What is an opioid?

Opioids are strong medicines your doctor may prescribe to help you manage your pain.

Your doctor might prescribe an opioid medicine to:

• treat acute (short-term) pain, such as pain after surgery or an injury
• treat chronic pain (pain lasting more than 3 months), such as pain caused by cancer
• reduce pain in palliative or end-of-life care
• manage addiction to other opioids — your doctor may prescribe methadone as a replacement for more harmful opioids such as heroin

What is opioid withdrawal?

Opioid withdrawal happens when you stop taking opioids after you have been taking them regularly. It can also happen if you take another medicine that blocks the opioid from working.

If you take opioids for a period of time, your body gets used to them. When you stop or cut down, you may experience withdrawal symptoms as your body adjusts.

Opioid withdrawal is rarely life-threatening, but it can be very uncomfortable and distressing for you or people close to you.

What are opioid withdrawal symptoms?

Opioid withdrawal symptoms may make you feel like you have a bad flu or stomach upset.

Withdrawal symptoms can include:

• hot and cold flushes, sweating and 'goosebumps'
• feeling anxious or irritable
• cravings for opioids
• nausea, vomiting, diarrhoea and lack of appetite
• tremor (shaking)
• watery eyes, runny nose and sneezing
• yawning and disturbed sleep

You may also experience different types of pain during opioid withdrawal, such as joint, bone or muscle pain, abdominal pain or headaches.

Who is most likely to experience opioid withdrawal symptoms?

You are more likely to have opioid withdrawal symptoms if:

• you are taking a high dose of opioids
• you've been taking opioids for a long time
• you reduce your dose too quickly

Even if you take an opioid medicine exactly as your doctor prescribes, you can become dependent on it. This means you will experience withdrawal symptoms if you suddenly stop.

If you take an opioid medicine only occasionally or for a very brief period, it's unlikely you will experience withdrawal symptoms.

How long do withdrawal symptoms last?

If you have opioid withdrawal, symptoms will usually peak around 2 to 3 days after you stopped taking opioids, and will usually resolve within 5 to 7 days.

The exact timing and duration of your symptoms will depend on the type and dose of opioid you are taking and how long you've been using it.

For example, if you are taking prescribed opioids that work quickly, such as oxycodone, or if you are using the drug heroin, you are likely to experience withdrawal symptoms 6 to 12 hours after taking your last dose.

If you are taking methadone or other opioids that are released more slowly in your body, you are likely to experience withdrawal symptoms about 1 to 3 days after taking your last dose. The symptoms are usually not as severe as for fast-acting opioids, but they may last for a few weeks.

How should I stop taking my opioid medicine?

Always talk to your doctor or pharmacist before you stop or reduce your opioid medicines.

If you want to stop taking your opioid medicine, speak with your doctor for advice. Your doctor will slowly lower your dose so you can reduce your chance of withdrawal symptoms.

This process is called tapering. Your doctor will work with you to create a day-by-day or week-by-week plan to reduce your dosage.

Your plan will depend on how urgent it is for you to stop taking opioids and how long you've been taking them. Your doctor may recommend other medicines to help you manage any opioid withdrawal symptoms.

How can I manage opioid withdrawal symptoms?

If you do develop opioid withdrawal symptoms, your doctor can prescribe medicines or give you tips to help manage your symptoms.

If you do develop withdrawal symptoms, remember that they are temporary and not usually dangerous.

Here are some tips to manage opioid withdrawal:

• Drink plenty of water to help you avoid dehydration. This can happen with opioid withdrawal, especially if you sweat, experience nausea or vomit.
• Mind-body therapies such as yoga, relaxation and mindfulness can help improve your mood, reduce agitation and cravings while you are going through opioid withdrawal.
• It is important to ask for help. Let your family and friends know that you may need some extra support while going through opioid withdrawal.
• Discuss your treatment options and strategies for dealing with withdrawal symptoms with your doctor.

Don't let fear of withdrawal prevent you from stopping or reducing your opioid use. Speak with your doctor about how you can prepare and manage your symptoms.

Medicines used to manage opioid withdrawal

Your doctor may prescribe you some of these medicines to help you manage your symptoms:

• clonidine — to treat symptoms such as sweating, irritability, fast heartbeat and high blood pressure
• diazepam — to reduce feelings of irritability and anxiety
• metoclopramide — to help you manage nausea or vomiting
• pain relief medicines, such as paracetamol or ibuprofen — to relieve headaches, muscle pain and joint pain
• loperamide — to stop or reduce diarrhoea

Your doctor may prescribe these medicines for about a week, depending on your circumstances.

In some cases, your doctor may prescribe methadone and buprenorphine. These opioids can be used to replace other more harmful opioids. Your doctor might prescribe these for an extended period of time to control your symptoms and minimise harmful opioid use, and may discuss stopping them at a later date.

Should I try to come off my opioid medicine?

If you have chronic (long-term) pain that is not caused by cancer, over time, you will experience less benefit from opioid pain medicine, and have more chance of harm. It's a good idea to talk to your doctor about coming off opioids.

Taking opioids can lead to:

• side effects such as nausea, constipation and drowsiness
• tolerance — where you need larger amounts of the opioid to get the same effect
• dependence — where you develop withdrawal symptoms if you stop taking the medicine
• life-threatening breathing problems
• worse pain, as your brain becomes more sensitive to pain

As your dose of opioid medicine increases, so does the risk of harmful side effects.

When should I see a doctor?

You should see your doctor if you:

• are considering stopping or reducing your opioid medicines
• are feeling unwell with withdrawal symptoms
• have a tapering plan and you think it's not working
• want support to overcome an addiction
• are feeling worried or overwhelmed

Your doctor can help you find strategies to cope.

Resources and support

• The Alcohol and Drug Foundation has a free Path2Help program to help you find tailored support if you have been impacted by alcohol and other drugs.
• NPS MedicineWise has a guide and action plan to help you successfully reduce your opioid dose.
• Call the National Alcohol and Other Drug Hotline on 1800 250 015 to speak to someone about opioid withdrawal.
• Call healthdirect on 1800 022 222 (known as NURSE-ON-CALL in Victoria) for more information and advice. A registered nurse is available 24 hours a day, 7 days a week.

Other languages

The Alcohol and Drug Foundation has translated resources in many community languages.

Information for Aboriginal and/or Torres Strait Islander peoples

The Alcohol and Drug Foundation has resources about alcohol and other drugs for Aboriginal and/or Torres Strait Islander people.