Symptoms of Opioid Withdrawal

The term “narcotic” is from the Greek word for “stupor” and initially referred to a wide array of substances that would suppress physical sensations, including pain. Today, narcotic drugs, also called opiates and opioids, refer specifically to powerful pain relievers made from opium and opium derivatives. Some, like heroin, are illegal, while others are legally available with a doctor’s prescription. 

Semi-synthetic opioids incorporate naturally-occurring opium products and include:

  • Heroin
  • Codeine
  • Morphine
  • Oxycodone/OxyContin 
  • Hydrocodone/Vicodin

Fully synthetic opioids include:

  • Fentanyl
  • Methadone
  • Meperidine
  • Tramadol

Opioids are highly addictive, although how you take them can influence how they affect you. If they are injected, they will have a faster and more intense effect. If they are swallowed as pills, then they take longer to reach the brain.

Why Opioids Are Addictive

The use of opioids can cause both physical and psychological dependence. We all have spots on the nerve cells in our brain, spinal cord and other organs throughout our bodies that are called opioid receptors. Opioids bind to, and activate, these receptors, particularly the ones involved in our sensations of pleasure and pain. Once they’re attached, opioids block pain signals between your brain and your body, releasing large amounts of dopamine, a brain chemical that boosts our feelings of pleasure, wellbeing, happiness, excitement and motivation. This can create a powerful craving for the drug and lead to continued use.

Other factors that influence addiction can include:

  • A genetic predisposition
  • Peer pressure
  • Emotional distress
  • Mood or other mental health disorders
  • Environmental stress 
  • Growing up seeing your parents use drugs

The longer you use opioids, the more of a tolerance you build in your system, meaning that over time, you need more of the drug to achieve the same effect. You’ll also need to use more of the opioid in order to prevent withdrawal symptoms.

The Opioid Withdrawal Process

Opioid withdrawal can feel like the bad flu. Symptoms typically begin within 12 hours of your last drug usage and within 30 hours of your last methadone use. While the symptoms aren’t generally life-threatening, it’s important to drink a sufficient amount of water during the withdrawal process, especially if you are sweating and/or vomiting, as both activities cause you to lose a lot of body fluids very quickly. 

Early symptoms of withdrawal can include:

  • Agitation and anxiety
  • Excessive yawning
  • Eye tearing
  • Insomnia
  • Muscle aches
  • Runny nose
  • Sweating

Late symptoms of withdrawal generally include:

  • Abdominal cramping
  • Diarrhea
  • Dilated pupils
  • Goosebumps and chills
  • Nausea and vomiting

If you have opioid use disorder and are pregnant, opioid withdrawal is not recommended, as it can result in miscarriage or premature delivery. Managed methadone treatment is recommended as an alternative. Conversely, if you are scheduled to begin methadone treatment for another reason, you should not begin the withdrawal process. 

Managing Opioid Withdrawal Symptoms

The intensity and duration of your withdrawal symptoms depend not only on the frequency and amount of your opioid use, but also on the type of opioid you were using. The onset of withdrawal symptoms from short-acting opioids such as heroin, codeine, morphine and oxycodone can begin anywhere from 8-24 hours after your last use of the drug and can last for four to ten days. Withdrawal symptoms from long-acting opioids such as fentanyl, methadone and oxymorphone typically begin 12-24 hours after your last use and may last 10-20 days. 

 will depend largely on how intense they are and how much they interfere with your daily functioning and wellbeing. Mild opioid withdrawal can be managed with symptomatic treatment and any of various types of  including:

Adequate hydration (2-3 liters of water daily) and vitamin B and C supplements can also help. Moderate to severe opioid withdrawal is managed using the same methods as mild withdrawal but may require the aid of medications such as:

  • Methadone
  • Clonidine 
  • Buprenorphine 
  • Codeine phosphate

There are strict parameters for the use of these medications in treatment. They all have potentially serious side effects that can damage your health. Let your rehab team know if you have:

  • Diabetes  
  • A head injury
  • A urinary blockage like kidney stones 
  • A respiratory (breathing or lung) condition
  • Hepatitis
  • Crohn’s disease or ulcerative colitis

Expect the dose to be evaluated daily, even three to four times a day. Your doctor will monitor your progress closely and make adjustments to your symptom management as necessary to help keep you comfortable, control cravings, prevent relapse and support your recovery. 

Opioids are naturally or synthetically derived from opium. They affect your brain, leading to both physical and psychological addiction. The longer you use opioids, the greater your tolerance and the more difficult the withdrawal process can be. While withdrawal symptoms can be mild, they can also be severe enough to require medicated treatment and close monitoring. It’s not recommended to try an opioid detox on your own. Your treatment team is a critical part of your support network. At Casa Palmera, we set you up for success both during and following treatment. Our Los Angeles treatment offers an array of options designed to meet your individual needs. If you want to free yourself of opioid addiction, reach out to us to talk about how to get back on track. You can take small steps towards your recovery to achieve bigger goals. Contact us today to start your path to recovery.


This blog is for informational purposes only and should not be a substitute for medical advice. We understand that everyone’s situation is unique, and this content is to provide an overall understanding of substance use disorders. These disorders are very complex, and this post does not take into account the unique circumstances for every individual. For specific questions about your health needs or that of a loved one, seek the help of a healthcare professional.