If you are thinking about quitting opioids or you have already stopped and still feel horrible, what you are experiencing doesn’t come from physical weakness or a weak will. What you are feeling is called opioid withdrawal symptoms. These symptoms show up when your body is used to opioids and you try to cut back or stop. At New Chapter Recovery in New Jersey, our dual diagnosis treatment center uses a combination of evidence-based therapy and medical intervention so patients can transition safely from early or severe symptoms into a state of recovery.
In this guide, we will walk through what opioid withdrawal is, the symptoms you can expect, how long it usually lasts, and how dangerous it can be. We will give you the facts about opioid addiction withdrawal, why it feels like the worst flu of your life with a mental strain on top, and what real treatment and support look like. You will see what opioid withdrawal treatment options exist, from medical detox and medication-assisted treatment to simple day-to-day coping tools you can use at home. We will also look at how doctors measure opioid withdrawal signs with diagnostic tools like the Clinical Opiate Withdrawal Scale (COWS) and why mental health issues and addiction often show up together.
Quick Takeaways
- Opioid withdrawal symptoms are a natural reaction when a dependent body and brain lose their supply of opioids, and are a significant challenge for your recovery, not to be taken lightly.
- Physical symptoms often mimic a severe flu plus stomach illness, while emotional symptoms can include anxiety, depression, and intense cravings.
- Typical timelines run 3 to 10 days for acute withdrawal, with longer-acting opioids causing a slower onset and longer duration.
- Opioid withdrawal is not often fatal on its own, but severe complications and relapse can be life-threatening without medical support.
- Tools like COWS help clinicians measure severity and guide opioid withdrawal treatment.
- Medications such as methadone, buprenorphine, and clonidine can significantly reduce opioid withdrawal manifestations and support long-term recovery.
- You do not have to do opioid detox alone; integrated addiction treatment and mental health care can dramatically improve outcomes for co-occurring disorders.
What Opioid Withdrawal Really Is
Opioid withdrawal happens when your body has gotten used to a certain level of opioids and you suddenly lower the dose or stop. This term includes withdrawals from street drugs like heroin and fentanyl, as well as prescription opioids like oxycodone, hydrocodone, morphine, codeine, and others.
Symptoms from the withdrawal process are exceedingly common. According to a 2020 study published by the International Society of Addiction Journal Editors, 85% of those injecting opioids experienced opioid withdrawal within the past 6 months, and 35% of the study group reported experiencing it on a weekly basis.
When taking opioids regularly over a period of time, your brain changes how it works as the opioids redirect pain signals in your central nervous system. It adjusts its own natural pain and reward systems to match the constant presence of opioid medicines. When those drugs disappear, your nervous system swings in the opposite direction. The result is a rush of symptoms of opioid withdrawal that can affect every part of your body.
What is going on inside you during withdrawal:
- Your brain’s opioid receptors are no longer getting the usual hit, so your body reacts with pain, anxiety, and cravings.
- Your autonomic nervous system goes into overdrive, leading to sweating, goosebumps, a racing heart, and gut issues.
- Your mood chemicals shift, which can trigger depression, panic, irritability, and insomnia.
- Many people who use opioids regularly, even when they started on prescription opioids for pain relief, will develop some level of physical dependence. That means withdrawal symptoms show up if you stop suddenly, even if you are not “using to get high.”
Opioid withdrawal symptoms are not proof that you are weak and beyond help. Opioids are powerful drugs that rewire your body whether you want them to or not. The same brain that adapted to opioids can adapt back over time, especially when you have good medical and emotional support.
Opioid Withdrawal Symptoms You Can Expect After Stopping Opioid Use
When people describe opioid withdrawal, you will often hear it described as “the worst flu in my life” combined with intense mental and emotional distress. That is a pretty accurate description of opioid withdrawal manifestations. The exact pattern depends on which opioid you used, how long and how heavily you used, your health condition, and whether other drugs are involved.
Physical Opioid Withdrawal Manifestations
Common physical withdrawal symptoms include:
- Muscle aches and joint pain
- Back pain and bone pain
- Sweating, hot and cold flashes, goosebumps
- Runny nose, watery eyes, constant yawning
- Nausea, vomiting, and diarrhea
- Stomach cramps and abdominal pain
- Dilated pupils and sensitivity to light
- Increased heart rate and higher blood pressure
- Tremors and restlessness
- Fatigue and weakness
These early symptoms of opioid withdrawal can start mildly, then ramp up to the point where even lying still feels impossible. You may not be able to keep food down. You might switch between chills and sweating through sheets in the same hour. It can be miserable, but in most healthy adults, it is often not life-threatening on its own when properly managed.
Emotional and Cognitive Withdrawal Symptoms From Opioid Medicines
The emotional side of opioid addiction withdrawal often hits just as hard:
- Anxiety and panic
- Irritability and anger at everyone around you
- Depression, hopelessness, or feeling emotionally numb
- Intense cravings that feel like they are screaming in your head
- Insomnia or only short bursts of shallow sleep
- Difficulty concentrating and racing thoughts
If you already live with a mental health condition like depression, anxiety, or PTSD, these emotional symptoms can feel supercharged. Many people in recovery also have what is called a dual diagnosis, meaning both a substance use disorder and a mental health disorder at the same time. Treating both is crucial for long-term recovery to ensure they don’t feed negatively into one another and make things worse.
Opioid Withdrawal Timeline and Stages
One of the biggest fears is not knowing how long opioid withdrawal will last. While every situation is different, doctors observe common patterns that can be extrapolated for typical timelines. Short or fast-acting opioids like heroin or immediate-release oxycodone usually trigger withdrawal within 6 to 12 hours after the last dose. Long-acting opioids like methadone can take 24 to 48 hours or more before symptoms kick in.
Here is a typical opioid withdrawal timeline for short-acting opioids after the last time you used:
| Stage | Time after last dose | Typical opioid withdrawal symptoms |
|---|---|---|
| Early stage | 6 to 24 hours | Anxiety, cravings, yawning, runny nose, sweating, mild aches |
| Peak stage | 24 to 72 hours | Severe muscle pain, vomiting, diarrhea, chills, insomnia, strong cravings |
| Late stage | 3 to 10 days | Gradual easing of physical symptoms, lingering insomnia, low mood, fatigue |
| Post acute phase (PAWS) | Weeks to months | Intermittent cravings, sleep issues, mood swings, low energy |
For many people, the worst physical withdrawal symptoms ease after 3 to 5 days, though you may still feel wiped out and emotionally raw for weeks.
Long-acting opioids shift the timeline, extending the progression of symptoms over 10-20 days. Symptoms start later, peak later, and can last longer. That is why tapering slowly or using medication-assisted treatment is often recommended for methadone or high-dose prescription opioids.
What surprises many people is the post-acute or “aftershock” phase. Even after opioid detox, you might struggle with sleep, mood, and motivation for months. This does not mean withdrawal never ends. It means your brain is still healing and needs time, support, and often ongoing addiction treatment.
How Dangerous is Opioid Withdrawal Syndrome?
A common and very real fear you may be wondering about is: Can you die from opioid withdrawal? Medical researchers and addiction specialists believe that opioid withdrawal itself is not often directly fatal in otherwise healthy adults. However, it can become life-threatening when severe vomiting and diarrhea lead to dehydration, electrolyte problems, or heart complications, especially in people with other medical issues.
Serious risks during opioid withdrawal include:
- Severe dehydration from constant vomiting and diarrhea
- Electrolyte imbalances that can affect heart rhythm
- Worsening of conditions like heart disease or uncontrolled blood pressure
- Suicidal thoughts or self-harm in the middle of intense emotional pain
- Return to heavy opioid use and overdose after your tolerance drops
This is why getting treatment for specific symptoms and not going it alone is the best course. A 2020 study published by the National Institutes of Health found that mortality was substantially reduced for those undergoing a medically managed opioid withdrawal or a residential treatment program.
Deaths from opioid withdrawal have been reported in jails and other settings where people are forced to stop opioids without proper medical care. These deaths are considered preventable when basic monitoring, fluids, and medications are used.
So, can you die from opioid withdrawal? Yes, you shouldn’t underestimate the possibility, but it’s rare when detox is supervised and complications are treated quickly. The bigger danger is often relapse and overdose once your tolerance is lower and you are out of a program. A 2019 study found that opioid addicts face the highest risk of an overdose after ending treatment, even if staying in treatment for as long as 18 months. That is why starting medication for opioid use disorder during or right after detox can literally save lives.
Red flag signs that mean you need emergency care:
- You cannot keep any fluids down for 24 hours
- You are dizzy, confused or passing out
- You have chest pain or severe shortness of breath
- You are thinking about hurting yourself or not wanting to live
Diagnosing Severity and Opioid Withdrawal Signs Clinicians Watch
When you show up at a clinic, detox center, or emergency department, staff will not just eyeball you and guess. They often use a tool called the Clinical Opiate Withdrawal Scale (COWS) to rate how severe your opioid withdrawal symptoms are.
Clinical Opiate Withdrawal Scale (COWS)
COWS is an 11-item checklist that scores symptoms like:
- Resting heart rate
- Sweating
- Restlessness
- Pupil size
- Bone or joint aches
- Runny nose or tearing
- Gastrointestinal upset
- Tremor
- Yawning
- Anxiety or irritability
- Gooseflesh skin
Each item gets a score that adds up to a total that places you in categories such as mild, moderate, moderately severe, or severe opioid withdrawal.
| Score | Rating |
| 5-12 | Mild |
| 13-24 | Moderate |
| 25-36 | Moderately Severe |
| 36+ | Severe Withdrawal |
This criterion helps healthcare providers guide decisions such as when to start buprenorphine or how much comfort medication to give you. Understanding this can make the process less mysterious. If your provider waits to start buprenorphine until your COWS score is high enough, it is not to torture you. It is to avoid triggering precipitated withdrawal by giving buprenorphine too early.
When Symptoms of Opioid Withdrawal Mask Other Problems
Clinicians also watch for opioid withdrawal signs that overlap with other conditions. Anxiety, sweating, high heart rate, and stomach issues could be withdrawal, but they can also signal infection, heart problems, or other serious issues.
If you have a dual diagnosis, where mental health disorders and substance use disorders occur together, it can be even harder to untangle what is what. For example:
- Is your panic due to withdrawal, an anxiety disorder, or both?
- Are nightmares from PTSD, opioid detox, or both?
- Is your low mood a temporary crash or a major depressive episode?
Good care means your opioid use, withdrawal symptoms, and mental health are all evaluated together rather than in separate boxes, making it rarely life-threatening, even if you are physically dependent on opioids.
Opioid Withdrawal Addiction Treatment and Opioid Detox Options
You do not earn extra credit, status, or recovery points by suffering alone. The safest and most effective path is usually some form of medically supervised opioid detox combined with ongoing addiction treatment and comprehensive care while your body adjusts to withdrawal.
Medications That Ease Opioid Addiction Withdrawal
Evidence-based medications for opioid withdrawal treatment and long-term care include methadone, buprenorphine, and naltrexone. These are often the medications called upon for treating opioid use disorder and opioid dependence. They help by stabilizing your brain chemistry, reducing cravings, and preventing the roller coaster of intoxication and withdrawal.
During acute withdrawal and opioid detox, doctors may use:
- Buprenorphine or methadone to relieve withdrawal symptoms and transition into maintenance treatment
- Alpha 2 agonists like clonidine or lofexidine to ease anxiety, sweating, hot flashes, and rapid heart rate
- Anti-nausea drugs for vomiting
- Antidiarrheal medications
- Non opioid pain relievers for aches
Medication-assisted treatment (MAT) is not just about “replacing one drug with another.” Instead, it is a a directed treatment option that aims to replace chaotic drug use with a steady, controlled dose of a medication that reduces harm and supports your recovery. Many people stay on these medications long-term and rebuild their lives as they gradually reduce their dependence on opioid pain medicines.
What To Expect in Medical Opioid Detox
A typical medically supervised detox program for opioid dependent patients will:
- Take a full history of your opioid use and other drugs.
- Check your vital signs, labs, and any urgent medical problems.
- Use the Clinical Opiate Withdrawal Scale to track your symptoms over time.
- Start you on a tailored plan that may include buprenorphine, methadone, or comfort meds.
- Offer mental health support, counseling, and planning for next steps.
Good programs also begin talking early about long-term addiction treatment, such as outpatient counseling, residential rehab, peer support groups, and ongoing medication. Opioid withdrawal treatment is just the first step. The goal is not just to get detoxed for a few weeks; you need to find ways to reduce pain and work on sustainable habits that will keep you clean.
Coping Day to Day With Opioid Withdrawal Symptoms
Even with medical support, you are still stuck with your own body and mind, and it isn’t always easy to handle. There are some practical things you can do to help you manage opioid withdrawal symptoms so they feel more manageable.
Practical Self-Care Tips
None of these replace professional, medically informed care, but many people in recovery find them helpful during opioid addiction withdrawal:
- Hydration: Sip water, electrolyte drinks, or clear broths often to fight dehydration from vomiting and diarrhea
- Light food: Try simple foods like toast, crackers, bananas, rice, or soup if you can tolerate them
- Temperature control: Use layers of clothing and blankets you can take on and off easily when hot and cold flashes hit
- Gentle movement: Short walks or stretching can ease muscle aches and restlessness when you feel up to it
- Sleep hygiene: Even if you cannot sleep, keep lights low, limit screens, and create a calm space to lie down
Over-the-counter meds, used with guidance, can also help with muscle aches, diarrhea, and nausea. Always check with your clinician first if you have other health conditions or are taking other medicines.
Building Support so You Are Not Doing This Alone
Opioid withdrawal symptoms can convince you that you should isolate. Try to do the opposite, and build a strong support system to support you after you have made it through the worst parts of withdrawal.
Helpful sources of support include:
- A trusted friend or family member who knows what you are doing and can check on you
- Peer support groups where people understand opioid withdrawal manifestations from lived experience
- Telehealth or in-person therapy focused on addiction and mental health.
- Resources like the Substance Abuse and Mental Health Services Administration’s (SAMHSA) support group finder.
Because many people with opioid use disorder also live with depression, anxiety or trauma, it is important to ask for a full mental health assessment, not just detox for the worst parts of it. Long-term healing and aftercare usually mean addressing both the substance and the emotional pain underneath.
FAQs About Opioid Withdrawal Symptoms
How soon do opioid withdrawal symptoms start after my last dose?
For short-acting opioids like heroin or immediate-release oxycodone, opioid withdrawal symptoms often start within 6 to 12 hours of the last dose. Long-acting opioids like methadone or extended-release pills may take 24 to 48 hours or more to trigger symptoms. This timing affects when doctors start medications like buprenorphine for opioid detox.
What are the withdrawal symptoms associated with opioids?
Opioid withdrawal symptoms usually feel like a rough case of the flu mixed with intense anxiety. Common signs include muscle aches, stomach cramps, nausea, vomiting, diarrhea, sweating, chills, runny nose, watery eyes, yawning, insomnia, irritability, and intense cravings. Many people also experience anxiety, restlessness, and low mood.
What are the worst opioid withdrawal manifestations to expect?
Many say the worst parts of opioid addiction withdrawal are the combination of severe muscle and bone pain, stomach cramps, vomiting, diarrhea, nonstop sweating, intense anxiety, and cravings that will not shut off. These can feel overwhelming, which is why medically supervised detox and comfort medications are strongly recommended.
Can I detox from opioids at home safely?
Some people manage mild withdrawal symptoms at home with support, but it can be risky, especially if you have health conditions or a history of heavy use. Severe dehydration, heart issues, or mental health crises can develop quickly. It is safer to speak with a clinician about opioid withdrawal treatment options, including outpatient or inpatient medical detox.
What medication is used for opioid withdrawal?
Medications commonly used for opioid withdrawal include buprenorphine and methadone, which reduce cravings and ease symptoms by stabilizing the brain’s opioid receptors. Clonidine or lofexidine can help with symptoms like anxiety, sweating, trouble sleeping, and rapid heartbeat. Providers may also use anti-nausea, anti-diarrheal, and non opioid pain relievers for comfort.
Overcoming Opioid Withdrawal With What You Now Know
Opioid withdrawal symptoms are one of the biggest reasons people feel trapped in opioid use. The fear of getting sick again, the memories of past failed attempts to quit, and the shame that often comes with addiction can make you feel stuck. Understanding what to expect from opioid withdrawal, how long it tends to last, and which treatments actually work can take away some of that fear.
If you are thinking about stopping, this is your sign to reach out for help instead of going it alone. At New Chapter Recovery, we offer a five-star outpatient program that that offers, better and faster confidential admissions for New Jersey patients. Contact our admissions team to take that first step and see our variety of treatment plans.
You are not a lost cause. Opioid withdrawal is a brutal chapter, but it doesn’t have to be the whole story. With the right combination of medical care, emotional support and honest information, you can get through this and start building a life that is not run by a pill, powder or bag.
