Opiate Withdrawal

The timeline for opiate withdrawal can vary based on the specific opiate used, the duration of use, and the individual’s overall health. Here are general timelines for various opioids:

Short-acting Opiates (e.g., Percocet, Heroin)

First 24 Hours:

• Symptoms: Anxiety, muscle aches, sweating, insomnia, agitation
• Physiology: Opiates act on the central nervous system by binding to opioid receptors, particularly in the brain and spinal cord. These drugs inhibit the release of neurotransmitters that mediate pain and emotional responses, such as dopamine and norepinephrine. When opiate use is abruptly stopped, the sudden absence of these inhibitory effects causes a rebound overactivity in these neurotransmitter systems, leading to anxiety, muscle aches (due to increased norepinephrine activity), sweating (due to autonomic hyperactivity), insomnia, and agitation.

Days 2-3:

• Symptoms: Nausea, vomiting, diarrhea, abdominal cramps, increased heart rate
• Physiology: The gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal cramps) arise from the sudden loss of opioid effects on the gastrointestinal tract. Opioids typically slow down gut motility; their absence leads to a hyperactive digestive system. The increased heart rate is a result of the autonomic nervous system becoming hyperactive due to the lack of opioid suppression.

Days 4-5:

• Symptoms: Fatigue, chills, body aches, irritability
• Physiology: As the body continues to adjust to the absence of opioids, it remains in a state of autonomic hyperactivity. Fatigue results from prolonged stress and the body’s efforts to restore balance. Chills and body aches are due to the continuing imbalance in neurotransmitter levels, which affect both the immune system and pain perception. Irritability is a common response to the ongoing discomfort and emotional strain of withdrawal.

Long-acting Opiates (e.g., Methadone, Suboxone)

First 24-48 Hours:

• Symptoms: Anxiety, restlessness, muscle aches, sweating
• Physiology: Long-acting opiates take longer to clear from the body, so withdrawal symptoms start later. Similar to short-acting opiates, the withdrawal begins with the body’s response to the absence of opioid activity, leading to anxiety and restlessness. Muscle aches and sweating are due to the increased release of norepinephrine and other stress-related neurotransmitters.

Days 3-7:

• Symptoms: Severe nausea, vomiting, diarrhea, abdominal cramps, increased heart rate
• Physiology: The body’s digestive and autonomic systems continue to react to the absence of opioids, resulting in severe gastrointestinal symptoms and increased heart rate due to the autonomic nervous system’s overactivity.

Weeks 1-4:

• Symptoms: Anxiety, depression, cravings
• Physiology: Even as acute physical symptoms diminish, psychological symptoms persist due to changes in brain chemistry. The brain’s reward system, heavily influenced by opioid use, struggles to regain balance, leading to prolonged anxiety, depression, and cravings. These symptoms are part of Post-Acute Withdrawal Syndrome (PAWS), reflecting the ongoing adaptation of the brain’s neurotransmitter systems.