Long-acting opioids (methadone): 24 to 48 hours from last dose
Symptoms progress over time, and vary with the patient, their health status, their frequency, duration, and amount of use, and any concurrent substance use
Within the first 6 to 12 hours: cravings, anxiety, anorexia, irritability, tachypnea, hypertension, sweating, yawning, lacrimation, rhinorrhea, piloerection, tremor, and dilated pupils
Within 24 to 48 hours: nausea, vomiting, insomnia, tachycardia, abdominal cramps, and involuntary muscle spasms and limb movements
Persistent symptoms usually resolve over 5 to 7 days
However, cravings, depression, irritability, and dysphoria may persist for weeks to months
Precipitated withdrawal
Occurs when buprenorphine or another partial opiate agonist is started while there is a full agonist still active