Post Acute Withdrawal Syndrome: The Symptoms & Treatment of PAWS

When a person suffering from opiate use disorder (OUD) stops using opioids, that person goes through acute withdrawal symptoms from about seven days to two weeks. After that period, lingering symptoms become Post-Acute Withdrawal Syndrome (PAWS). PAWS symptoms can be physical, psychological or social and can last as long as two years or even indefinitely. 

Post-Acute Withdrawal Symptoms

There is no specific agreed-upon cause of PAWS. In general, it stem either from disturbances in the nervous system or deteriorated brain function from opioid use or the stress of living without opiates causes these symptoms to occur. 

Stages of Withdrawal Timeline
Stages of Withdrawal Timeline

Unfortunately, PAWS can come and go unexpectedly. That’s why it’s often the best course of action to enlist the help of professionals to identify post-acute withdrawal symptoms and then gain the medication or coping skills necessary to heal from them.

Some post-acute withdrawal symptoms include:

  • Irritability and hostility
  • Depression
  • Low energy and fatigue
  • Withdrawal insomnia
  • Fatigue
  • Memory lapses
  • Emotional numbness
  • Anxiety
  • Increased susceptibility to emotional and physical pain
  • Intense cravings to use opiates
  • Lack of focus
  • Lack of sexual desire or the ability to experience pleasure
  • Inexplicable chronic pain

Others may experience different withdrawal symptoms, but these are the most common. People can experience PAWs whether the opioid was a prescription pain pill, heroin or even more potent opioids like fentanyl or ISO drug.

Tips For Living With PAWS

Recovery is an ongoing process even for those who complete a medication-assisted treatment program. Keeping up the healthy habits help a person work through about with PAWS safely and successfully. These include:

"PAWS can be frustrating, but by being able to relax and enjoy the good parts of life will get you through the difficult days. Believing in yourself and your ability to overcome detox is the biggest part of getting to the other side."

Isha Kothari PA-C, PA at Symetria's Naperville Suboxone Clinic

Medication Options for PAWS

If you or a loved one are experiencing post-acute withdrawal symptoms, the medication Suboxone may help. (See How Does Suboxone Work?).

Comfort medicines can also be prescribed as-needed. For example:

These medications also come with side effects and some can be habit-forming. Addiction doctors help you weigh the benefits of any medications against your symptoms and adjust until you feel your best.

If PAWS symptoms are impacting your function or quality of life, consider involving an addiction doctor to start feeling better. 

Get Help with Post-Acute Withdrawals

Still Have Questions?

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What are the alternatives to using Suboxone or other medication for relief from opiate PAWS?

Isha Kothari, PA-C, PA
Isha Kothari, PA-C, PA
Reply to  Robert

Comfort Medications are prescribed based on patients’ withdrawal symptoms such as clonidine, Zofran, Trazadone, benzyl, and in some cases, a muscle relaxer.


How can I keep my nerves calm while going thru withdrawals from fentanyl? I’m going to be starting soon because I want off. I know not to quit cold turkey. A hospital put me on Suboxone but I didn’t wait the full 72hrs and the Suboxone mixed wrong with what I still had in my system and I lost my mind for a bit, but that only lasted 5 days but I relapsed shortly after. Can I taper myself off of opioids? I keep having the fear it’s going to end up bad like the first time.

Reply to  Monica

What happened to you was precipitated withdrawal. You need to wait several days and be in medium to heavy withdrawal from fentynal to take suboxone. Tapering can help. Then take suboxone and taper that. Suboxone helps but honestly the withdrawal symptoms are milder but last longer.

Symetria doctors follow rigorous sourcing guidelines and cite only trustworthy sources of information, including peer-reviewed journals, court records, academic organizations, highly regarded nonprofit organizations, government reports and their own expertise with decades in the field.

Post–Acute Withdrawal Syndrome, Relapse Prevention, and Homeopathy | Alternative and Complementary Therapies. (2021). Retrieved July 16, 2022, from Alternative and Complementary Therapies website:

Haskell, B. (2022). Identification and Evidence-Based Treatment of Post–Acute Withdrawal Syndrome. The Journal for Nurse Practitioners18(3), 272–275.

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