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Detox Local's Periodic Table of Drug Withdrawal
Drug withdrawal, in essence, is the result of changes made by the body and brain to continue functioning in the presence of drugs. Withdrawal symptoms are not a result of the drug per se, but the responses the body makes to the continued presence of a drug. Different drugs affect the body in different ways and to different degrees, thus there can be a wide range of withdrawal symptoms ranging from slightly uncomfortable to life-threatening depending on the specific drug used.
The changes that are made by the body and brain in response to chronic drug use will produce extremely uncomfortable effects once drug use ceases. The timeline for drug withdrawal can vary from just a few days to several weeks depending on a number of different factors. Following this acute phase of detox, many experience post-acute withdrawal syndrome.
Our interactive Periodic Table features drug withdrawal timelines and symptoms for the 38 most addictive drugs in the world. For more information on a specific drug, select it using the table or scroll down to browse each of them individually.
One of the oldest drugs used by humans, alcohol is very dangerous; both through use and from withdrawal. It acts primarily on both GABA and glutamate systems and produces a profound depression of neurological functions. The most immediate effects of alcohol include anxiety reduction, loss of inhibitions, relaxation, euphoria, drowsiness, and loss of coordination. Alcohol use can produce dependence and withdrawal symptoms in a fairly short time as well; usually after just a month of daily use.
Some of the most common symptoms are increased anxiety, tremor, insomnia, depression, confusion, and cardiovascular disruptions. The more severe symptoms include seizures, hallucinations, and delirium which may progress to a condition unique to alcohol withdrawal known as delirium tremens.
The symptoms of alcohol withdrawal are some of the most dangerous out of any withdrawal syndrome. Unmonitored alcohol withdrawal can easily be fatal due to the severity of the neurological disruptions it produces. If someone is expecting to go through alcohol withdrawal, they often need medical supervision as this is an extremely dangerous withdrawal syndrome.
Withdrawal Timeline: 3 to 7 Days
The timeline for alcohol withdrawal can vary greatly between individuals, largely dependant upon use history and liver health. In general, the withdrawal symptoms from alcohol can begin between 6 to 12 hours after the last time someone had a drink. These symptoms will worsen over the first few days with the greatest risk of dangerous complications being from 36 to 72 hours after withdrawal began. From there, symptoms will fade and are typically resolved by a week after the last drink. Post-acute symptoms may persist for several more weeks or months, although these will dissipate with time.
Heroin is a very powerful semi-synthetic opiate painkiller which produces an intense physical euphoria and is a powerful suppressor of emotions. Use can produce intense physical dependence, usually in just a few weeks of regular use. Withdrawal from heroin can be one of the most painful withdrawal syndromes, both due to its potency and because it is either snorted or injected. Since this produces such a profound change in the opioid system of the brain, the withdrawal symptoms will begin soon after use stops, and they will escalate quickly.
The symptoms of heroin withdrawal can be extremely painful, both physically and psychologically. It will cause pain in the muscles, joints, and bones while also producing insomnia, diarrhea, vomiting, tremors, repeated yawning, cardiovascular issues, and intensely hot and cold flashes.
Mental symptoms include intense anxiety, strong cravings, and deep depression which may persist for weeks or months.
Withdrawal Timeline: 4 to 7 Days
This timeline may vary between people, but it can be as short as 4 days or as long as 7 days. Note that this is the acute phase of withdrawal which exhibits symptoms both physical and mental. The post-acute phase is strictly psychological and may last for weeks or months. The largest contributor is how much heroin someone used, how long they used it, and which route they chose to use it
Cocaine is a very old drug which surprisingly is still used today for medical purposes, albeit very rarely. This drug is a psychostimulant and a local anesthetic which produces increased motivation, elevated mood and energy, and also produces a numbing effect. Cocaine produces its psychological effects in the brain by increasing levels of dopamine, serotonin, and norepinephrine. While it affects all 3 neurotransmitters, its strongest effect is on dopamine. For its numbing properties, cocaine is able to block peripheral nerves to produce numbness and a general loss of sensation.
Cocaine is able to increase dopamine levels in the brain by ~300%. Through Chronic use, the brain will adapt through a process called downregulation; essentially turning down the potency of dopamine. The result is that once cocaine use ceases, the individual experiences a profound dopamine deficiency. Along with lowered levels of serotonin and norepinephrine, this produces the symptoms of cocaine withdrawal.
The most common symptoms include deep depression, overwhelming fatigue, lethargy, increased appetite, sleep problems, strong cravings, and cognitive problems including clouded thinking and memory difficulties.
Withdrawal Timeline: 7 to 10 Days
The timeline for cocaine withdrawal can be fairly long, commonly lasting several weeks. The half-life of cocaine is extremely short at roughly 1 hour, so withdrawal symptoms will begin very shortly after the last use. While there is technically no “acute” phase of cocaine withdrawal, the symptoms will start out very intense and then gradually reduce over subsequent weeks. The first week will exhibit severe symptoms, but after 7 to 10 days, these should be greatly reduced. The symptoms which typically persist the full 10 weeks and are the last to resolve are usually cravings, irritability, and lethargy.
Crack is a concentrated and hyper potent form of cocaine that is smoked to produce an almost instantaneous and very intense euphoria. Being a different formulation of cocaine, crack is the same compound, just delivered in a different manner. It works in an identical way by increasing dopamine levels in the brain to produce its effects. The half-life of crack is extremely short, however, at roughly 20 minutes. This means that a crack user needs to smoke very frequently to avoid withdrawal.
Symptoms of crack withdrawal include severe depression (possibly with suicidal thoughts), profound fatigue, lethargy, sleeping troubles, increased appetite, extremely strong cravings, and severe cognitive problems. While there is technically no “acute” phase of crack withdrawal since the symptoms are strictly psychological, it is still an extremely uncomfortable experience
Withdrawal Timeline: 7 to 10 Days
The timeline for crack withdrawal is difficult to describe accurately, as there are no controlled studies. Due to its similar mechanism of action, potency, and half-life we can infer that it is a more intense, but short-lived version of cocaine withdrawal. Based on those 3 factors, it makes sense that it would be roughly 1/3rd as long at roughly 3½ weeks. This is an estimate, however, and as with most stimulant withdrawal syndromes, there will certainly be remnant symptoms which will persist much longer than this.
Fentanyl is an extremely powerful synthetic opiate painkiller, which is somewhere between 50 to 100 times as potent as morphine. It is a “pure opioid” similar to morphine and hydromorphone and produces strong interactions at all 3 major opioid receptors, and the μ-opioid receptor in particular. Fentanyl has a medium half-life of ~7 hours and produces no active metabolites. There are multiple fentanyl analogs with varying potency, up to ~10,000 times more potent than morphine in the case of carfentanil.
The physical symptoms include insomnia, frequent diarrhea, stomach cramps, vomiting, shakes and tremor, severe cardiovascular fluctuations, intensely hot and cold flashes, along with deep pain in the muscles, joints, and bones. The psychological symptoms are just as intense and include very intense cravings for fentanyl, a deep and profound depression, and severe anxiety.
Withdrawal Timeline: 5 to 7 Days
The timeline for fentanyl withdrawal is similar to other opiates, and may possibly be a little longer. Due to fentanyl’s half-life, someone may begin experiencing symptoms within 12 hours of the last time they used the drug. The physical and psychological symptoms will appear and intensify rapidly, typically reaching their peak around 4 days after they begin. Toward the end of the first week after they appeared, the physical symptoms will begin to dissipate, usually being resolved around 8 days after they first appeared. The psychological symptoms are another story, and while the first week may see a slight improvement, they should be expected to remain at high levels for several weeks at least. They may be present to some degree for several more months.
Morphine is the oldest natural opiate that has seen consistent medical use. It is known as a “pure opioid” and is the gold standard by which the potency of other opiates is measured through a “relative-to-morphine” equivalency scale. It should be noted that heroin breaks down to morphine very quickly in the body, and is essentially a rapid delivery system for morphine. Morphine use produces depression of pain, vital functions, and intense euphoria and as far as illicit use is concerned it is mostly eaten in pill form. It produces strong interactions at all 3 major opioid receptor sites and thus produces severe withdrawal symptoms.
The physical symptoms of morphine withdrawal include tremors, insomnia, diarrhea, vomiting, constant yawning, cardiovascular abnormalities, with intense flashes of hot and cold. Psychologically, morphine withdrawal may manifest anxiety, strong morphine cravings, and depression.
Withdrawal Timeline: 5 to 7 Days
Morphine withdrawal symptoms usually begin within 6 to 12 hours after the last time morphine was used. The length of morphine withdrawal can vary somewhat but is usually around 5 to 7 days. The physical symptoms will emerge, escalate, and disappear over this timeline, but psychological symptoms may persist for several weeks or even months afterward. It is often a months-long process to fully recover from morphine withdrawal.
Oxycodone is a very powerful semi-synthetic opioid that has risen dramatically in abuse rates since 1995 and is about 1.5 times as potent as morphine. It is a potent agonist at all 3 major opioid receptor sites, thus capable of producing very intense withdrawal symptoms after a relatively short period of daily use, sometimes in under a month. Additionally, the process of oxycodone metabolism produces other active opioid metabolites such as oxymorphone, which can prolong oxycodone’s duration of action. With a combination of high potency and a medium half-life of ~6 hours, oxycodone withdrawal can be an extremely painful and long-lived experience.
Oxycodone withdrawal seems to affect the gastrointestinal tract more than other opiates so nausea, diarrhea, and abdominal cramping can be severe. In addition, someone may experience insomnia, tremor, cardiovascular problems, hot and cold flashes, as well as pain in the muscles, joints, and bones. The psychological symptoms include deep depression, intense anxiety, and strong cravings.
Withdrawal Timeline: 5 to 7 Days
Oxycodone withdrawal symptoms will begin to appear between 6 to 12 hours after the last time someone used the drug. The withdrawal timeline from oxycodone may be roughly 5 to 7 days, but will most likely tend towards the higher end. This is due to its potency as well as the half-life of oxycodone and its active metabolites. This week will mark the appearance, intensification, and finally the resolution of the physical symptoms, although the psychological symptoms will persist much longer than this; oftentimes lasting for several months.
Nicotine is possibly the oldest drug used by humans (either nicotine or alcohol) and the earliest records of tobacco use date back several thousand years BCE. Using nicotine produces stimulant effects including increased alertness, stress reduction, and elevated cardiovascular function in the short term. Nicotines mechanism of action is mediated by receptors known as nicotinic acetylcholine receptors, which get their name from the fact that nicotine was the earliest known stimulator of these receptors. It is also an extremely addictive drug, with psychologically intense withdrawal symptoms, although they are not dangerous.
Symptoms of acute nicotine withdrawal include increased anxiety, irritability, headaches, clouded thinking, insomnia, depression, and severe cravings. While not fatal or dangerous, these symptoms are intense and extremely unpleasant.
Withdrawal Timeline: 4 to 5 Days
The timeline for nicotine withdrawal is fairly short compared to other drug withdrawal syndromes. Nicotine has a short half-life of ~1 to 3 hours, so withdrawal symptoms will begin around 4 to 5 hours after the last time someone used nicotine. The acute symptoms will escalate over the first two days without nicotine and may resolve on the fourth or fifth day. The next three weeks will exhibit a gradual reduction in the post-acute symptoms and after a month without nicotine, most of these symptoms should be resolved.
One of the first fully synthetic opioids, methadone is an extremely potent painkiller. It works not only as an agonist on 2 of the major opioid receptors but also as an antagonist at the NMDA glutamate receptor. Through this unique mechanism of action, it produces strong pain relief and general depressant effects. Methadone also has an exceptionally long half-life of 7 to 59 hours (officially listed), but it has been estimated to be somewhere between 15 to 207 hours. There are also multiple genetic factors that affect the metabolism, and subsequent half-life, of methadone so there is substantial variability in half-life between individuals. Methadone also lacks a single equivalence potency, with the rate of metabolism affecting its specific potency between people.
In addition to the usual physical withdrawal symptoms from opiates such as insomnia, intense tremor, diarrhea, vomiting, stomach cramps, and hot and cold flashes there will also usually be a greater degree of cardiovascular disruption. The psychological symptoms will be much more intense as well and include crippling anxiety, profound depression, and severe cravings for methadone. Due to the added effects on glutamate receptors, there will be more neurological hyperactivity during methadone withdrawal than with other opiates.
Withdrawal Timeline: 10 to 14 Days
The timeline for methadone withdrawal is much longer than it is for other opiates. This is mostly due to the extremely long half-life of methadone. The symptoms can commonly last for around 2 weeks, with a gradual appearance, increase, and slow dissipation over this timeline. The intense psychological symptoms may persist for much longer than 2 weeks, however, typically lasting 6 months or more.
Suboxone is actually a combination of 2 different drugs, naloxone and buprenorphine, and is used in the treatment of opiate addiction. We will confine our discussion to buprenorphine, as it is the active semi-synthetic opioid that produces dependence and the subsequent withdrawal symptoms. Buprenorphine is a partial agonist of μ-opioid receptors and an antagonist at κ-opioid receptors. Due to this, it does not produce very strong effects, and it exhibits a phenomenon known as the “ceiling effect” which means that after a certain dose is reached, euphoria will not increase further. Suboxone also has a very long half-life of ~30 hours, so withdrawal takes a while to begin and is quite prolonged.
The major physical symptoms during suboxone withdrawal include insomnia, minor stomach cramps, diarrhea, repeated yawning, severe restlessness, and mild pain in the muscles, joints, and bones. The psychological symptoms include anxiety, depression, and cravings for suboxone.
Withdrawal Timeline: 14 to 17 Days
Suboxone withdrawal is a very long process; much longer than withdrawal from most other opiates. Due to suboxone’s long half-life and the fact that it is very lipophilic, symptoms usually don’t appear until 2 to 3 days after the last dose was taken. Once they do appear, they may increase slowly over 5 days or so, plateau, and then gradually reduce. Usually, about 14 to 17 days after the last dose was taken, the physical withdrawal symptoms have resolved, although the psychological symptoms may remain for several months.
Hydrocodone is a fairly old and very common semi-synthetic opiate painkiller which is roughly as potent than morphine. It is an agonist at both the μ and δ opioid receptors, and it has a fairly long half-life of ~8 hours. Using hydrocodone will produce roughly similar painkilling effects as morphine, although the euphoria is not as intense. Hydrocodone metabolism produces the active metabolite hydromorphone, another potent opiate, although this is not present in sufficient quantities to contribute to hydrocodone’s euphoric or painkilling effects.
The physical symptoms can include insomnia, diarrhea, minor tremors, yawning, minor cardiovascular irregularities, hot and cold flashes, and minor pain in the muscles, joints, and bones. The psychological symptoms include intense anxiety, depression, and cravings for hydrocodone.
Withdrawal Timeline: 5 to 8 Days
The timeline for hydrocodone withdrawal is similar to most opiates, and while not quite as intense, it may tend slightly to the longer side. Lasting roughly between 5 to 8 days, the physical symptoms should appear within a day of last use and will increase, stabilize, and begin resolving over this timeframe. The psychological symptoms will begin alongside the physical symptoms but will persist long after the physical symptoms have resolved, typically taking several weeks to fully subside.
Both Vicodin and Lortab are a combination of hydrocodone and acetaminophen, with the weakest strengths for each being 5/300mg (Vicodin) and 5/325mg (Lortab). The high levels of acetaminophen in these drugs are incapable of producing withdrawal, however, it is extremely toxic to the liver especially when used in the high doses required to become addicted to Vicodin or Lortab. The liver issues that may arise from chronic use can be dangerous, and possibly even deadly.
The physical symptoms may appear as insomnia, diarrhea and minor stomach cramps, slight tremor, repetitive yawning, cardiovascular abnormalities, minor hot and cold flashes, with mild pain in the muscles, joints, and bones. Psychological symptoms can include cravings, depression, and anxiety.
Withdrawal Timeline: 5 to 8 Days
Due to the quite long half-life of ~8 hours, the withdrawal timeline for Vicodin may be slightly longer than withdrawal from other opiates. Symptoms should appear within ~18 hours of the last time someone used the drug and will increase over the next few days. By the third or fourth day after the last use, the symptoms should reach their maximum level, and begin a slow remission. All in all, the physical symptoms of Vicodin withdrawal may last between 5 to 8 days in total. The psychological symptoms will persist for several more weeks.
Codeine is an old and fairly weak natural opiate painkiller, more commonly used as a cough suppressant, and is roughly 1/6th as strong as morphine. It is an agonist at all 3 major opioid receptors, so it will exhibit classical opioid withdrawal symptoms, however, it has a weak affinity for these receptors. Due to its weak receptor affinity and its similar half-life to morphine, the withdrawal symptoms may be much less intense than other opioid withdrawal symptoms.
Physical withdrawal symptoms from codeine will include the standard opiate withdrawal symptoms including insomnia, nausea and mild diarrhea, frequent yawning, slightly increased heart rate or blood pressure, minor holt and cold flashes, and mild pain in the muscles, joints, and bones. The psychological symptoms will include anxiety, depression, and cravings.
Withdrawal Timeline: 4 to 7 Days
The timeline for codeine withdrawal is roughly 4 to 7 days and symptoms will begin within 24 hours of the last time someone used the drug. The physical symptoms will begin and intensify over the first few days, peak on the third or fourth day, and decrease until resolved by the end of 7 days. The psychological symptoms will appear alongside the physical symptoms, but often persist much longer; commonly taking several weeks to fully resolve.
Dilaudid is an extremely potent semi-synthetic opiate painkiller which is used as a fallback treatment for severe pain relief when other first-choice options have failed. It is known as a pure opioid, similar to morphine and fentanyl, and is an agonist at all 3 major opioid receptor sites. Dilaudid has particularly strong interactions at the μ-opioid receptor which is responsible for its strong painkilling effects. Dilaudid also has a similar half-life as morphine while it is at least 4x as potent and this will produce very intense withdrawal symptoms.
The physical symptoms include insomnia, tremors, excessive diarrhea, vomiting, constant yawning, cardiovascular disturbances, with intense hot and cold flashes. Pain in the joints, bones, and muscles will be moderate to severe and a feeling of intense restlessness is common. The psychological symptoms include severe anxiety, deep depression, and very intense cravings for Dilaudid is common.
Withdrawal Timeline: 5 to 7 Days
Dilaudid withdrawal can be excruciating, and due to its potency and short half-life, the symptoms can begin and escalate within 6 to 12 hours of the last time the drug was used. The total time frame involved is somewhere between 5 and 7 days. The physical symptoms will appear and escalate quickly, usually reaching their peak within two or three days before plateauing and gradually declining. The psychological symptoms may persist for many weeks or even months longer than this, although they will decrease with time.
Opana is an extremely potent semi-synthetic opiate painkiller which is roughly 3x more potent than morphine. It acts to some degree on all 3 major opioid receptors, but it has particularly strong agonist activity at the μ-opioid receptor. It has a rapid onset of action of about 30 minutes and medium half-life of between 8 to 10 hours, depending on the formulation someone takes. That being said, there does seem to be some variability in oxymorphone metabolism between individuals, and this can affect the half-life significantly.
These physical symptoms include insomnia, constant yawning, cardiovascular issues, frequent diarrhea, tremors, vomiting, intensely hot and cold flashes, and moderate or severe pain in the bones, joints, and muscles. The psychological symptoms include intense anxiety, profound depression, and severe cravings for opana.
Withdrawal Timeline: 5 to 7 Days
The timeline for opana withdrawal is quite similar to general opiate withdrawal, typically lasting between 5 and 7 days. Due to the half-life of opana, someone may begin to feel withdrawal symptoms between 12 and 16 hours after the last time they used the drug. These symptoms will intensify over the next few days, stabilize by the third or fourth day, and begin resolving until they are gone. The physical symptoms are often totally gone by the end of the seventh day. The psychological symptoms may persist for many weeks, or possibly even months longer.
Tramadol is a low potency synthetic opiate painkiller which is about 1/10th as strong as morphine. It produces typical opiate agonist effects at the μ-opioid receptor (although very weakly), and it also acts in a unique way compared to most opiates by preventing the reuptake of serotonin and norepinephrine. This complex mechanism of action may make it an atypical and effective painkiller, but it also gives the tramadol withdrawal syndrome some added challenges and discomforts. Tramadol has an elimination half-life of ~6 hours, but it does produce potent, active metabolites with half-lives of around 8 hours.
The physical symptoms include stomach cramps, insomnia, mild diarrhea, yawning, hot and cold flashes, and aches in the muscles, joints, and bones. Some of the psychological symptoms include deep depression (possibly with suicidal thoughts), severe anxiety and/or panic attacks, wild mood swings, fatigue, a profound lethargy, and strong cravings for tramadol. The psychological symptoms are the real threat, as they can be quite severe.
Withdrawal Timeline: 5 to 7 Days
The timeline for tramadol withdrawal can vary, depending greatly on co-occurring mental health issues. For the most part, the physical symptoms will be resolved within 7 days; starting between 6 to 12 hours after the last time someone used the drug. The psychological symptoms may persist for many weeks or possibly even months. The severity of these mental symptoms will diminish over time, but withdrawal from tramadol can be a psychologically harrowing experience.
First off, it should be noted that kratom is not technically a proper opioid, although it does act on many of the same opioid receptors as true opioids do. While the exact way kratom works is unclear, it can act as both a stimulant and a sedative depending on the dose. It works on the three major opioid receptors with the strongest interaction at the κ-opioid receptor. At low doses, stimulant-like properties are dominant while at higher doses, opioid-like sedation is produced. Kratom also produces painkilling effects which are likewise dose-dependent, although they are present to some degree regardless of the amounts used.
The most common symptoms include yawning, anxiety, depression, insomnia, mood swings, tremor, diarrhea, nausea, elevated blood pressure, and pain in the muscles, joints, or bones.
Withdrawal Timeline: 6 to 10 Days
The timeline for kratom withdrawal may be slightly longer than classical opioid withdrawal. The main active compound has a half-life of ~6 hours, which is about twice as long as morphine. Additionally, due to the relative weakness of kratom compared to morphine coupled with its half-life, a rough estimate of the acute withdrawal timeline is between 6 to 10 days, although this depends greatly on the amounts that someone used. Similar to opioids, there will be an acute withdrawal phase characterized by painful or uncomfortable physical symptoms followed by a protracted but, strictly psychological, post-acute set of symptoms which may take additional weeks or months to fully resolve.
One of the oldest benzos, this drug is the gold standard by which other benzos are compared and measured through a “potency-to-diazepam” equivalency. Diazepam is mild in strength and has an extremely long duration of action due to a long half-life of between 20 to 100 hours (including its active metabolites). There is a great deal of variation between individuals regarding diazepam half-life depending on genetics and liver function. Because of its long duration and half-life, the withdrawal symptoms may not be as intense as from other benzos, but they will last longer.
Some of the most common symptoms include tremors, severe anxiety, insomnia, irritability, muscle pain, muscle spasms, hallucinations, cravings, and clouded or disorganized thinking. These symptoms may be relatively mild as far a benzo withdrawal goes, but they are nonetheless extremely unpleasant.
Withdrawal Timeline: 2 to 3 Weeks
The duration of valium withdrawal can be prolonged, often lasting many weeks or even months. Symptoms will usually emerge slowly between 2 and 3 days after the last time someone used the drug. While the symptoms may vary throughout the duration, the first and second weeks seem to exhibit the most severe symptoms. Hallucinations are most intense during the first week, and then gradually subside over the next month. Tremor, anxiety, irritability, muscle spasms, and insomnia may remain intense until ~4 weeks after the last drug use and then begin to resolve slowly. Muscle pains may begin slowly during week 1, increase until week 3, and then begin a slow resolution. It is often many months before someone will begin to feel normal again after quitting valium.
Xanax is one of the most commonly prescribed anti-anxiety medications and is roughly 15x as potent as Valium. It is very short-acting with a half-life of ~11 hours although there are some genetic factors that can alter the metabolism, and subsequently the half-life, between individuals. Xanax use has been shown to produce withdrawal symptoms in as little as 1 week of use, although these are initially minor and would not likely require detox by this point. Due to the high potency and short half-life of Xanax, withdrawal symptoms can become very intense and possibly dangerous in long-time users.
The most common symptoms of withdrawal include muscle pain, involuntary muscle spasms or jerks, sensitivity to light and sound, severe anxiety and irritability, strong cravings, depression, hallucinations, insomnia, confusion and delirium, and an increased risk of seizures. Xanax withdrawal seizures have been documented to result in coma and death if left untreated.
Withdrawal Timeline: 1 to 2 Weeks
Because of the half-life of Xanax, withdrawal symptoms will begin within a day of the last time someone used the drug. The symptoms may escalate rapidly and remain intense for an extended time. Hallucinations and risk of seizure are most severe in the first week of withdrawal, but the rest of the symptoms will persist for at least 2 weeks on average. While the majority of the physical symptoms may have resolved by 2 to 3 weeks after ceasing Xanax use, the psychological symptoms and insomnia may persist for many more weeks or even months.
Klonopin is most commonly used to treat seizure disorders but also sees use as a treatment for anxiety issues. This is a very potent and very long-acting benzo, being roughly 15x as potent as Valium with a half-life of ~20-60 hours. Because of these characteristics, the Klonopin withdrawal syndrome is severe and long-lived. Additionally, due to its potency, the risk of seizures during withdrawal is greatly increased when compared to Valium.
Symptoms include insomnia, muscle pain and spasms, hallucinations, hypersensitivity to light and sound, severe anxiety, intense cravings, deep depression, increased risk of seizure, and profound disorientation or delirium. In the absence of medical supervision, Klonopin withdrawal seizures may result in coma and/or death.
Withdrawal Timeline: 3 to 4 Weeks
These symptoms will appear and intensify slowly but will reach extreme severity within a week of the last time someone used Klonopin. These may persist at a high level for several weeks, and the worst of the physical symptoms may resolve around 3 to 4 weeks after they began. The psychological symptoms commonly persist for many months or even years before they resolve completely.
Ativan is primarily used to treat anxiety but is also commonly used off label for treating alcohol withdrawal seizures and delirium. It is a potent benzo which is roughly 5-10x more potent than Valium and has a medium half-life of ~9 to 16 hours. Due to the potency and half-life, the withdrawal symptoms may be similar to those of Xanax, although slightly less intense. The risk of seizures during withdrawal is increased when compared to Valium withdrawal.
Symptoms of Ativan withdrawal include insomnia, intense anxiety and irritability, hallucinations, confusion and delirium, depression, muscle pain and involuntary spasms, increased sensitivity to light and sound, strong cravings, and an increased risk of seizure. Ativan withdrawal seizures may be fatal if left untreated.
Withdrawal Timeline: 3 to 4 Weeks
The timeline for Ativan withdrawal is quite long as far as drug withdrawal goes; typically lasting several weeks. Symptoms may begin to appear around 1 day after the last time someone used the drug and escalate quickly over the first few days. Hallucinations and delirium may be severe at first and slowly resolve over the first week. The rest of the physical symptoms may appear and increase over 2 weeks or so before plateauing and finally dissipating. In total, the acute withdrawal symptoms may be resolved after 3 to 4 weeks after the last Ativan use, but the psychological symptoms will remain for several months to some degree.
Meth is one of the most mentally and socially destructive drugs known today. While methamphetamine is used medically as a treatment for ADHD, narcolepsy, and obesity in the form of Desoxyn, this is very rare as the risks often outweigh the benefits. The immense neurological disruptions produced through chronic use can permanently change people’s behaviors and personalities, usually for the worse. Meth is able to increase dopamine levels in the brain by over 1,000% and this can cause neurological changes in a very short amount of time and after relatively brief exposures. Meth also works to increase levels of serotonin and norepinephrine, but its strongest effect by far is on dopamine.
Symptoms include a profound depression, utter fatigue, profound lethargy, sleep problems (either insomnia or hypersomnia), psychosis and confusion, cognitive issues, and intense cravings for meth. It is not uncommon for people experiencing meth withdrawal to become delirious or even psychotic when the drug begins to wear off, although this commonly resolves in the first day or two of abstinence. The symptoms of crystal meth withdrawal are strictly psychological in nature, however they are extremely severe.
Withdrawal Timeline: 7 to 10 Days
With a half-life of ~6 to 17 hours, the symptoms of meth withdrawal will begin within a day of the last time someone used the drug. The acute phase of meth withdrawal commonly lasts between 7 to 10 days which is the average time it takes dopamine levels to stabilize after such a profound depletion. Upon quitting meth use, the psychosis and delirium will fade first but the cognitive issues and other psychological symptoms will persist for a very long time. It is often many months or even years before the symptoms have completely resolved. This timeline can differ, sometimes greatly, between people and has a great deal to do with individual genetics and the possibility of co-occurring mental health issues.
Adderall is a common medication used in the treatment of ADHD but is frequently abused due to its potency. This drug is a 50/50 mix of amphetamine and dextroamphetamine which produces effects vaguely similar to meth, although much less intense. Adderall works by increasing levels of dopamine and norepinephrine in the brain, subsequently producing an intense euphoria, mood elevation, promotes attention and focus, and increased energy levels. While withdrawal from Adderall is not fatal, it is an extremely unpleasant experience.
Someone may expect depression, fatigue, lethargy, sleep disturbances, cravings, irritability, and minor cognitive issues during withdrawal. The sleep symptoms in particular may begin as hypersomnia, but progress to insomnia throughout the course of withdrawal. Cognitive issues may range from being slightly distracted, to having extremely clouded and disorganized thoughts.
Withdrawal Timeline: 6 to 8 Days
The withdrawal timeline for Adderall can vary quite a bit between people due to genetics and overall mental health. Due to Adderall’s half-life of ~12 hours, the symptoms will begin to appear about 1 day after the last time someone used Adderall. These symptoms will typically worsen in the first few days, stabilize around the middle of the first week, and begin to resolve a few days after they began. In total, about 7 days is the extent of acute Adderall withdrawal from symptom appearance to dissipation. That being said, some of the symptoms such as depression and fatigue may be present for quite some time; often several months after Adderall use has ceased.
Ritalin is a common stimulant used to treat ADHD issues and is frequently abused. It is about 1/2 as strong as Adderall, but it is still perfectly capable of producing addiction and subsequent withdrawal symptoms. Ritalin works by increasing levels of dopamine and norepinephrine in the brain, thereby increasing attention and focus while also producing a mild euphoria at higher doses.
Symptoms of Ritalin withdrawal include depression, fatigue, lethargy, sleep trouble, clouded thinking, cravings, and increased irritability. Due to Ritalin’s relatively low potency, these symptoms will be very uncomfortable but pose no direct danger to the individual themselves, nor to others since psychosis is extremely rare during Ritalin withdrawal.
Withdrawal Timeline: 5 to 7 Days
The timeline for withdrawal from Ritalin is fairly short as far as stimulants go, although vestigial symptoms may linger for several weeks or months. Ritalin has a very short half-life of between 3 to 4 hours, so someone will begin experiencing withdrawal symptoms within 12 hours of their last use. These symptoms will appear and amplify over 3 days or so before stabilizing and beginning a gradual resolution. All in all, the most severe symptoms should be gone within 7 days of the last time someone used Ritalin.
Vyvanse is another amphetamine which is commonly used to treat ADHD and frequently sees abuse. Vyvanse is a unique medication in that the active ingredient, lisdexamfetamine, is actually a prodrug delivery system for its active metabolite dextroamphetamine. Due to this, there is substantial variability in Vyvanse’s half-life, since metabolism must first break Vyvanse down into the main psychoactive compound. Vyvanse primarily works through increasing levels of dopamine and norepinephrine, and effects normally take over an hour to be felt, exhibiting increased attention, energy, and mood.
Some of the most common symptoms of Vyvanse withdrawal include sleep problems, depression, fatigue, lethargy, cognitive problems, irritability, and cravings. These symptoms are not fatal, and dangerous symptoms such as psychosis or delirium are extremely rare.
Withdrawal Timeline: 6 to 8 Days
The timeline for Vyvanse withdrawal can be difficult to pin down, due to the individual differences in metabolism which can affect the levels of the drug someone was exposed to. The half-life of lisdexamfetamine is less than 1 hour but the half-life of dextroamphetamine, the major active metabolite of Vyvanse, is 12 hours. Due to this, the Vyvanse withdrawal timeline may be very similar to Adderall withdrawal in duration, usually lasting about 7 days from the last time someone used the drug. Minor symptoms may persist for several weeks, or possibly even months after use has ceased but these will reduce in intensity over time.
Ecstasy is technically a methamphetamine which also produces hallucinogenic and entactogenic effects. It works by strongly increasing levels of serotonin, dopamine, and norepinephrine with the strongest effect on serotonin. It may also increase levels of oxytocin as a byproduct of serotonin stimulation, which may contribute to the empathic and emotional effects. Using ecstasy produces an intense euphoria, strong feelings of connection and/or love, visual and tactile hallucinations, increased energy, and an elevation of mood and motivation.
Some of the most commonly reported symptoms include deep depression (with or without suicidal thoughts), irritability, extreme fatigue, severe lethargy, increased appetite, sleep disturbances, memory difficulties, and cognitive issues which can be quite severe. Both the memory and cognitive issues can be quite severe, and a full recovery may take years if it happens at all.
Withdrawal Timeline: 2 Weeks
The timeline for ecstasy withdrawal is close to that of crystal meth, although slightly less intense. Ecstasy’s half-life of between 6 to 10 hours means that someone will begin to experience withdrawal symptoms within a day of their last use. Symptoms will begin and intensify over the first week, stabilize, and begin to reduce during the second week. Usually, by 12 to 15 days after symptoms have begun, they should be greatly improved. Memory issues and cognitive problems may be a long term, or even permanent, feature after chronic ecstasy use and withdrawal.
Marijuana is commonly perceived as a “safe and harmless” drug, but this is absolutely not true. Even marijuana can produce withdrawal symptoms and these are frequently very protracted, as the major compounds in marijuana are highly fat-soluble, thus taking a very long time to leave the body. This may actually reduce the severity of withdrawal but can prolong the experience. While the major psychoactive compounds in marijuana are THC and CBD, there are over 60 other compounds in marijuana that interact with the cannabinoid system of the brain.
Some of the most common symptoms include increased anxiety, insomnia, irritability, depression, headaches, stomach pain, shakiness, and clouded or disorganized thinking. These may be mild, but they usually last for an relatively long time.
Withdrawal Timeline: 3 Weeks
The half-life of THC can vary between regular and infrequent users due to its fat solubility. In a regular marijuana user, the half-life can be around 10 days. Due to the long half-life and high solubility of the active compounds, particularly THC and CBD, the marijuana withdrawal timeline can often take several weeks. The first week will see the emergence of the worst symptoms with a gradual decrease in severity over the second week. The third week may mark the resolution of the worst symptoms, and it may be several more weeks or months for post-acute symptoms to fully resolve.
A drug commonly found in cough medications, dextromethorphan (DXM) is actually derived from an analog of codeine, a natural opiate. This drug works in a similar way to opioids along with some unique properties. It interacts with all three major opioid receptors as well as serotonin, norepinephrine, and glutamate systems. At low doses, it may produce stimulant-like effects, and as the dose increases, these effects may become more psychedelic and dissociative in nature.
Common symptoms include disorganized or slowed thinking, impaired coordination, depression, fatigue, nausea, diarrhea, lethargy, and increased anxiety. These symptoms are certainly uncomfortable, but as far as withdrawal syndromes go, dextromethorphan seems to be on the milder side.
Withdrawal Timeline: 3 to 6 Days
There have not been many human studies performed on the timeline for dextromethorphan withdrawal. That being said, due to its relatively short half-life of between 3 to 6 hours and the disparate neurological systems affected, dextromethorphan withdrawal may last between 3 to 6 days roughly. Of course, this depends on the amount of DXM someone was using, and the length of their use, as both of these factors can alter the timeline.
GHB is a very powerful sedative and central nervous system depressant. It acts on the GABA system of the brain and produces intense euphoria, increased libido, lowered inhibitions, impaired memory, and coordination. Strong sedatives like GHB have very unpleasant and possibly fatal withdrawal symptoms since the body and brain become hyperactive during withdrawal. Withdrawal from GHB can be considered a medical emergency and absolutely requires medical attention.
Some of these symptoms include delirium, seizures, hallucinations, psychosis, paranoia, tremors, hyper- or hypothermia, cardiovascular abnormalities, insomnia, irritability, and extreme anxiety. Many of these symptoms may result in death or injury, not only to the person experiencing withdrawal but others nearby if the GHB user becomes psychotic and violent.
Withdrawal Timeline: 2 Weeks
Due to the very short half-life of GHB of roughly 1 hour, symptoms will appear and intensify very quickly, often within 6 hours of the last time someone used the drug. The acute withdrawal symptoms typically last for about 14 days, although delirium may come and go over this time. After this time, post-acute withdrawal syndrome will be the biggest concern, although the symptoms are strictly psychological. Post-acute symptoms include strong cravings, depression, and anxiety and these may last for many more weeks or even months before completely resolving.
Ambien is a sedative-hypnotic drug that is commonly used to treat insomnia. The way it works on the GABA neurotransmitter system is extremely similar to benzodiazepines such as Xanax, although zolpidem is ~10x less potent than Xanax. Even though they work in a very similar manner, Ambien is technically not a benzo and is instead classified more generally as a sedative/hypnotic and referred to colloquially as a Z-drug. Taking higher than prescribed amounts will produce intense relaxation and drowsiness, severely impaired memory, impaired coordination, and increased reaction time. Ambien is capable of producing withdrawal symptoms through chronic use, and these symptoms can be quite severe.
The symptoms include muscle cramps, intense headaches, severe anxiety and irritability, depression, hallucinations, insomnia, confusion and delirium, and an increased risk of seizures. These symptoms require medical attention and may be fatal if left untreated.
Withdrawal Timeline: 5 to 10 Days
The symptoms of Ambien withdrawal usually begin about 48 hours after the last time someone used the drug. While there have been very few clinical studies describing Ambien withdrawal, mostly due to the low rate of abuse, it most likely is shorter than benzodiazepine withdrawal, due to both the very short half-life and the relative weakness of zolpidem compared to other benzos. After symptoms begin, it may be between 5 to 10 days before the most dangerous acute symptoms fade. After this, the post-acute symptoms of depression, anxiety, and cravings will most likely persist for several more weeks or months.
Ketamine is a powerful anesthetic that can be used in humans, although it is most often used in veterinary medicine today as a sedative, and increasingly as a treatment for chronic pain. It has a very complex mechanism of action as it interacts with glutamate, serotonin, dopamine, norepinephrine, and opioid systems. In small doses, it can act as a sedative and relaxant but in higher doses, it produces hallucinogenic effects. Common effects of ketamine include euphoria, intense relaxation, dissociation from one’s body, strong painkilling effects, and intense hallucinations.
Symptoms of acute ketamine withdrawal include anxiety, depression, irritability, psychosis, tremors, fatigue, cravings, and cognitive difficulties. The possibility of psychosis, hallucinations, and irritability can be a dangerous cocktail of symptoms that may result in violent outbursts. Medical help is definitely advised if someone is going to undergo ketamine withdrawal.
Withdrawal Timeline:3 to 7 Days
Due to the lack of clinical studies on ketamine withdrawal since such heavy use is exceedingly rare as well as its very complex mechanism of action, it is difficult to pin down the exact timeline for ketamine withdrawal. As an estimate, acute withdrawal may last between 3 to 7 days while post-acute withdrawal symptoms may linger for several weeks afterward.
Lyrica is a fairly new drug that was originally used to treat nerve pain and as a seizure prevention aid. It is structurally similar to the neurotransmitter GABA, although it does not bind to GABA receptor sites in the brain. The exact mechanism of action of Lyrica is not fully understood, but it produces effects that are roughly similar to Gabapentin and Valium. It reduces levels of excitatory neurotransmitters including glutamate and norepinephrine. The effects of Lyrica use can include mild euphoria, decreased inhibition, relaxation, reduced anxiety, and drowsiness. During withdrawal from Lyrica, the symptoms can be severe, as are most withdrawal syndromes from depressant drugs.
The symptoms of Lyrica withdrawal include severe headaches, fatigue, lethargy, anxiety, depression, tremors, insomnia, and joint or muscle pain. There may be an increased risk of seizure as well, although this is rare.
Withdrawal Timeline: 1 Week
The exact timeline for Lyrica withdrawal is hard to define clearly. While it works in a roughly similar way to other drugs, it does so in an indirect and roundabout manner. That being said, it has a half-life of ~6 hours so withdrawal symptoms should start within a day or two after the last time someone used the drug. Due to its relatively low potency, the withdrawal symptoms will most likely subside after around 7 days, although this has not been well studied. Keep in mind that these are the acute withdrawal symptoms, and the post-acute symptoms may persist for several more weeks or months.
Gabapentin is a synthetic analog of the neurotransmitter GABA and it is used to treat minor seizures and nerve pain disorders. It is very similar to Lyrica and produces effects similar to those produced by benzodiazepines and alcohol. Gabapentin works through interactions with the neurotransmitter GABA, and subsequently reduces the levels of excitatory neurotransmitters, although the exact way it works is unclear. Using gabapentin in supratherapeutic doses can result in relaxation, euphoria, loss of coordination, reduced inhibition, and it may also boost the high produced by other drugs. Gabapentin withdrawal is very uncomfortable and may even be dangerous.
Some of the most commonly experienced symptoms include seizures, tremors, nausea, anxiety, depression, fatigue, headaches, and increased irritability. Seizures are an especially dangerous risk, as these can progress to status epilepticus, which may be fatal. It is necessary to acquire medical help and supervision if gabapentin withdrawal is expected.
Withdrawal Timeline: 1 to 3 Weeks
The timeline for gabapentin withdrawal can vary quite a lot between people. Symptoms may start between 12 hours to 7 days since the last time someone used the drug. The symptom timeline closely resembles benzodiazepine withdrawal in that the acute phase may last for several weeks, followed by a protracted post-acute withdrawal syndrome lasting several months. Since the time of symptoms onset varies so much, the overall withdrawal timeline may vary greatly between individuals as well.
A fairly old anti-anxiety medication initially developed and used in Russia, this drug is seeing more widespread use recently. It acts on the GABA system, particularly the GABA-β receptors, somewhat similar to GHB and gabapentin. It can produce feelings of euphoria, deep relaxation, lowered inhibitions, increased sociability, and a sense of clear thinking. It is capable of producing dependence and the withdrawal symptoms can range from painful to potentially fatal.
The most common symptoms of phenibut withdrawal include severe anxiety, increased irritability or hostility, insomnia, depression, delirium, and possibly seizures. In rare cases, hallucinations have also manifest. These symptoms can vary greatly in intensity, both due to tolerance as well as the fact that there is no regulation of purity for most phenibut outside of Russia. These symptoms may become life-threatening due to seizures, and medical help is absolutely recommended when someone is undergoing phenibut withdrawal.
Withdrawal Timeline: 3 Weeks
The timeline for phenibut withdrawal has not been studied very closely, but we can present a rough guide due to its similarity to benzodiazepines and other GABA agents. Phenibut has a short half-life of ~5 hours, so withdrawal symptoms will begin within 12 hours of the last time someone used the drug. The acute symptoms may intensify over the first week and begin dissipating during the second week. Around three weeks after the last time someone used phenibut, the withdrawal should enter the post-acute phase with strictly psychological symptoms. These may linger for several months but will gradually decrease in intensity.
Phenergan is technically an antihistamine that is used to relieve allergies, but its main ingredient, promethazine, is commonly used as a drug or to enhance the effects of other drugs. It may also come in different formulations that include the opiate drug codeine and dextromethorphan. It works through a complex mechanism of action involving the dopamine, glutamate, and adrenergic neurotransmitter systems and a variety of others as well. Phenergan can directly produce sedation and is able to amplify the effects of opioids.
Some common symptoms include intense anxiety, tremors, depression, insomnia, and increased irritability. Other formulations of Phenergan which include codeine or dextromethorphan will produce additional withdrawal symptoms, as both of those combination drugs are highly addictive as well. Obtaining medical help is advised if someone is expecting to go through Phenergan withdrawal.
Withdrawal Timeline: 1 to 2 Weeks
The exact withdrawal timeline for Phenergan is difficult to pin down as there have been very few clinical studies of the withdrawal duration. The half-life of promethazine may give us a rough idea for the timeline. Having a fairly long half-life of between 12 and 15 hours, this drug may produce acute withdrawal symptoms for between 7 to 14 days and these will most likely be quite mild. The post-acute phase may last much longer, possibly several months after the last time someone used the drug.
LSD is an extremely potent hallucinogen that can produce an extremely intense high, or trip, that lasts many many hours. LSD works primarily through stimulation of the serotonin neurotransmitter system of the brain and it interacts with a multitude of serotonin receptor subtypes. The exact way these interactions produce the experience of an “acid trip” is unknown, but it is an extremely potent drug.
Common symptoms of serotonin agent withdrawal include a deep depression, increased anxiety, insomnia, and antisocial tendencies. There is little to no documentation of cases of LSD withdrawal. The nature of LSD lends itself to episodic use, and not necessarily binging or consistent, daily use. On the other hand, if it does produce withdrawal symptoms, we can look at other serotonin agents to get an idea of what the symptoms may be.
Withdrawal Timeline: Probably Less Than 1 Week
Again, with almost no clinical studies to draw from, the timeline for LSD withdrawal (if in fact, it is a condition) is completely unknown. We are unaware of any documented cases of this condition. It has a fairly short half-life of 3 hours which means that symptoms should not last too long; probably a few days at most. Again, this is purely speculation and not to be taken as fact.
Bath salts are a slang term for a class of drugs known more formally as synthetic cathinones. They are a man-made, and much more potent, version of the drug cathinone which is found in the Khat plant of Africa and the Middle East. Being closely related to ephedrine, from which methamphetamine is derived, cathinone is a stimulant that can be highly addictive. Bath salts work by increasing the levels of the 3 major neurotransmitters dopamine, serotonin, and norepinephrine. They work in a similar way as both amphetamines and methamphetamines and produce similar withdrawal symptoms.
The symptoms of bath salt withdrawal include fatigue, depression, anxiety, cravings for bath salts, clouded or disorganized thinking, fatigue, and lethargy. Sleep issues are common as well, usually beginning as hypersomnia that is followed by insomnia.
Withdrawal Timeline: 7 to 10 Days
The timeline for withdrawal from bath salts has not been closely studied in a controlled environment. Additionally, due to purity differences between batches, it is extremely difficult to even quantify the amount of synthetic cathinone someone is actually doing when they use bath salts. Due to their structural similarity with other, better-understood drugs, it may be possible to liken the withdrawal duration to that of methamphetamine at roughly 7 to 10 days. One particular synthetic cathinone, methcathinone, is almost identical to methamphetamine in structure. That being said, there can still be substantial differences in effect even if two compounds have very similar structures, so further research is needed to better describe the withdrawal timeline.
Spice is a blanket term for a variety of synthetic cannabinoids which are synthetic analogs of the active ingredient in marijuana, known as delta-9-tetrahydrocannabinol (THC). These synthetic versions may be much more potent than natural THC and may be able to produce more severe withdrawal symptoms. That being said, spice sold in the US is labeled as “not for human consumption” to avoid drug laws, although this also means it is not subject to quality or potency regulation. Due to this, the quality of these synthetic cannabinoids can vary greatly between suppliers.
The symptoms of spice withdrawal are very similar to marijuana withdrawal and include insomnia, increased anxiety, depression, stomach pain, increased irritability, shakiness, headaches, and clouded or disorganized thinking. These symptoms may not be very severe, but they often last a long time.
Withdrawal Timeline: 2 to 3 Weeks
The timeline for spice withdrawal is difficult to describe accurately, as the active ingredients in spice change rapidly, as does the ratio of active ingredient to filler between batches. They are synthetic cannabinoids, and when one becomes illegal, manufacturers simply put a newer, not-yet-illegal cannabinoid in place of the recently illegalized one. Because of this, there is no way to know for sure what the exact timeline is. For a rough guide, we can trace the marijuana withdrawal timeline which is roughly 3 to 4 weeks depending on how much someone used. The worst symptoms should be gone by week two, with an almost complete resolution by the end of a month. Post-acute symptoms may persist for several more weeks or months, although these will decline in intensity over time.