Recognizing Opioid Withdrawal and Linking to Immediate Treatment

What is opioid withdrawal?

Opioid withdrawal has a wide range of symptoms, as shown in Table 4, that occur after stopping or reducing the use of opioid drugs. With short-acting opioids, such as heroin or morphine, withdrawal can last up to 10 days, but it most often lasts between 3 and 5 days. With longer- acting opioids, such as methadone, symptoms peak between day 3 and day 8 and may persist for several weeks.
Although opioid withdrawal can cause very troubling symptoms (such as vomiting, cramps, sweating, diarrhea, and dehydration), it is rarely life-threatening when treated appropriately. However, for the individual, these symptoms can be acutely distressing, potentially triggering suicidal thoughts and actions.

Using medications to control withdrawal is almost always recommended over managing withdrawal without medication.
Specifically, buprenorphine and methadone can be started immediately to treat opioid withdrawal, following the ASAM or SAMHSA guidelines (see the Resources section).
When participants try to quit "cold turkey," it can lead to risky complications, stronger cravings, and continued use, potentially leading to overdose and death.
Withdrawal management on its own is not a treatment method. It may cause strong cravings, which can lead to continued use. In addition, the risk of death from fatal overdose is markedly increased after withdrawal management due to the loss of tolerance and high likelihood of return to use.
Initiation of methadone or buprenorphine will quickly resolve withdrawal symptoms and can then be continued for maintenance treatment.
Opioid withdrawal should be avoided during pregnancy due to fetal risk and potential for return to use. Buprenorphine and methadone can be safely administered during pregnancy. See the 2020 ASAM guideline for the treatment of OUD.
If a participant takes buprenorphine or methadone for withdrawal management, the gold standard would be to continue this medication for the effective treatment of OUD. However, if a participant chooses not to continue medication for OUD, using medications for opioid withdrawal is recommended over abrupt cessation of opioids.