As the opioid crisis continues to affect people’s lives, it’s imperative to provide educational resources on how to best combat opioid addiction. While withdrawal from most substances is a difficult journey, opiates pose a greater risk during the withdrawal period due to the occasional severity of the symptoms. Despite its daunting nature, undergoing opiate withdrawal in a safe facility led by addiction experts is the best way to start your sobriety journey. Before learning about the different withdrawal symptoms, it’s essential to know the differences between different opioids.

Are opioids and opiates the same?

While these terms can be used interchangeably, opioids and opiates refer to two similar things. Opiates, for the most part, refer to naturally occurring opioids like heroin, morphine and codeine. Opioids, on the other hand, is a more broad term referring to all-natural, semisynthetic and synthetic opioids. That means, for example, that all opiates are opioids, but not all opioids are opiates. It’s a small distinction that’s important when it comes down to how we manage withdrawal symptoms.

Let’s look at the different withdrawal symptoms across numerous substances.

Different opiate and opioid withdrawal timelines

While the withdrawal symptoms are pretty similar across the board, the major distinctions come from either short-acting to long-acting, the amount of the substance that’s left in the body and the severity of the substance use disorder (SUD).

• 8 to 24 hours after last dose: Withdrawal symptoms begin for short-acting opioids like fentanyl, heroin and codeine that may include:
  • Headaches
  • Aggression, irritation, anxiety
  • Muscular aches and pains
  • Loss of appetite
  • Difficulty sleeping
  • Drug cravings
• 24 to 48 hours after last dose: Withdrawal symptoms begin for long-acting opioids like OxyCodone extended-release and fentanyl transdermal patches that may include:
  • Symptoms from Day 1
  • Excessive sweating
  • Runny nose
  • Panic attacks
  • Stomach problems
  • Insomnia

• 48 to 72 hours after last dose: Withdrawal symptoms peak for short-acting opioids that may include
  • Symptoms from days 1–2
  • Nausea
  • Vomiting
  • Diarrhea

• 72 to 144 hours after last dose: Withdrawal symptoms peak for long-acting opioids that may include:
  • Symptoms from days 1–3
  • Enlarged pupils
  • Cramping
  • Gastrointestinal discomfort
  • Shivering
  • Fatigue

• After 144 hours (seven days): Withdrawal should begin to subside. Lingering symptoms can include:
  • Fatigue
  • Depressed or irritable mood
  • Insomnia

Some individuals develop long-term withdrawal symptoms — known as Post-Acute Withdrawal Syndrome (PAWS). It can continue for months after the last dose and include symptoms like:

• Depressed or irritable mood
• Fatigue
• Sleep disturbances
• Drug cravings

Some additional factors that can affect the opiate withdrawal timeline are:

• The number of opiates in your system
• The severity of the SUD
• A patient’s physical and mental health
• Their genetics and biology
• The use of Medication Supported Recovery (MSR)

While opiate withdrawal can be difficult to overcome, there are a variety of treatment options available to help patients begin their life in recovery.