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A Timeline Of Opiate Withdrawal

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 26, 2019

Withdrawaling from opiates can be a difficult and even painful process, but it does not last forever. If an individual can make it through the withdrawal process, then they stand a better chance for a long-term recovery.

Opiate withdrawal is an incredibly painful situation that the American Society of Addiction Medicine estimates drives 1.9 million Americans into addiction. However, it is important to understand that opiate withdrawal does not have an infinite timestamp: it has an obvious timeline and endpoint. And while it may be extremely difficult to weather, reaching the finish line can help you live a life free of opiate addiction.

The Stages Of Acute Opiate Withdrawal

Acute opiate withdrawal is the period during which your body will suffer from severe to mild mental and physical pain. There are three distinct stages of opiate withdrawal, with the most painful occurring over the first three to five days. The severity of the first stage is the primary influence on relapse.

The second stage usually lasts for two weeks and is milder. That isn’t to say it will be easy, but the worst part of the process is usually done. The third stage is often ignored, but it shouldn’t be: it can last several months and, in some ways, may be the most difficult stage to overcome.

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The First Stage

When you first quit taking opiates, the onset of first-stage symptoms will vary, depending on the type of opiate used. Severe opiates, such as heroin, cause withdrawal symptoms as quickly as 12 hours after your last use. Less severe opiates, like methadone, cause withdrawal symptoms after about 30 hours.

Your withdrawal symptoms will be at their most severe in the first stage. You may suffer from heavy flu-like symptoms, including an extreme fever and even hallucinations. Other symptoms, such as nausea, vomiting, diarrhea, and abdominal cramps are also likely.

First-stage symptoms are so severe because your body will have stopped creating endorphins, due to the natural euphoric effect caused by opiate use. Once your body is clean of opiates, that euphoric feeling disappears and your body will struggle to fill the gap with its own production.

Thankfully, the first stage will last no longer than five to six days and attending a professional detox service can help you work through this difficult process. For many people recovering from opiate addiction, getting first stage help may be the only step necessary.

The Second Stage

After working your way through the first stage, your body will have regained much of its natural balance. It should start naturally creating endorphins, which will stabilize your mood. It will also help naturally kill much of the physical pain you are feeling after the initial detoxification period.

However, your body still isn’t quite back to a stable state. It will still occasionally crave opiates and may react in negative ways to their absence. Common second-stage withdrawal symptoms include:

  • Continued depression
  • Less severe fever
  • Sudden chills
  • Cramps primarily focused in your legs
  • Goosebumps
  • Fear or paranoia
  • Dilated pupils
  • Clammy hands

Although the severity of these symptoms isn’t as problematic for most people, they may still cause a relapse. Thankfully, detox centers often have inpatient and outpatient rehabilitation services. If you find yourself struggling during the second stage, check yourself into one right away.

The Third Stage

After the second stage, your withdrawal symptoms will decrease in severity. Any type of physical pain should have subsided or become easier to handle. However, you aren’t quite out of the dark yet: you still have to get through the third stage.

Thankfully, this stage is the least severe, but it still causes mental and psychological problems, such as anxiety and insomnia. These symptoms can last as long as two months, a lengthy period that often makes the third stage the most difficult for many people.

However, once you get through this stage, you are likely going to feel balanced and “normal.” Rehabilitation care during this stage often focuses on aftercare procedures, such as getting acclimated to a return to your everyday activities and learning how to avoid relapses.

The Potential Dangers Of Protracted Withdrawal

While acute opiate withdrawal is generally done after the third stage, there is still the chance that you may suffer from “protracted withdrawal.” Protracted withdrawal is defined by SAMHSA as symptoms that mirror those felt during the early stages of acute withdrawal.

While your withdrawal symptoms during this phase aren’t likely to be as severe as the initial pain of withdrawal, they can still be troubling. Typical protracted withdrawal symptoms include:

  • Irritability
  • Sudden depression
  • Fatigue
  • Lack of energy
  • Poor sleep patterns
  • Trouble focusing

Treat these symptoms by utilizing any medicines prescribed to you by your doctor. Commonly, these symptoms are treated by the short- to long-term use of anti-depressant and anti-anxiety medicines.

Reaching Out For The Help You Deserve

Opiate withdrawal is a difficult and even dangerous process for people to do alone. Getting help in a detoxification and rehabilitation center can help ensure you stay safe and healthy during this difficult process. If you need help finding a center, please contact us at We can help you find someone to help you get through the difficult stages of opiate withdrawal.

View “A Timeline Of Opiate Withdrawal” Infographic

A Timeline Of Opiate Withdrawal Infographic

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