Opioid Withdrawal Timeline: What to Expect and When It Ends

The withdrawal timeline

Timing depends mainly on how long the opioid stays in the body. The table below shows a typical pattern for short acting opioids such as heroin, oxycodone and hydrocodone. Everyone is different, and dose, length of use and overall health all shift the timing.

How timing differs by opioid

• <strong>Heroin and short acting pills:</strong> symptoms start within 8 to 24 hours and usually ease within a week.
• <strong>Extended release pills:</strong> symptoms may start later, around 12 to 48 hours, and last a little longer.
• <strong>Methadone:</strong> symptoms often begin 24 to 48 hours after the last dose and can last two to three weeks or more.
• <strong>Fentanyl:</strong> onset is often fast, but symptoms can be drawn out and unpredictable, especially after heavy use.
• <strong>Buprenorphine:</strong> withdrawal tends to be milder but longer, often starting after two to four days.

Our fentanyl page and heroin page cover each drug in more depth, and methadone vs Suboxone compares the two main medications.

Danger signs and overdose risk

After even a few days without opioids, the body loses much of its tolerance. Using a previous amount can stop breathing. This is why the weeks after detox are one of the highest risk periods for overdose death.

1. Keep naloxone (Narcan) nearby and make sure someone knows how to use it.
2. Avoid using alone. If that is not possible, the Never Use Alone line is 1-800-484-3731.
3. Do not mix opioids with alcohol, benzodiazepines or other sedatives.
4. Assume street drugs may contain fentanyl or xylazine. Fentanyl test strips can help.

Our step by step guide to using Narcan explains what to do in an overdose.

Medications that ease withdrawal

• <strong>Buprenorphine</strong> (including Suboxone and Sublocade) relieves withdrawal and cravings. It is usually started once moderate symptoms appear.
• <strong>Methadone</strong> is given through licensed opioid treatment programs and can be continued long term.
• <strong>Lofexidine</strong> and clonidine can reduce sweating, anxiety and cramps, but do not reduce cravings.
• Comfort medications for nausea, diarrhea, pain and sleep may be added by a clinician.

Learn more in our Suboxone treatment guide and Sublocade guide, or find a provider on FindTreatment.gov.

Getting through the first week

1. Talk to a clinician first. Many can start buprenorphine the same day, including by telehealth.
2. Sip water, broth or electrolyte drinks often, especially with vomiting or diarrhea.
3. Eat small, plain meals such as toast, rice, bananas and soup.
4. Use warm baths, heating pads and gentle stretching for muscle aches.
5. Ask a trusted person to check in daily and to keep naloxone at hand.
6. Plan what comes next: a follow-up appointment, counseling or a support group.

Our understanding withdrawal guide covers withdrawal in general, and the article on post-acute withdrawal explains the slower later phase.

Frequently asked questions