Opioid Withdrawal

Opioid withdrawal usually follows a recognisable pattern: symptoms begin, become more intense, then start to ease. The timing depends on the opioid, dose and length of use, and some people continue to experience low mood, poor sleep and cravings after the physical symptoms settle.¹

This page explains what opioid withdrawal feels like, how long it tends to last, and why it is something to go through with support rather than alone. It covers prescription and pharmacy opioids such as codeine, dihydrocodeine, tramadol and other prescribed painkillers. Heroin is also an opioid, and withdrawal from it follows a similar pattern; we cover that separately on our page on heroin withdrawal.

If you are still working out whether opioid use has become a problem, rather than only how to come off it, our page on opioid addiction may be a better place to start.

For some people, withdrawal comes as a shock, because the opioid was prescribed, or bought legally, and taken for pain. Withdrawal can still happen in that situation. It does not mean someone has done something wrong. It means the body has adapted.

How long does opioid withdrawal last?

Opioid withdrawal follows a recognisable shape, though the exact timing depends on the specific opioid, how long it has been used, and the usual dose. For shorter-acting opioids it generally moves through these stages:¹

• First 12 to 24 hours: early symptoms begin, often anxiety, restlessness, a runny nose and difficulty sleeping.
• Days two to three: symptoms are usually at their most intense, with muscle aches, sweating, stomach cramps, nausea and strong cravings.
• Days four to seven: the physical symptoms begin to ease, though sleep and energy can still be disrupted.
• Weeks afterwards: a longer psychological phase can follow, with low mood, poor sleep, low motivation and cravings that come and go. This is sometimes called post-acute withdrawal.

Longer-acting opioids tend to start later and last longer. The psychological phase is the brain re-adjusting after a period of opioid use, and it is one reason that stopping on its own often does not hold. Getting through the physical withdrawal is a beginning, not the finish.

What opioid withdrawal feels like

Withdrawal tends to come in two stages: the physical symptoms first, followed by the longer psychological tail described above. The early physical symptoms often feel like a heavy flu. People commonly describe:

• Aching muscles and bones
• Sweating, chills and a runny nose
• Stomach cramps, nausea and diarrhoea
• Restlessness and difficulty sleeping
• Anxiety, low mood and strong cravings

Opioid withdrawal is genuinely hard to get through, but it is not usually life-threatening in the way that alcohol or benzodiazepine withdrawal can be. The discomfort can still be intense. Vomiting, diarrhoea, poor sleep, anxiety and cravings can lead people to return to using before symptoms pass. That is not a lack of willpower. It is the body and brain trying to make the symptoms stop.

Why stopping suddenly can be risky

If you have been taking opioids for more than a few weeks, it is best not to stop suddenly on your own.

After a period of regular use, stopping abruptly or cutting down too quickly can bring on withdrawal that is difficult to manage. The NHS advises that if you have been taking opioids long term and want to stop, you should speak to your GP, who can help you reduce safely.²

The main physical risk comes from heavy vomiting and diarrhoea, which can cause serious dehydration and dangerous changes in blood chemistry. If left untreated, these complications can in rare cases become life-threatening. They are preventable with proper medical care, which is the central reason to come off opioids with support rather than alone.⁴

There is one further risk that is important to understand. During withdrawal, the body quickly loses its tolerance to opioids. If someone stops, goes through some withdrawal, and then returns to the dose they were taking before, that dose can now be far too strong for the body to handle, which can lead to overdose.² This is part of why coming off opioids is safer done gradually and with support than alone.

If you are struggling or unsure where to turn, contact your GP, call NHS 111, or speak to a pharmacist.

How opioid withdrawal is managed

Opioid withdrawal is usually managed through a planned, supervised reduction rather than stopping all at once. In some cases medication such as buprenorphine or methadone may be used under specialist supervision. The right approach depends on the opioid, the dose, physical and mental health, and whether other substances are involved.³

Where it is needed, this can be done as part of a medically supervised detox, with clinical staff able to ease symptoms and keep the process safe. You can read more about what that involves on our page on medically supervised detox.

Because the psychological side of withdrawal lasts longer than the physical side, getting through detox is not the same as treating the underlying problem. Detox settles the body; the work of understanding what the opioid had come to manage usually comes next. We cover what that involves on our page on opioid rehab.

Helping someone through opioid withdrawal

If you are supporting someone going through withdrawal, the most useful things are often simple: helping them stay hydrated, keeping the environment calm, and encouraging them to stay in contact with a GP or a professional service rather than trying to manage it alone. The cravings and low mood can be hardest in the days after the physical symptoms ease, which is often when support matters most.

If they become very drowsy, confused, dehydrated, hard to wake, or you are worried they may have taken opioids or other substances again, seek urgent medical help.