Opioid withdrawal: symptoms, treatment and getting help in the UK

Opioids are a group of strong medicines that relax the body and can help with pain. Guy's and St Thomas' NHS Foundation Trust gives codeine, morphine and heroin as examples. If you use opioids for a long period, your body adapts to their presence, and there is a risk of becoming dependent on them. When you reduce the dose or stop, you may get withdrawal symptoms.

Withdrawal can affect people who have been prescribed opioids for pain as well as people who use heroin. NICE guideline CG52 covers opioid detoxification for adults and young people over 16 who are dependent on opioids, with the aim of helping them stop using drugs and improving physical and mental health, relationships and employment.

The hospital trust's patient information lists flu-like symptoms such as muscle aches, sweating and chills; digestive problems such as feeling sick, being sick and diarrhoea; effects on mood such as anxiety, irritability and depression; and effects on the body such as widened pupils, yawning, and an increased heart rate and blood pressure.

The NHS methadone page lists heroin withdrawal symptoms as feeling restless or anxious, a runny nose, sweating, feeling or being sick, diarrhoea, shaking and muscle cramps. The pages read for this guide do not give a precise timeline for how long withdrawal lasts, so ask your treatment service what to expect for the opioid you use.

• Muscle aches, sweating, chills, restlessness.

• Nausea, vomiting and diarrhoea.

• Anxiety, irritability and low mood.

• Widened pupils, yawning, runny nose, faster pulse.

• Cravings, which treatment aims to reduce.

The NHS explains that treatment depends on personal circumstances and the drug used, and may include talking therapies such as CBT, treatment with medicines, detoxification and self-help. For people dependent on heroin or another opioid, a substitute medicine such as methadone or buprenorphine may be offered, so that treatment can proceed without worrying about withdrawing or buying street drugs.

The NHS describes two main ways of using methadone for heroin dependence: maintenance therapy, where you switch from heroin to methadone and stay on it, usually long term, and detox, where you switch to methadone and then gradually withdraw until you are free from both. Methadone for heroin dependence is available on prescription only, from a local drug treatment service or GP, and it is addictive, so dose reductions need to be slow and discussed first.

In hospital, the trust says an assessment includes a health and social history, physical checks such as pulse and blood pressure, a urine test to confirm which drugs are in use, and a care plan that includes continuing opioid substitution therapy in the community after discharge. A low dose is prescribed at first, and it may take several weeks to find the most effective dose.

The NHS says a GP may be a good place to start, and that they will usually refer you to the local drug service. If you are not comfortable talking to a GP you can approach a local drug treatment service yourself. Charities and the NHS provide most drug treatment, and there are also private drug and alcohol treatment organisations that you would pay for.

At a first appointment, staff will ask about your drug use, work, family and housing situation, and may ask for a urine or saliva sample. You will be given a keyworker and agree a treatment plan. People who want to reduce painkillers prescribed for pain should speak to their prescriber rather than stopping suddenly.

The trust stresses that while having opioid substitution therapy it is important not to take heroin or other non-prescribed drugs, including alcohol, because this can lead to overdose. The NHS says it is best to avoid alcohol while taking methadone because it can cause very serious side effects, and that grapefruit and grapefruit juice can affect how methadone works.

Call 999 for anyone who is unresponsive or struggling to breathe after taking opioids. These pages do not describe overdose management in detail, and your drug service can advise on carrying naloxone.

Drug treatment in the UK is free through NHS-commissioned local services and charities, with GP involvement. Private detox and residential rehabilitation are available for a fee, and the NHS notes that you would need to pay for private treatment. Whichever route you take, continuing care after detox matters because tolerance falls and relapse carries overdose risk.