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January 27, 2019

How Long Will Withdrawal Last?

You’re contemplating quitting drinking or realize that you’ve become much too dependent on prescription painkillers. Yet, getting off them may not be so easy, especially if you’ve tried and failed before. The scariest part is probably withdrawal since you don’t want to put yourself through unnecessary pain or discomfort. Everyone has their own idea of what withdrawal is, which may or may not be very accurate. Worse yet, nobody seems to know how long it takes to withdraw from alcohol or drugs. Overriding everything, you want to know how long will withdrawal last.

WHAT IS WITHDRAWAL?

When you discontinue taking alcohol or drugs, especially if you’ve been using these substances regularly or have been increasing frequency, quantity or dose, or combined them with other substances, the process of withdrawal sets in. In fact, no one who’s become dependent upon or addicted to alcohol or drugs can escape withdrawal. Most people have a general idea what withdrawal is, yet few know the facts about what’s involved during withdrawal, how long symptoms last, and how long the entire withdrawal process will take. The short answer is that withdrawal is a process that occurs in stages, and withdrawal symptoms—as well as the withdrawal process—varies.

HOW LONG DOES WITHDRAWAL LAST?

How long withdrawal lasts depends on many factors, including, age and weight of the individual, type of substance used, prior dosage, frequency of use, history of substance abuse, prior treatment for substance abuse, relapse history, family history of substance abuse, co-occurring medical and/or mental health disorders and more. As such, each person’s withdrawal experience will be slightly different, although there are some common withdrawal symptoms, depending on the substance used, and each has a general timeline for first appearance and duration. In addition, the concurrent use of alcohol and other substances complicates and further lengthens the overall withdrawal process. Indeed, using opiates and alcohol and/or benzodiazepines, for example, can result in life-threatening consequences, even death.

How can you know how long withdrawal will last for you? A good way to start is to look at the range for withdrawal timeline depending on the drug you’re withdrawing from, while also taking into account factors already listed.

But don’t let the fact that you’ll experience withdrawal symptoms prevent you from quitting alcohol or drug use. Medical professionals at drug and alcohol treatment centers use medication-assisted treatment (MAT) to help with the pain and discomfort of withdrawal symptoms and reduce cravings that occur during detox. In addition to already-approved methadone, buprenorphine, and naltrexone, in 2018, the U.S. Food and Drug Administration (FDA) approved the first non-opioid treatment drug Lucemyra (lofexidine hydrochloride) for managing opiate withdrawal symptoms in adults.

WHAT ARE WITHDRAWAL SYMPTOMS?

Physical and psychological changes occur when someone stops drug and alcohol use. These are called withdrawal symptoms. Some withdrawal symptoms begin soon after stopping use of the substance. Others may take a few days to set in, while some may not begin until a few weeks after quitting. Symptoms may overlap, especially if drugs and alcohol are combined, and it may be difficult to distinguish which symptom is associated with which substance. The presence of any co-occurring mental disorder, such as clinical depression or anxiety, can also affect the type, intensity, and duration of withdrawal symptoms.

ALCOHOL WITHDRAWAL

According to the 2017 National Survey on Drug Use and Health (NSDUH), an estimated 140.6 million people were current alcohol users, including 66.6 million binge drinkers, and 16.7 million heavy drinkers, and 7.4 million underage drinkers. The 2017 NSDUH also estimates 14.5 million people with alcohol use disorder (AUD).

Once drinking stops, alcohol withdrawal symptoms set in within hours. How long these symptoms last depends on the severity of the drinking problem, lasting anywhere from a few days to one week, or two weeks in more extreme cases. Detoxing and attempting alcohol withdrawal on your own is extremely risky and dangerous, even life-threatening. Only medically-supervised alcohol withdrawal should be considered if drinking is more than occasional, causes problems of an increasingly negative nature, coincides with other substance use, or the user also has a mental health disorder.

OPIATE WITHDRAWAL

In 2017, an estimated 2.1 million people had an opioid use disorder (OUD). Opiate withdrawal, due to the complications that may occur and complexity and overlap of symptoms from polydrug use, or combination of drugs and alcohol, and/or substance use and co-occurring mental disorder, should always be medically supervised at a drug and alcohol rehab center.

Heroin Withdrawal

In 2017, an estimated 494,000 people were current heroin users, while 652,000 had heroin use disorder. While heroin detox and withdrawal is rarely life-threatening, the physical symptoms can be uncomfortable. Heroin physical withdrawal generally lasts about 6-7 days. However, the cravings for heroin can continue for months. That’s why ongoing psychological treatment is strongly recommended as the recovering heroin addict learns how to live a drug-free life, manage cravings and cope with triggers and stressors that may precipitate relapse.

Fentanyl Withdrawal

Fentanyl is an extremely potent opiate painkiller, 100 times more potent than morphine and 50 times greater than the illicit opiate heroin. In 2016, fentanyl was responsible for more than half of all opiate-related deaths in 10 states, according to the Centers for Disease Control and Prevention. Fentanyl that’s sold on the street is often laced with heroin and cocaine, further increasing potency and magnifying overdose risk.

Chronic fentanyl addiction sets the stage for withdrawal symptoms to set in once the drug is not available or the dose is reduced. But anyone who uses fentanyl and then discontinues the drug (or greatly reduces doses) will go through withdrawal. The timetable for fentanyl withdrawal ranges from about 2 weeks, in general, to months or years for fentanyl addicts who suffer from post-acute withdrawal syndrome (PAWS).

Fentanyl detox makes use of MATS to help minimize or prevent precipitated withdrawal, which is the rapid and potentially dangerous acceleration of withdrawal symptoms.

Prescription Pain Reliever Withdrawal

Prescription drugs to relieve pain fall into the category of opiate narcotics. Drugs in this category include hydrocodone (Vicodin, Norco, Lortab, Zohydro ER, generic), oxycodone (Oxycontin, Percocet, Percodan, Roxicodone, generic), hydromorphone (Dilaudid), tramadol products, codeine, morphine, fentanyl, oxymorphone, buprenorphine products, Demerol, and methadone. Hydrocodone and oxycodone misuse account for the largest prescription pain reliever misuse, with 6.3 million and 3.7 million current users in 2017, respectively. In 2017, an estimated 11.1 million people reportedly misused prescription opiate painkillers and 1.7 million had prescription pain reliever use disorder.

Vicodin Withdrawal

Although the hydrocodone drug generally disappears from the body in about eight hours, full Vicodin withdrawal can take from one week to 10 days. The duration of withdrawal is dependent on how long the user has been addicted, how much tolerance they have for the drug, psychological factors (cravings), and method of detox. Going cold turkey results in a shorter withdrawal, but one that is more painful than medically supervised detox utilizing MAT to ease symptoms.

Oxycontin Withdrawal

Oxycontin, the brand name of the oxycodone pain reliever, is particularly addicting and subject to abuse. Mild oxycodone withdrawal symptoms start as soon as four hours after last use, with more moderate symptoms occurring in 12-24 hours. While the worst withdrawal symptoms peak in about 3-4 days, it will take about a week or two for symptoms to diminish. Professionally managed drug detox is critical during the Oxycontin withdrawal since users are most fragile and vulnerable at this point. Long-term effects of chronic oxycodone use (PAWS) following acute withdrawal stage can persist for months, possibly years.

Dilaudid Withdrawal

Among hydromorphone pain relievers, Dilaudid withdrawal starts within the first 3-6 hours after last use. Symptoms will generally worsen and peak within 36-72 hours, and begin to disappear after about one week. However, intense cravings can occur throughout the Dilaudid withdrawal process, with PAWS that can last for months or years.

Buprenorphine (Suboxone, Subutex) Withdrawal

Suboxone is a combination of buprenorphine and naloxone, a medication that reduces cravings and helps manage withdrawal symptoms in heroin and other opiate addicts, while Subutex combats withdrawal symptoms (it contains only buprenorphine). Used in the treatment of opioid use disorder (OUD), Suboxone can be abused and addicting itself and require the medically supervised withdrawal and subsequent treatment. Suboxone detox and withdrawal typically starts the worst physical symptoms within the first 72 hours, and symptoms begin to subside after one week, although persisting insomnia, body aches and pains and mood swings can last up to three months.

Methadone Withdrawal

Often used as a transitional medication in overcoming addiction to opiates such as heroin, methadone is also a highly addictive drug that has been responsible for numerous overdose deaths. Methadone withdrawal requires professional medical management and ongoing psychiatric evaluation. Withdrawal symptoms typically appear within 30 hours of the last dose, and most are mild to moderate. Phase one is the acute stage, lasting 2-3 days or up to 3 weeks in severe cases. Most symptoms begin to improve by day 10. PAWS, however, may persist for months and years as the body gradually begins to regain its equilibrium.

BENZODIAZEPINE WITHDRAWAL

Benzodiazepines (or “benzos”) are prescription tranquilizers that include shorter-acting drugs such as Xanax, Ativan and Halcion and longer-acting drugs such as Valium and Klonopin. For short-acting benzos, withdrawal symptoms typically begin within two days of the last dose. For longer-acting benzos, symptoms of withdrawal may start between 2-3 days after the last dose. The benzodiazepine withdrawal process generally lasts about 10-14 days, although some long-term, chronic benzodiazepine users may experience persistent withdrawal symptoms for months or even years after cessation of use.

Drinking alcohol during benzodiazepine withdrawal can worsen symptoms and increase the amount of time it takes to complete the withdrawal process. In addition, using benzodiazepines in combination with alcohol and other drugs (prescription and illicit) can be life-threatening. Anyone who’s been on benzodiazepines for a long time should seriously consider working with a medical professional for a safe slow tapering off the sedative, both to minimize withdrawal symptoms and to experience a successful withdrawal.

MARIJUANA WITHDRAWAL

The substance with the second largest number of users (after alcohol) is marijuana. An estimated 26 million people were current marijuana users in 2017, and the largest user group was the 18-25 category, followed by age 26+. An estimated 4.1 million people had marijuana use disorder in 2017.  Marijuana withdrawal generally lasts about 20 days, with initial symptoms appearing within the first week, the worst symptoms experienced by day 10, and subsiding by day 20. Relapse risk is about 40-60 percent for marijuana use disorder, and an even higher percentage if there have been multiple attempts to quit.

STIMULANT WITHDRAWAL

Withdrawal from stimulant drugs such as cocaine, methamphetamines (including crystal meth) and amphetamines (such as Adderall) generally begins with the onset of symptoms within the first 24 hours after last use and the first stage of withdrawal can last 3-10 days. Second and subsequent stage duration depends on the type of drug, among other factors, and can range from 1-10 weeks, and 11 weeks to 6 months or longer, respectively.

Cocaine withdrawal consists of three major stages: crash, withdrawal, and extinction. During the crash stage, which lasts between 7-10 days, cocaine users experience intense withdrawal symptoms that include agitation, drowsiness, depression, binge eating, tremors, and body aches. The second stage, withdrawal, can last from 3-10 weeks and involves anxiety, lethargy, recurring cravings and a high vulnerability to relapse. The third and final stage is extinction, lasting anywhere from 11 weeks to 6 months. The recovering cocaine addict remains highly susceptible to triggers and risk of relapse. In 2017, an estimated 2.2 million people were current cocaine users, while 966,000 had cocaine use disorder. 

However, in the case of acute stimulant withdrawal, longer protracted withdrawal (also called PAWS) can go on for an extended period of time, months or even years.

Crystal meth has a withdrawal process that includes intense physical and emotional symptoms beginning in the first 24 hours after last use of the drug and a withdrawal timeline that lasts anywhere from 7-10 days. The actual withdrawal length depends upon numerous factors, but longer withdrawal can be expected for severe crystal meth addiction. The second and longer phase of crystal meth withdrawal can go on for 4-6 weeks. During this time the body is getting used to functioning without crystal meth. Again, depending on the severity of the addiction, the individual may feel some symptoms more than others and may experience a longer withdrawal. Without drug rehab and aftercare participation, however, relapse is high with crystal meth users. An estimated 774,000 people were current meth users in 2017, and 964,000 had methamphetamine use disorder.

PRECIPITATED WITHDRAWAL

Precipitated withdrawal is a rapid and intense onset of opiate withdrawal symptoms that is triggered by certain medications used for MAT in overcoming opiate dependence and addiction, such as Suboxone (which combines buprenorphine and naloxone) and naltrexone. Precipitated withdrawal symptoms may be severe, even requiring hospitalization in some cases.

For more about alcohol and drug detox and withdrawal, check out these articles:

  1. Adderall Detox Guide – Withdrawal Symptoms and Timeline
  2. Addiction to Oxycodone, Hydrocodone and Other Opiates: Warning Signs, Effects and Stats
  3. Benzos Detox – Withdrawal Symptoms and Timeline
  4. Cocaine Detox Guide
  5. Crystal Meth Withdrawal Timeline
  6. Fentanyl Detox – Withdrawal Symptoms and Timeline
  7. Heroin Detox Guide
  8. How Long Does Alcohol Withdrawal Take?
  9. How Long Does it Take to Detox From Alcohol?
  10. How Long Does it Take for Opiates to Leave Your System?
  11. How Long Does Methadone Withdrawal Last?
  12. How Long Does Precipitated Withdrawal Last?
  13. Marijuana Detox Guide – Withdrawal Symptoms and Timeline
  14. Methadone Detox – Withdrawal Symptoms and Timeline
  15. Methamphetamine Detox – Withdrawal Symptoms and Timeline
  16. Morphine Dependence
  17. Oxycodone Detox – Withdrawal Symptoms and Timeline
  18. Suboxone Detox – Withdrawal Symptoms and Timeline
  19. Synthetic Drugs Detox – Withdrawal Symptoms and Timeline
  20. Vicodin Withdrawal Timeline – Common Symptoms to Expect

Sources:

AccessDataFDA.gov. “Dilaudid.” Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019034s018lbl.pdf

Drugs.com. “Dilaudid.” Retrieved from https://www.drugs.com/dilaudid.html

Centers for Disease Control and Prevention. “Deaths Involving Fentanyl, Fentanyl Analogs, and U47700 – 10 States, July-December 2016.” Retrieved from https://www.cdc.gov/mmwr/volumes/66/wr/mm6643e1.htm

Drugs.com. “Benzodiazepines.” Retrieved from https://www.drugs.com/drug-class/benzodiazepines.html

Journal of Addiction Medicine. “Transferring Patients from Methadone to Buprenorphine: The Feasibility and Evaluation of Practice Guidelines.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/?term=Journal+of+Addiction+Medicine.+Transferring+Patients+from+Methadone+to+Buprenorphine+%3A+The+Feasibility+and+Evaluation+of+Practice+Guidelines.+May%2C+2018.

National Institute on Drug Abuse. “Cocaine.” “What are the long-term effects of cocaine use?” Retrieved from https://www.drugabuse.gov/publications/research-reports/cocaine/what-are-long-term-effects-cocaine-use

Substance Abuse and Mental Health Services Administration. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.” Retrieved from https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report

U.S. Food and Drug Administration. “FDA Approves the First Non-Opioid Treatment for Management of Opioid Withdrawal Symptoms in Adults.” Retrieved from https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm607884.htm

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