Drug withdrawal is what the body and mind go through when someone who has been using a drug regularly stops or cuts down. Symptoms depend on the drug: heroin brings sweating, aches, vomiting and diarrhoea, syabu brings a crash of exhaustion and low mood, and cannabis brings irritability and poor sleep. Most withdrawals are miserable without being life-threatening. Alcohol, benzodiazepines and sleeping pills are the exceptions: stopping them suddenly can cause seizures, so they need a doctor involved.
In Malaysia, people often call withdrawal "sakau". This guide covers what is normal, what is dangerous and what to do.
Why withdrawal happens
With regular use, the brain and body adjust to having the drug there. Take it away and that adjusted system is left without it for a while, which is what produces the symptoms. Withdrawal is a sign of physical dependence. It says nothing about a person's character.
Getting through withdrawal is the start of treatment. The World Health Organization's guidelines note that withdrawal management on its own is unlikely to lead to lasting abstinence, so the psychological work that follows matters as much.
Withdrawal by substance
These timelines are typical ranges from clinical guidelines. They vary with how much someone used, for how long, and what else they took.
Heroin and other opioids
- Starts 8 to 24 hours after the last dose of heroin, and lasts 4 to 10 days. With methadone it starts later, 12 to 48 hours, and lasts 10 to 20 days.
- Early signs: anxiety, restlessness, muscle aches, runny nose, watery eyes, sweating, yawning and poor sleep.
- Later signs: stomach cramps, diarrhoea, nausea, vomiting and goosebumps.
Opioid withdrawal is very uncomfortable but not usually life-threatening. The risks are dehydration from vomiting and diarrhoea, and breathing vomit into the lungs. The biggest danger comes afterwards. Withdrawal lowers tolerance, and MedlinePlus notes that most opioid overdose deaths happen in people who have just been through detox, because they go back to a dose their body can no longer handle.
Methadone and buprenorphine are medicines that ease opioid withdrawal and cravings. In Malaysia, methadone has been given at government hospitals and klinik kesihatan since 2005 as part of a Ministry of Health programme. Our page on heroin and opioid addiction treatment explains the options.
Syabu (methamphetamine) and other stimulants
Amphetamine-type stimulants, mostly syabu, made up 139,909 of the 192,857 people recorded by the National Anti-Drugs Agency (AADK) in 2024, about seven in ten.
- Symptoms: depression, anxiety, irritability, aches, sleeping a great deal or badly, hunger, poor concentration and strong cravings.
- According to NIDA, symptoms peak 2 to 3 days after the last use and can last about a week.
- Low mood, anxiety and cravings can carry on for several months.
The WHO guidelines also note that people who use large amounts of methamphetamine can become paranoid and start seeing or hearing things that are not there.
Cannabis (weed, ganja)
AADK recorded 7,121 cannabis cases in 2024, up 63.4 per cent on the year before. Heavy or long-term users can get withdrawal symptoms when they stop.
- Symptoms: irritability, anger, anxiety, restlessness, low mood, poor sleep, strange dreams, loss of appetite, headaches and sweating.
- Starts 1 to 2 days after the last use, and is worst between days 2 and 6.
- Usually settles in 2 to 3 weeks, although poor sleep can last for months.
Benzodiazepines and sleeping pills
This group includes many prescription sedatives, and illegal pills sold as Erimin 5, which a Universiti Sains Malaysia analysis found contain nimetazepam or etizolam, both benzodiazepine-type drugs. Our article on sleeping pills and cough syrup misuse covers how dependence on them starts.
- Symptoms: anxiety, poor sleep, restlessness, irritability, poor concentration and memory, muscle tension and aches, sweating, confusion and a feeling that things are not real.
- With short-acting tablets, withdrawal starts 1 to 2 days after the last dose and lasts 2 to 4 weeks or longer. With long-acting ones it starts 2 to 7 days after and lasts 2 to 8 weeks or longer.
The US Food and Drug Administration warns that stopping benzodiazepines suddenly, or cutting the dose too fast, can cause seizures that can be life-threatening. The safe way off is a slow, planned reduction under a doctor, which the UK medicines regulator says can take weeks or months.
Ketum
NIDA describes ketum (kratom) withdrawal as mild to moderate in most studies, with pain and sleep problems among the main complaints. Some people get it much worse. In a Universiti Sains Malaysia study of 293 ketum drinkers in the northern states, a third reported severe withdrawal, and people drinking four or more glasses a day were more likely to be among them. NIDA also notes that some ketum users in Malaysia use heroin or syabu as well, which changes the risks.
Alcohol
Alcohol withdrawal is the most dangerous on this list. Seizure risk is highest 24 to 48 hours after the last drink, and delirium tremens, a state of severe confusion, can appear at 48 to 72 hours. About 5 to 10 per cent of people who develop delirium tremens die from it. Our full guide to alcohol withdrawal explains the timeline.
When to call 999
Call 999 straight away if someone who has stopped or cut down on any drug or alcohol:
- has a seizure (fit)
- is confused, does not know where they are, or is seeing or hearing things that are not there
- is very drowsy, breathing slowly or cannot be woken
- talks about ending their life, or threatens to harm someone
Do not wait to see if it passes. If they are vomiting or have diarrhoea and cannot keep fluids down, get medical help the same day.
How to help someone with drug withdrawal
- Find out what they have been taking, how much and for how long, and tell the doctor.
- Do not let anyone stop alcohol, benzodiazepines or sleeping pills suddenly without medical advice.
- Keep them drinking water, offer simple food, and keep the room quiet and calm.
- Stay with them, or make sure someone else is, during the first few days.
- If they used heroin or other opioids, they need to know their tolerance has dropped and that their old dose could now kill them.
- Expect irritability and low mood. They come from the withdrawal itself, so try not to take them personally.
Why supervised withdrawal helps
In medically supervised withdrawal, a doctor assesses the risk first, then the team watches for danger signs around the clock and treats symptoms as they come. It is safer for the substances that can cause seizures, and more bearable for the rest. The WHO guidelines note that care given with empathy at this stage helps build trust between the patient and the people treating them.
Our drug rehabilitation centre page explains how withdrawal fits into a longer stay.
Common questions
How long do drug withdrawal symptoms last?
It depends on the drug. Heroin withdrawal usually lasts 4 to 10 days, syabu withdrawal peaks at 2 to 3 days and eases over a week, and cannabis withdrawal usually settles in 2 to 3 weeks. Benzodiazepine withdrawal can last weeks or longer, and low mood and cravings can carry on for months after any of them.
Can you die from drug withdrawal?
Withdrawal from alcohol, benzodiazepines and sleeping pills can cause seizures, and alcohol withdrawal can cause delirium tremens, both of which can kill. Opioid withdrawal is rarely deadly in itself, but dehydration is a risk, and so is overdose if the person uses again after their tolerance has dropped.
What are the withdrawal symptoms of weed?
Irritability, anger, anxiety, low mood, poor sleep, strange dreams and loss of appetite. They start a day or two after stopping and usually settle within 2 to 3 weeks.
Is benzodiazepine withdrawal dangerous?
It can be. Stopping suddenly after regular use can cause seizures, which can be life-threatening. Never stop benzodiazepines or sleeping pills suddenly; a doctor can plan a slow reduction.
What does sakau mean?
Sakau is the everyday Malaysian word for drug withdrawal, the physical and mental symptoms that come when someone stops a drug their body has got used to.
How Salus can help
Salus is a private, confidential, voluntary 90-day residential programme for adults aged 18 and over in Cyberjaya, Selangor. Every guest has a medical, psychiatric and psychological assessment on arrival, and withdrawal is managed alongside medical care. A Salus Clinician then plans daily life alongside that medical care. The cost is RM7,000 per month, all-inclusive: private room, meals, 24-hour care and medical oversight, individual and group therapy, family sessions and an aftercare plan.
Families can call first, before the person has agreed to anything. Call or WhatsApp Salus for a confidential conversation about what you are seeing and what the options are.
This article is general information, not medical advice.
