A dependence on sleeping pills, painkillers or cough syrup rarely starts with someone looking for a high. It usually starts with a real complaint: pain, insomnia, a persistent cough, and a medicine that worked. Months later, stopping it is no longer simple, and for some sedatives, stopping it suddenly can be dangerous. This is what families and the people themselves need to know before that point.
How it usually starts
Most people with this kind of dependence did not set out to misuse anything. A doctor prescribed a benzodiazepine, a sedative such as diazepam or lorazepam, for a few weeks of bad sleep or anxiety, and it was never properly stopped. Or someone bought a cough syrup containing codeine over the counter, or on the black market pills sold as Erimin 5, and kept using it because it also numbed stress or helped them sleep.
Erimin 5 is the Malaysian street name for nimetazepam, or sometimes etizolam sold under the same name. It is a benzodiazepine, chemically related to prescription sedatives, and it is banned in Malaysia because of how easily it is misused, according to research from Universiti Sains Malaysia analysing seized pills. It is still seized regularly. In March 2026, police in Seberang Perai, Penang, recovered 4,000 Erimin 5 tablets alongside syabu, together worth more than RM2.7 million, according to Portal Berita RTM.
Codeine, found in some cough syrups, is a different kind of drug, an opioid, but dependence builds in a similar way. In Malaysia, cough medicine is often mixed with air ketum and fizzy drinks into a drink called chakoroi. In one operation in August 2017, Ministry of Health pharmacy enforcement officers seized 100,480 bottles of cough medicine over this, according to a ministry statement published by the government fact-check portal Sebenarnya.my. Because it is sold as a medicine and drunk like any other drink, families are often slow to see it as a problem.
Strong painkillers follow a similar pattern. Psychiatrists interviewed by the health news outlet CodeBlue in 2019 described Malaysians becoming dependent on painkillers that were first prescribed for ordinary pain.
What families usually notice
- The medicine runs out faster than it should, and there are stories about a lost prescription or a helpful friend.
- Sleep, mood or pain that used to respond to a small dose no longer does, and the amount taken keeps creeping up.
- Drowsiness, slurred speech or unsteadiness at times that do not match a normal dose.
- Irritability, shaking or anxiety in the hours before the next dose is due, easing once it is taken.
- For cough syrup specifically, empty bottles that do not match how sick anyone has been, or a habit of mixing it into drinks.
- Secrecy about where medicine comes from, including online sellers or more than one pharmacy or doctor.
Why stopping suddenly can be dangerous
Families often want to flush the pills and stop everything at once. With sedatives, that can be dangerous.
Benzodiazepines, including prescription sedatives and Erimin 5, change how the brain regulates itself. Stop them abruptly after weeks or months of regular use and the withdrawal can include severe anxiety, confusion and seizures, according to the UK's medicines regulator, which updated its guidance in January 2026 to stress that patients should never stop without medical advice. Coming off safely is usually a gradual, supervised process that can take weeks or months. Opioid painkillers and codeine are rarely life-threatening to stop, but withdrawal is still severe, with restlessness, vomiting, diarrhoea and pain that most people cannot manage without support, according to the US National Institute on Drug Abuse.
If someone is very drowsy, breathing slowly or irregularly, unresponsive, or has a seizure, call 999 immediately. This applies whether it looks like an overdose or a withdrawal reaction. Do not wait to see if it passes.
What treatment looks like
At Salus, every guest is seen by a psychiatrist on arrival, and where a benzodiazepine or opioid dependence is involved, the medical team manages that withdrawal safely before anything else begins. That assessment also looks for what was underneath the original prescription, since insomnia, anxiety, pain and trauma are treated in the same plan as the dependence itself.
Once withdrawal is medically stable, the work is the same as for other dependencies: understanding what the medicine was doing for the person, and building a life that does not need it. That is what the Social Prescription Model is built around, a clinical prescription alongside a living prescription, worked out with a Salus Clinician around sleep, routine, work and relationships. The diagnosis decides the therapy, which for this group often means cognitive behavioural therapy for the anxiety or insomnia that started it, alongside structured relapse prevention. A 90-day stay tends to be the length this needs, because the sleep or pain problem underneath has to be properly resolved.
What to do today
If someone is drowsy in a way that worries you, breathing oddly, unresponsive, or has had a seizure, call 999.
Otherwise, do not try to manage a benzodiazepine or strong painkiller withdrawal at home, and do not confront the person with an ultimatum before you understand what you are dealing with. A confidential call to Salus is a sensible first step, and our guide on how to raise it with someone you love covers that conversation itself. If cost is what is holding you back from asking, our breakdown of what rehab costs in Malaysia and our page on what we help with are worth reading before you call.
Dependence on a medicine that started as genuine treatment is common, and it responds to treatment, as long as coming off it is done with medical support.
