Withdrawal timeline phase by phase
Below is the typical withdrawal timeline for heroin & opioids. Individual experience varies — duration of use, average daily dose, polysubstance use, age, liver/kidney function, and co-occurring mental health all shift the pattern. The phases below describe the average presentation in clinical settings.
Phase 1 · 8–24 hours after last use (heroin) / 24–48 hours (methadone)
Early withdrawal
- Anxiety
- Restlessness
- Sweating
- Yawning
- Lacrimation
- Rhinorrhea
- Muscle aches
Phase 2 · Days 2–4 (heroin) / 3–5 (methadone)
Peak withdrawal
- Severe muscle and bone pain
- Vomiting and diarrhoea
- Pupillary dilation
- Goosebumps
- Tachycardia and hypertension
- Severe insomnia
- Profound restlessness
Phase 3 · Days 5–10
Resolution of acute withdrawal
- Acute physical symptoms gradually settle
- Sleep starts to return
- Mood remains low and anxious
Phase 4 · Weeks 2–24
Post-acute withdrawal
- Sleep disturbance
- Anhedonia
- Anxiety
- Cravings episodically severe — often triggered by environmental cues
- Sometimes called 'protracted withdrawal' for opioids
Medications and medical management
Methadone or buprenorphine maintenance is the gold standard for opioid use disorder — both significantly reduce mortality compared to abstinence-based approaches. For supervised withdrawal: buprenorphine taper, lofexidine or clonidine for autonomic symptoms, antiemetics, antidiarrhoeals, NSAIDs for muscle aches. Naltrexone implant is an option for some.
Where to detox safely
Most opioid use disorder is managed in the community on methadone or buprenorphine programs delivered through public clinics, GPs with relevant authority, or specialist addiction medicine. Residential is appropriate where polysubstance use or chaotic home environment makes community-based treatment unviable.
When to call 000
What helps in the post-acute phase
The hardest part of heroin & opioids withdrawal is rarely the first few days — it is the weeks that follow. Sleep is disrupted, mood is low, cravings come and go in waves, and cognitive sharpness recovers slowly. The interventions that consistently help: structured psychological therapy (CBT, motivational interviewing, mindfulness-based relapse prevention), peer support (SMART Recovery, AA, NA, CA — choose by fit), continued GP and addiction-medicine follow-up, ongoing relapse-prevention medication where relevant, and a written relapse-prevention plan that names triggers and rehearsed responses.
People who engage with structured aftercare for 12 months or more after a withdrawal episode have dramatically better long-term outcomes than people who treat withdrawal as a one-off event. The single most predictive question to ask any program: "What does aftercare look like in the 12 months after I leave?"
Frequently asked questions
How long does heroin & opioids withdrawal last?
Acute heroin & opioids withdrawal typically lasts 2–24. Post-acute symptoms — sleep, mood, cravings — can persist for weeks to months. The acute phase is the medically dangerous one; the post-acute phase is uncomfortable but rarely dangerous.
Is heroin & opioids withdrawal dangerous?
Heroin & Opioids withdrawal is not directly life-threatening but is uncomfortable and produces high relapse risk if unmanaged. Opioid withdrawal is not directly life-threatening but is intensely uncomfortable and produces extreme craving. The biggest risk is overdose during relapse, which IS frequently fatal — tolerance drops rapidly during withdrawal, and a previously-tolerated dose can be fatal after even a few days of abstinence.
Can I detox from heroin & opioids at home?
Not safely without medical supervision. Most opioid use disorder is managed in the community on methadone or buprenorphine programs delivered through public clinics, GPs with relevant authority, or specialist addiction medicine. Residential is appropriate where polysubstance use or chaotic home environment makes community-based treatment unviable.
What medications help with heroin & opioids withdrawal?
Methadone or buprenorphine maintenance is the gold standard for opioid use disorder — both significantly reduce mortality compared to abstinence-based approaches. For supervised withdrawal: buprenorphine taper, lofexidine or clonidine for autonomic symptoms, antiemetics, antidiarrhoeals, NSAIDs for muscle aches. Naltrexone implant is an option for some.