Overview of opioid withdrawal

Opioid withdrawal is very rarely life threatening, but often very distressing for the patient and those close to them; avoiding withdrawal can be a principal cause of relapse. For symptoms and signs of withdrawal, see Symptoms and signs of opioid withdrawal.

Planned opioid withdrawal is rarely successful as a standalone treatment for opioid dependence; treatment with buprenorphine or methadone as part of medication-assisted treatment of opioid dependence (MATOD) is much more effectiveGowing, 2017.

Note: Managed (planned) opioid withdrawal as a sole treatment is rarely successful.

Pregnant individuals are advised not to undergo opioid withdrawal; refer to a drug and alcohol specialist service to discuss options. MATOD is recommended as it is safer for the patient and the fetusCentre for Alcohol and Other Drugs, 2014Manning, 2018.

Withdrawal from opioids with unusual pharmacokinetics (eg fentanyl, methadone) is complex; seek specialist advice.

If a patient chooses managed withdrawal after discussion of the options, ensure that withdrawal takes place in a safe environment. For advice on how to assess safety of an environment for managed withdrawal, see Choice of setting for planned withdrawal management. For advice on safe prescribing and supply during withdrawal in a home setting, see Safe prescribing and supply during planned substance withdrawal.

Relapse after withdrawal can be life threatening because the patient’s tolerance to opioids is decreased. All patients undergoing opioid withdrawal should be given take-home naloxone, and significant others (partner, family, friends) should be instructed on how to use it and advised to call an ambulance if overdose occurs.