Opioid Withdrawal Symptoms

Withdrawal Symptoms of Opioid Addiction: Complete Guide to Recognition

Key Takeaways on Opioid Withdrawal Symptoms

  • Withdrawal symptoms are predictable but dangerous without medical supervision.
  • COWS scoring helps assess severity and guide treatment decisions.
  • MAT with buprenorphine or methadone reduces relapse and improves recovery.
  • Holistic support including therapy and lifestyle care improves long-term outcomes.

👉 If you or a loved one is struggling with opioid withdrawal, learn more about our Opioid Rehab Programs at Legacy Healing Center, or call us today for confidential support.

What are opioid withdrawal symptoms and why does recognition matter?

Opioid withdrawal symptoms are the clinical manifestations—both physical and psychological—that occur when someone with opioid addiction or opioid use disorder (OUD) stops or reduces their use of opioids, including heroin, fentanyl, and prescription opioid analgesics once prescribed for pain relief. Recognizing these symptoms is essential for safe detoxification, relapse prevention, and long-term recovery through evidence-based addiction treatment.

Unmanaged withdrawal can lead to severe complications such as dehydration, suicidal ideation, and relapse, which dramatically increases overdose risk due to reduced tolerance. Many patients attempting withdrawal without support end up in the emergency department, highlighting the importance of supervised treatment options.

At Legacy Healing Center, we provide medically supervised opioid withdrawal in luxury environments, combining medical oversight with trauma-informed therapy and holistic wellness. This comprehensive care model ensures that withdrawal symptoms are managed safely, comfortably, and with dignity—helping clients break free from the opioid epidemic and begin healing that addresses not just withdrawal, but the root causes of substance use disorder and the impact of other drugs or co-occurring conditions.

What are the key symptoms of opioid withdrawal?

Opioid withdrawal syndrome, as characterized by DSM-5 diagnosis criteria, occurs when patients with opioid dependence or long-term substance use disorder experience three or more symptoms after reducing or stopping opioid use. This serious problem can develop with commonly misused opioids such as heroin, fentanyl, oxycodone, or even prescription medicines like hydromorphone used for pain management.

Physical symptoms of withdrawal

These symptoms are most often seen in dependent individuals and may vary in duration and dose severity depending on individual factors, including pregnancy or co-occurring conditions:

  • Nausea, vomiting, diarrhea, abdominal cramping
  • Muscle aches, restlessness, joint pain
  • Sweating, goosebumps, rapid heartbeat, high blood pressure
  • Runny nose, watery eyes, yawning
  • Hot/cold flashes, pupil dilation

Psychological symptoms of withdrawal

Opioid withdrawal also includes other symptoms that affect mental health and require careful assessment by trained prescribers to determine appropriate pharmacotherapy or behavioral treatment options:

  • Anxiety, irritability, and intense drug cravings
  • Depression, dysphoria, and emotional numbness
  • Insomnia and disrupted sleep cycles
  • Difficulty concentrating or managing stress

Precipitated withdrawal

Precipitated withdrawal may occur when an opioid antagonist like naloxone—or a partial agonist such as buprenorphine—is administered too soon, triggering immediate and severe withdrawal symptoms. This highlights the importance of medical oversight, proper timing, and the role of FDA-approved medications in safely helping patients treat opioid addiction and abuse through structured treatment programs.

What causes opioid withdrawal symptoms in the brain and body?

Opioid withdrawal occurs because chronic opioid use disrupts the central nervous system (CNS), altering the function of mu-opioid receptors in the brain and spinal cord.

When opioids are removed, the locus coeruleus region of the brainstem becomes hyperactive, releasing excess norepinephrine and triggering symptoms such as rapid heartbeat, high blood pressure, sweating, and agitation. At the same time, the adenylyl cyclase system becomes overactive, elevating cAMP levels that drive the “fight-or-flight” response.

This neurobiological imbalance explains why withdrawal feels like a combination of severe flu symptoms and extreme anxiety, and why medical supervision with proper medications is necessary to reduce suffering and stabilize the nervous system.

Why is recognizing opioid withdrawal symptoms critical for recovery?

Recognizing and treating withdrawal symptoms improves safety, reduces relapse, and increases retention in treatment programs. Studies from the National Institute on Drug Abuse (NIDA) and the Centers for Disease Control and Prevention (CDC) show:

  • Medically supervised detox improves retention rates by 40–60%.
  • Unmanaged withdrawal increases overdose risk by 300% in the first month post-detox.
  • Medication assisted treatment (MAT) during detox reduces relapse from 80% to 30–40%.
  • Emergency visits for withdrawal complications cost the healthcare system over $2 billion annually.

At Legacy Healing Center, withdrawal management is never the end point—it’s the first step in a continuum of care that includes Partial Hospitalization (PHP), Intensive Outpatient (IOP), trauma therapy, and holistic wellness programs.

What is the timeline of opioid withdrawal symptoms?

The timeline of withdrawal depends on whether the opioid is short-acting (like heroin or fentanyl) or long-acting (like methadone).

Opioid Type Onset Peak Symptoms Duration COWS Score Range
Heroin 4–6 hrs 48–72 hrs 7–10 days Severe (25–36+)
Oxycodone 6–12 hrs 48–72 hrs 7–14 days Moderate–Severe (13–36)
Morphine 8–12 hrs 48–96 hrs 10–14 days Moderate–Severe (13–36)
Fentanyl 2–4 hrs 24–48 hrs 5–7 days Severe (25–36+)
Methadone 24–48 hrs 5–7 days 14–21 days Moderate (13–24)
Codeine 8–12 hrs 48–72 hrs 7–10 days Mild–Moderate (5–24)

COWS (Clinical Opiate Withdrawal Scale) scoring system

  • Mild: 0–12 → manageable outpatient care possible
  • Moderate: 13–24 → significant discomfort, medication recommended
  • Moderately Severe: 25–36 → requires medical detox
  • Severe: 36+ → emergency intervention required

This structured assessment helps providers at Legacy Healing Center determine whether detox can be safely managed outpatient or requires inpatient medical supervision.

What is PAWS (Post-Acute Withdrawal Syndrome)?

Post-Acute Withdrawal Syndrome (PAWS) refers to symptoms that linger for weeks or months after acute withdrawal resolves, often derailing recovery if not managed correctly.

Common PAWS symptoms include:

  • Mood swings, depression, and anxiety
  • Insomnia or irregular sleep cycles
  • Ongoing fatigue and low motivation
  • Cognitive fog and poor concentration
  • Persistent cravings

PAWS occurs because the brain’s dopamine and serotonin systems need time to recalibrate after long-term opioid misuse. At Legacy, clients experiencing PAWS receive extended care with trauma-informed therapy, MAT, coping skills training, and holistic practices like yoga and meditation, helping them regain stability and emotional resilience.

How can you recognize early opioid withdrawal signs?

Early opioid withdrawal symptoms within 6–24 hours resemble flu-like illness, including tearing, runny nose, frequent yawning, restlessness, tremors, dilated pupils, anxiety, and cravings.

Vital signs of opioid dependent patients often show elevated blood pressure, increased heart rate, and piloerection. Using structured tools like the Clinical Opioid Withdrawal Scale (COWS) helps providers assess baseline severity and begin early interventions such as clonidine to prevent escalation.

What happens during peak opioid withdrawal symptoms?

Peak opioid withdrawal symptoms, usually within 24–72 hours, bring the most severe discomfort and highest relapse risk, requiring close monitoring and sometimes inpatient care.

  • GI distress: vomiting, diarrhea, severe cramping, appetite loss.
  • Cardiovascular stress: tachycardia, hypertension, fever, dehydration risk.
  • Red flags: COWS > 36, chest pain, suicidal thoughts, seizures.

During this stage, buprenorphine or methadone induction may be used under medically supervised opioid withdrawal to stabilize symptoms and prevent complications.

How can medication assisted treatment (MAT) help manage withdrawal?

Medication Assisted Treatment (MAT) uses FDA-approved medications such as methadone, buprenorphine (Suboxone), and naltrexone to stabilize brain chemistry, reduce cravings, and prevent relapse.

  • Buprenorphine: Partial opioid agonist that relieves cravings with a safer profile; induction often begins during peak withdrawal.
  • Methadone: Full agonist prescribed in certified opioid treatment programs (OTPs) for patients with severe opioid use disorder (OUD).
  • Naltrexone (Vivitrol): Antagonist given after detox to block euphoric effects of opioids.

At Legacy Healing Center, MAT is paired with counseling, group therapy, and holistic recovery programs to address the biological, psychological, and social dimensions of addiction. This combination prevents relapse and builds long-term recovery stability for opioid dependent patients.

What mistakes should be avoided in managing opioid withdrawal?

  • Cold turkey detox: Abrupt cessation without medical supervision increases risk of seizures, relapse, and dangerous complications.
  • Focusing only on physical symptoms: Anxiety, depression, and cravings are equally debilitating and must be treated alongside physical discomfort.
  • Stopping medications too soon: Prematurely discontinuing MAT increases relapse and overdose risk.
  • Failing to use proper tools: Skipping validated scales like COWS leads to underestimating severity.

Pro Tip: Treat withdrawal like the first stage of recovery—not the end. At Legacy, detox is integrated into a continuum of care that ensures clients transition safely into PHP, IOP, or residential treatment.

What is a real-life example of opioid withdrawal management?

Case Study: 35-year-old patient with 3-year oxycodone misuse

  • Day 1 (12 hrs): Mild withdrawal, COWS score 8 → clonidine and supportive care.
  • Day 2 (48 hrs): Moderate withdrawal, COWS score 22 → IV fluids, nausea management.
  • Day 3 (72 hrs): Peak withdrawal, COWS score 28 → buprenorphine induction and psychiatric support.
  • Day 7: Mild residual symptoms → stabilized on buprenorphine, therapy initiated.
  • 90 Days: Sustained recovery, returned to work, improved family relationships, no opioid use.

This case demonstrates how supervised MAT and therapy reduce suffering, prevent relapse, and support lasting recovery.

Next Steps for Entering an Opioid Addiction Treatment Program

Opioid withdrawal is challenging, but with proper medical supervision, MAT, and behavioral support, it can be the first step toward lasting recovery. At Legacy Healing Center, clients receive private, luxury-level detox and personalized care, supported by physicians, therapists, and holistic wellness experts.

👉 Ready to take the first step?

Frequently Asked

Questions about Withdrawal Symptoms Of Opioid Addiction

Acute withdrawal symptoms peak at 72 hours and typically resolve within 7-10 days for short-acting opioids like oxycodone and heroin. However, psychological symptoms including anxiety, depression, and sleep disturbances may persist for weeks or months. Long-acting opioids like methadone can cause withdrawal lasting 2-3 weeks.

While opioid withdrawal is rarely fatal alone, severe complications can occur. Dehydration from persistent vomiting and diarrhea, cardiovascular complications in patients with heart disease, and suicide risk from severe depression require immediate medical attention. Medical supervision significantly reduces these risks.

Withdrawal symptoms are fundamentally similar across all opioids, but timing and intensity vary based on the drug’s half-life, potency, and individual factors. Heroin causes rapid, intense withdrawal due to its short half-life, while prescription opioids like OxyContin may have slightly delayed onset but similar peak intensity.

Seek immediate emergency department evaluation for: COWS scores above 36, persistent vomiting with signs of dehydration, chest pain or blood pressure exceeding 180/110, thoughts of self-harm, seizure activity, or any symptoms causing concern about patient safety.

Yes, protracted withdrawal syndrome can cause recurring symptoms for months, particularly anxiety, depression, sleep disturbances, and cravings. This phenomenon affects up to 75% of patients and requires ongoing clinical support, often including medication assisted treatment and comprehensive behavioral health services.

FDA-approved options include buprenorphine, methadone, and naltrexone. Clonidine may also help manage physical symptoms.

The safest option is medically supervised detox in a licensed facility like Legacy Healing Center, where symptoms are managed, and clients transition directly into therapy and long-term recovery care.