What is an opioid?

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

Your doctor might prescribe an opioid for the short-term treatment of moderately severe or severe pain, such as pain after surgery or an injury. They also help people manage pain caused by cancer and terminal illness.

What are opioid withdrawal symptoms?

Opioid withdrawal symptoms are unpleasant effects that can occur if you suddenly stop or suddenly reduce your dose of opioid medicines. They can also happen if you take another medicine that blocks the opioid from working.

Opioid withdrawal symptoms can make you feel unwell, so it's important to plan how you come off your medicine. It's best to do this slowly and carefully, with guidance from your doctor.

Withdrawal symptoms are similar for all opioids. They 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. These include joint, bone or muscle pain, abdominal (stomach area) pain or headaches.

Why 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 get less benefit from your opioid pain medicine, and have more risk 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.

About 4 in 5 people with chronic non-cancer pain who take opioids long term will experience at least one harmful side effect.

How should I stop taking my opioid medicine?

It's important to review your medicines with your doctor regularly. They can help you taper your opioid medicine. This means slowly reducing the dose under guidance from your doctor.

Tapering your medicine can help reduce withdrawal symptoms or prevent them occurring.

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
• you've been taking opioids for more than 6 months
• you reduce your dose too quickly

Withdrawal symptoms can happen after one month of taking an opioid every day.

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 have been taking an opioid medicine from time to time or for a very brief period, you are not likely to experience withdrawal symptoms.

How long do withdrawal symptoms last?

How long it takes for opioid withdrawal symptoms to start — and how long they last — depends on the type and dose of opioid you are taking and how long you've been using it for.

For example, if you're taking prescribed opioids that work quickly, such as oxycodone, or if you're using the drug heroin, you are likely to experience withdrawal symptoms 6 to 12 hours after taking your last dose. The symptoms are usually at their worst after about 2 days after stopping, and settle down after a week or so.

If you're taking methadone or other opioids that are released slowly in your body, you're likely to experience withdrawal symptoms 1 or 2 days after taking your last dose. The symptoms are usually not as bad as for fast-acting opioids, but they can last for 3 to 6 weeks.

How can I prevent opioid withdrawal symptoms?

There are ways to relieve withdrawal symptoms and help you feel more comfortable. Some people can avoid withdrawal symptoms by reducing their dosage carefully and gradually.

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.

This 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?

Tapering opioid medicines with your doctor's guidance is the best way to avoid unpleasant withdrawal symptoms. But if you do experience symptoms, remember they are temporary and not usually dangerous. Your doctor can help you manage them.

Strategies to manage opioid withdrawal:

• Drinking plenty of water will help you avoid dehydration. This can happen with opioid withdrawal, especially if you sweat, have nausea or vomit.
• Mind-body therapies such as yoga, relaxation and mindfulness can help manage your pain 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. Ask your doctor about how to gradually decrease your dose — this will make the process more manageable.

Medicines used to manage opioid withdrawal

Some medicines can be useful in managing the symptoms of opioid withdrawal and making the process more comfortable for you. These include:

• 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

Methadone and buprenorphine are opioids that 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 help you succeed in coming off opioids when you no longer need them.

When should I see a doctor?

It's very important to speak to your doctor if you are considering stopping or reducing your opioid medicines. It's safer and more effective to go through this process with a doctor's guidance.

If you are feeling unwell with withdrawal symptoms, or if you feel that your tapering plan is not going well, see your doctor as soon as possible. They can provide you with strategies to reduce these effects. They can also help you find support if you're worried or overwhelmed.

Resources and support

Check out this guide and action plan for reducing your opioid dose.

If your friend or relative is going through opioid withdrawal, read the Drug and Alcohol Office booklet to find out how to support them.

Call the National Alcohol and Other Drug Hotline on 1800 250 015 to speak to someone about opioid withdrawal. (Available 24 hours a day, 7 days a week).

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.