have extended withdrawal periods. Professional support is important throughout.
Complete List of Withdrawal Symptoms
Physical Symptoms
- •Muscle, bone, and joint aches
- •Headaches
- •Hot and cold flashes
- •Excessive sweating
- •Goosebumps ("cold turkey")
- •Chills and shaking
- •Dilated pupils
- •Runny nose and watery eyes
- •Sneezing and yawning
- •Nausea and vomiting
- •Diarrhea and abdominal cramping
- •Elevated heart rate
- •Increased blood pressure
Psychological Symptoms
- •Intense anxiety
- •Severe agitation
- •Irritability
- •Restlessness
- •Insomnia and disturbed sleep
- •Intense cravings for opioids
- •Poor concentration and focus
- •Mood swings
- •Depression
Note: Psychological symptoms can be just as challenging as physical ones. This is why comprehensive care that addresses both is essential.
Critical: High Overdose Risk After Detox
The period immediately after detox is when overdose risk is HIGHEST. This is the most dangerous time.
Why this happens: During detoxification, your body's tolerance to opioids decreases rapidly. If you relapse and use the same dose you were using before detox, it can cause a fatal overdose.
Essential Overdose Prevention:
- •Have naloxone (Narcan) readily available
- •Tell family and friends where naloxone is kept and how to use it
- •Never use alone - always have someone present
- •Consider continuing on medication-assisted treatment (buprenorphine or methadone)
- •Have a strong relapse prevention plan in place
Ready to Find Treatment?
Medication-Assisted Treatment (MAT) with medical supervision dramatically improves outcomes. Find facilities that offer comprehensive opioid treatment.
Medication-Assisted Treatment (MAT): The Gold Standard
Why MAT Is Essential
Medication-Assisted Treatment (MAT) is the most effective, evidence-based approach for opioid use disorder. Research consistently shows that MAT:
- ✓Dramatically reduces withdrawal discomfort
- ✓Reduces cravings and relapse risk
- ✓Decreases fatal overdose risk by 50% or more
- ✓Improves retention in treatment programs
- ✓Allows you to rebuild your life while managing opioid use disorder
Buprenorphine (Suboxone®, Zubsolv®)
How It Works:
- •Partial opioid agonist - activates opioid receptors partially
- •Eases withdrawal symptoms without producing a "high"
- •Reduces cravings significantly
- •Blocks other opioids from producing effects (ceiling effect)
- •Often combined with naloxone to prevent misuse
Benefits:
- ✓Can be prescribed by certified physicians in office settings
- ✓Take-home medication (no daily clinic visits required)
- ✓Lower risk of respiratory depression than full opioids
- ✓Lower potential for misuse
- ✓Can be used short-term or long-term
- ✓Dramatically reduces overdose risk
Methadone
How It Works:
- •Full opioid agonist - completely activates opioid receptors
- •Eliminates withdrawal symptoms
- •Prevents cravings
- •Long-acting - lasts 24-36 hours
- •Blocks euphoric effects of other opioids
Important Notes:
- ✓Must be dispensed at certified opioid treatment programs (OTPs)
- ✓Typically requires daily clinic visits initially
- ✓Take-home doses possible after stability is established
- ✓Highly effective - decades of research supporting use
- ✓Excellent for severe opioid use disorder
- ✓Significantly reduces overdose deaths
| Feature | Buprenorphine | Methadone |
|---|---|---|
| Type | Partial agonist | Full agonist |
| Prescription | Office-based (certified doctors) | Certified clinics (OTPs) only |
| Take-Home | Yes, from day 1 | After earning privileges |
| Overdose Risk | Lower (ceiling effect) | Moderate (full agonist) |
| Best For | Mild-moderate OUD, privacy, flexibility | Severe OUD, structured support |
| Effectiveness | Excellent | Excellent |
Additional Medications for Symptom Management
Along with MAT, other medications can help manage specific withdrawal symptoms:
Clonidine / Lofexidine
For physical symptoms:
- • Sweating
- • Rapid heartbeat
- • High blood pressure
- • Stomach cramps
For Insomnia
- • Trazodone
- • Doxepin
- • Mirtazapine
For Nausea/Vomiting
- • Metoclopramide
- • Ondansetron
- • Anti-nausea medications
For Diarrhea
- • Loperamide
- • OTC anti-diarrheal
For Pain
- • Acetaminophen (Tylenol)
- • Ibuprofen
- • Other NSAIDs
For Anxiety
- • Non-addictive anti-anxiety meds
- • Diazepam (controlled settings)
Where Should Detox Happen?
Inpatient Detoxification
Recommended for:
- •Heavy, long-term opioid use
- •Previous failed detox attempts
- •Co-occurring medical conditions
- •Co-occurring mental health disorders
- •Lack of stable home environment
- •High risk of relapse
- •Use of multiple substances
Features:
- ✓ 24/7 medical supervision
- ✓ Medication management
- ✓ Structured environment
- ✓ Immediate intervention if needed
- ✓ Comprehensive support services
Outpatient Detoxification
May be appropriate for:
- •Mild to moderate opioid dependence
- •Stable, supportive home environment
- •Strong support system
- •High motivation for recovery
- •No serious co-occurring conditions
Features:
- ✓ Regular medical check-ins
- ✓ Buprenorphine prescription management
- ✓ Maintain work/family responsibilities
- ✓ Lower cost than inpatient
- ✓ Counseling and support groups
Beyond Detox: Long-Term Treatment
Important: Detoxification alone is often not sufficient for long-term recovery.
Opioid use disorder is a chronic condition, similar to diabetes or hypertension. It requires ongoing management. Research shows that continuing on medication-assisted treatment and engaging in behavioral therapies dramatically improve long-term outcomes.
Medication for Opioid Use Disorder (MOUD)
Many people benefit from staying on MAT long-term:
Buprenorphine
Long-term maintenance, taken daily, reduces relapse risk by over 50%
Methadone
Long-term maintenance, highly effective for severe OUD
Naltrexone (Vivitrol®)
Monthly injection, blocks opioid effects, requires full detox first
Behavioral Therapies
Cognitive Behavioral Therapy (CBT)
Identifies and changes negative thought patterns and behaviors related to drug use
Contingency Management (CM)
Provides tangible rewards for positive behaviors like staying drug-free
Motivational Interviewing (MI)
Enhances motivation for change and commitment to treatment
Dialectical Behavior Therapy (DBT)
Teaches emotional regulation and distress tolerance skills
Support Groups and Community
Medication-Assisted Recovery Groups
Support groups specifically for those on MAT
Celebrate Recovery
Faith-based recovery support program
Frequently Asked Questions
Is opioid withdrawal dangerous?
While opioid withdrawal is rarely life-threatening for otherwise healthy individuals, it can be extremely uncomfortable and complications can occur. Severe dehydration from vomiting and diarrhea, aspiration of vomit, and cardiac issues (in those with heart conditions) are possible. The biggest danger is the high risk of fatal overdose if someone relapses after detox due to reduced tolerance. Medical supervision is strongly recommended.
Isn't MAT just replacing one drug with another?
No. This is a common misconception. Medications like buprenorphine and methadone are prescribed at stable doses that eliminate cravings and withdrawal without producing a "high." They allow people to function normally, hold jobs, maintain relationships, and rebuild their lives. MAT is evidence-based medicine—the same way insulin treats diabetes or blood pressure medication treats hypertension. Research consistently shows MAT saves lives and improves outcomes far better than detox alone.
How long does opioid withdrawal last?
It depends on the type of opioid. Fast-acting opioids (heroin, fentanyl, oxycodone) cause withdrawal symptoms that start within 8-24 hours, peak at 1-3 days, and last 4-10 days. Long-acting opioids (methadone, extended-release formulations) have symptoms that start up to 36 hours after the last dose, peak at 4-7 days, and can last 2-4 weeks or longer. With MAT, withdrawal symptoms are significantly reduced or eliminated.
Will insurance cover opioid detox and MAT?
Most insurance plans cover medically necessary opioid detoxification and medication-assisted treatment under the Mental Health Parity and Addiction Equity Act. Coverage specifics depend on your plan, deductible, and whether the facility is in-network. The facility's admissions team can verify your benefits. Our directory helps you find in-network facilities that accept your insurance.
Can I detox from opioids at home?
While it's physically possible, it's not recommended. "Cold turkey" opioid withdrawal is extremely uncomfortable and rarely successful long-term. Medical supervision provides medications that reduce discomfort, prevent complications, and dramatically improve success rates. Additionally, starting MAT during detox sets you up for long-term recovery. If inpatient isn't possible, outpatient medical detox with buprenorphine is a safer alternative to attempting it alone.
What's the difference between buprenorphine and methadone?
Both are highly effective for opioid use disorder, but they work differently. Buprenorphine is a partial opioid agonist with a "ceiling effect," making it safer and available through office-based prescriptions. Methadone is a full agonist that must be dispensed at certified clinics. Buprenorphine offers more flexibility and privacy, while methadone programs provide more structure. Both reduce overdose risk by over 50% and improve long-term recovery outcomes. The best choice depends on individual circumstances.
Ready to Find Treatment?
If you or a loved one needs help with opioids, finding the right treatment facility is an important next step.
Medical Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with qualified healthcare professionals before making decisions about opioid detoxification or treatment. If you are experiencing a medical emergency, call 911 immediately.
Sources: Content based on research from the National Institute on Drug Abuse (NIDA), Substance Abuse and Mental Health Services Administration (SAMHSA), and peer-reviewed medical literature.
Last Updated: January 2026