What are the time-line differences for the Opioid Withdrawal Severity Scale (OWSS)?
Date created:
Monday, December 8, 2025
Opioid Withdrawal Reference Table
1. FENTANYL (illicit inhaled/smoked/IV equivalent patterns)
Morphine Equivalent Dose¹ : 1 mcg/hr of Fentanyl is 2.4 mg/day of Morphine
Parameter | Typical Range |
Onset | 6–12 hrs |
Peak | 24–48 hrs |
Duration | 5–7 days |
Notes | Fast, spiking, unpredictable |
2. HYDROMORPHONE – Immediate Release (Dilaudid)
Morphine Equivalent Dose¹ : 1 mg/day of Hydromorphone is 5 mg/day of Morphine
Parameter | Typical Range |
Onset | 6–12 hrs |
Peak | 12–24 hrs |
Duration | 2–5 days |
Notes | Sharp, intense, short duration |
3. OXYCODONE – Immediate Release (Percocet)
Morphine Equivalent Dose¹ : 1 mg/day of Oxycodone is 1.5 mg/day of Morphine
Parameter | Typical Range |
Onset | 8–14 hrs |
Peak | 48–72 hrs |
Duration | 4–6 days |
Notes | Classic short-acting withdrawal |
4. MORPHINE – Immediate Release (Mosinar / Statec)
Morphine Equivalent Dose¹ : 1 mg/day of Morphine is 1 mg/day of Morphine
Parameter | Typical Range |
Onset | 8–12 hrs |
Peak | 36–72 hrs |
Duration | 3–5 days |
Notes | Moderate, short-acting |
5. CODEINE – Immediate Release (Tylenol #2,#3,#4)
Morphine Equivalent Dose¹ : 1 mg/day of Codeine is 0.15 mg/day of Morphine
Parameter | Typical Range |
Onset | 6-12 hrs |
Peak | ~24 hrs |
Duration | 1–3 days |
Notes | Usually mild to moderate |
6. METHADONE / METHADOSE (0.1mg/ml while Methadose is commonly 1mg/ml)
(Methadone is extremely slow to eliminate.)
Morphine Equivalent Dose¹ : 1 mg/day of Methadone/Methadose is 4.7 mg/day of Morphine
Parameter | Typical Range |
Onset | 24–36 hrs |
Peak | 72–96 hrs |
Duration | 10–21 days |
Notes | Longest, heaviest withdrawal |
7. MORPHINE – Extended Release (MS Contin)
(note: uses timed-release coated beads over 8–12 hours)
Morphine Equivalent Dose¹ : 1 mg/day of Morphine is 1 mg/day of Morphine
Parameter | Typical Range |
Onset | 12–24 hrs |
Peak | 48–96 hrs |
Duration | 4–7 days |
Notes | Stronger, slower-release version |
8. MORPHINE – Extended Release (Kadian / M-Eslon / SROM)
(Kadian’s long duration comes from the beads, not the drug half-life.)
Morphine Equivalent Dose¹ : 1 mg/day of Morphine is 1 mg/day of Morphine
Parameter | Typical Range |
Onset | 8–24 hrs |
Peak | 36–72 hrs |
Duration | 3–7 days |
Notes | Similar to other MS Contin |
9. OXYCODONE – Controlled Release (OxyContin)
(uses timed-release coated tablets over 8–12 hours)
Morphine Equivalent Dose¹ : 1 mg/day of Oxycodone is 1.5 mg/day of Morphine
Parameter | Typical Range |
Onset | 12–24 hrs |
Peak | 72–96 hrs |
Duration | 6–8 days |
Notes | Longer buildup and taper |
10. HYDROMORPHONE – Extended Release (Hydromorph Contin)
(uses timed-release coated beads over 8–12 hours)
Morphine Equivalent Dose¹ : 1 mg/day of Hydromorphone is 5 mg/day of Morphine
Parameter | Typical Range |
Onset | 12–24 hrs |
Peak | 24–48 hrs |
Duration | 4–7 days |
Notes | Slow escalation, longer tail |
11. CODEINE – Extended Release (Codeine Contin)
(Used far less now, but exists.)
Morphine Equivalent Dose¹ : 1 mg/day of Codeine is 0.15 mg/day of Morphine
Parameter | Typical Range |
Onset | 12–24 hrs |
Peak | 24–48 hrs |
Duration | 3–5 days |
Notes | Usually mild to moderate |
¹ Morphine equivalency calculator, source: https://northwestpainguidance.org/opioidmedcalculator/
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