Opioid withdrawal symptoms and timeline: what to expect, from our clinical experts

Opioid addiction is an escalating concern in the UK, affecting individuals from all walks of life. According to the British Journal of Pain (in collaboration with SAGE), the UK had the world’s highest rate of opioid consumption in 2019; furthermore, opiate-related drug poisoning deaths have increased by 388% since 1993 in England and Wales1.

The situation transcends socioeconomic boundaries. In fact, there are a number of risk factors that can lead to opioid addiction2, including stress, a personal / family history of substance misuse, depression, anxiety, PTSD, compulsive / thrill-seeking tendencies, and heavy tobacco smoking.  

This means opioid use disorder (OUD) impacts not only vulnerable groups but also high-achieving professionals, including business leaders and public figures. Indeed, celebrities such as actor Robert Downey Jr.3 and Nicole Richie4 have openly discussed their struggles with opioid addiction, shedding light on the hidden ways opioid dependency can affect individuals across society.

“When I pictured heroin, I pictured some crazy crackhead with no shoes under a bridge. You never think that is going to be you. And it never was me. I was never under a bridge, and I always had shoes.”

• Nicole Richie

In short, opioids are powerful substances, providing pain relief by binding to opioid receptors in the brain and altering the perception of pain. However, their use comes with significant risks, including dependency, tolerance, and severe withdrawal symptoms5. 

What are opioids?

Opioids are a class of drugs that act on the body’s opioid receptors, primarily located in the central nervous system, the peripheral nervous system, and the gastrointestinal tract6. Their chemical structure mimics endogenous peptides such as endorphins, which are naturally produced by the body to modulate pain and stress. 

This similarity allows opioids to bind effectively to receptors, producing effects ranging from pain relief to euphoria7.

Some examples

• Heroin: an illicit opioid derived from morphine, known for its powerful euphoric effects.
• Fentanyl: a synthetic opioid approximately 100 times stronger than morphine, often prescribed for severe pain but frequently misused.
• Oxycodone: a prescription opioid used to manage moderate to severe pain, often sold under brand names like OxyContin.
• Methadone: commonly used in addiction treatment to manage withdrawal symptoms and cravings.
• Codeine: a milder opioid often found in cough syrups and painkillers.

Historically, opioids have been used for thousands of years8, with opium derived from the poppy plant serving as a cornerstone of ancient medicine. Morphine, isolated in the early 19th century, marked the beginning of the modern pharmaceutical opioid industry, followed by the development of synthetic opioids such as oxycodone and fentanyl. 

While these medications revolutionised pain management, they also led to widespread misuse and addiction due to their potent effects and high dependency potential.

The effects of opioids on the brain

Opioids exert their effects by binding to mu-opioid receptors in the brain, spinal cord, and gastrointestinal tract9,10. This binding inhibits the release of neurotransmitters such as substance P, which is responsible for transmitting pain signals11. Simultaneously, opioids trigger the release of dopamine, the neurotransmitter associated with pleasure and reward. This surge in dopamine creates the euphoria often experienced by opioid users12, reinforcing the cycle of misuse and addiction.

Chronic opioid use leads to neuroadaptation13, where the brain’s chemistry adjusts to the presence of the drug. This can result in:

• Desensitisation of opioid receptors, necessitating higher doses to achieve the same effects (tolerance)
• Reduced endogenous dopamine production, leading to anhedonia (inability to feel pleasure) when not using the drug14
• Structural changes in key brain areas15, such as the prefrontal cortex and amygdala, which govern decision-making and emotional regulation

How opioids are expressed, physically & behaviourally

Physically, opioid use manifests as drowsiness, slowed breathing, and ‘pinpoint pupils’, while behaviourally, individuals may exhibit mood swings, social withdrawal, and a preoccupation with obtaining and using the drug. 

Over time, these effects become more pronounced, with users potentially neglecting personal and professional responsibilities, engaging in risky behaviours, or experiencing troubles in their personal lives.

Opioid withdrawal symptoms and timeline

Opioid withdrawal is a highly individualised process, varying based on factors such as the type of opioid used, dosage, duration of use, and the individual’s overall health. The withdrawal process is characterised by a range of physical and psychological symptoms as the body adjusts to the absence of the drug.

What are the symptoms of withdrawal from opioids?

Withdrawal symptoms are often intense, and can include:

• Physical symptoms: muscle aches, sweating, diarrhea, nausea, vomiting, chills, and rapid heartbeat16
• Psychological symptoms: anxiety, irritability, depression, and intense cravings17

For instance, a long-term heroin user may experience severe gastrointestinal distress18, coupled with overwhelming fatigue and anxiety. These symptoms arise as the body’s opioid receptors regain sensitivity and the brain’s natural endorphin production gradually resumes.

What is the timeline for recovery?

While every individual’s recovery journey is unique, a general timeline for opioid withdrawal19 may look like this:

6-12 hours after the last dose

• Early symptoms such as muscle aches, restlessness, and anxiety begin.

1-3 days

• Symptoms peak, with vomiting, diarrhea, sweating, and intense cravings becoming prominent.

4-7 days

• Physical symptoms start to subside, though psychological challenges like depression and cravings may persist.

Following weeks to months

• Long-term recovery focuses on addressing psychological and emotional effects, with ongoing therapy and mental health support.

A report from Psychology Today20 highlights the importance of personalised care in navigating these stages, as factors such as previous trauma or co-occurring mental health conditions can influence the recovery timeline.

Curated & confidential care in the heart of the city

At Harbor London, we believe in treating the whole person – not just the symptoms of addiction. Our approach integrates:

• Medical detoxification: supervised by healthcare professionals to ensure safety and comfort during withdrawal.
• Therapeutic interventions: including Cognitive Behavioural Therapy (CBT) and Dialectical Behaviour Therapy (DBT) to address underlying psychological factors.
• Diet and nutrition: tailored plans to support physical recovery and restore energy levels.
• Lifestyle adaptations: including stress management techniques and physical activities to rebuild resilience.

Set in tranquil, serene locations throughout central London, our multidisciplinary team provides a serene and luxurious environment where individuals can focus on healing and growth in a calm space, with utter discretion.

Make a referral now

If you know someone struggling with opioid addiction, make a referral today – let our multidisciplinary team help in their journey to reclaim wellbeing and fulfillment.

References

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC10278447/ 
2. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372#:~:text=Genetic%2C%20psychological%20and%20environmental%20factors,their%20teens%20or%20early%2020s. 
3. https://americanaddictioncenters.org/blog/recovery-spotlight-robert-downey-jr
4. https://thedetoxcenterla.com/blog/nicole-richies-addiction/#:~:text=The%20drug%20experimentation%20in%20her,constant%20partying%20and%20legal%20problems.
5. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/expert-answers/what-are-opioids/faq-20381270
6. https://www.nih.gov/news-events/nih-research-matters/how-opioid-drugs-activate-receptors
7. https://www.ncbi.nlm.nih.gov/books/NBK546642/
8. https://www.neurology.org/doi/10.1212/WNL.92.15_supplement.P4.9-055#:~:text=Results%3A,a%20panacea%20for%20all%20maladies.
9. https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/opioid-receptor#:~:text=These%20receptors%20are%20most%20predominant,depression%2C%20dependence%2C%20and%20tolerance.
10. https://www.ncbi.nlm.nih.gov/books/NBK546642/
11. https://www.jneurosci.org/content/jneuro/20/11/4345.full.pdf
12. https://www.nature.com/articles/npp201612
13. https://pubmed.ncbi.nlm.nih.gov/18414400/
14. https://www.sciencedirect.com/science/article/pii/S0376871617301965
15. https://pubmed.ncbi.nlm.nih.gov/9829295/#:~:text=Morphine%20attenuates%20the%20response%20of,basolateral%20amygdala%20and%20the%20hippocampus.
16. https://www.ncbi.nlm.nih.gov/books/NBK310652/
17. https://www.ncbi.nlm.nih.gov/books/NBK526012/
18. https://pmc.ncbi.nlm.nih.gov/articles/PMC2074872/#:~:text=It%20has%20long%20been%20recognized,pain%20(1%E2%80%933).
19. https://www.ncbi.nlm.nih.gov/books/NBK310652/#:~:text=Opioid%20withdrawal%20syndrome,Nausea%20and%20vomiting
20. https://www.psychologytoday.com/gb/blog/harm-reduction-or-abstinence/202407/a-personalized-plan-is-key-to-overcoming-substance-use