Opioid / heroin dependence treatment

What is opioid (heroin) dependence treatment?

Opioid dependence treatment helps you stop or stabilise the use of heroin or other opioids and rebuild your health and life. The cornerstone for many people is opioid substitution treatment (OST) — a prescribed substitute medicine, usually methadone or buprenorphine, that prevents withdrawal and cravings without the dangerous highs and lows of street drugs. This is well-evidenced treatment, recommended by NICE, and it keeps people safer and more stable.

Treatment can aim at maintenance (staying on a stable dose, often for a long time) or at detox (gradually reducing the substitute until you are off it). Both are valid; the right choice depends on you. Alongside medicine, treatment includes a keyworker, talking therapy such as CBT, harm reduction and practical help.

A crucial safety point: opioid overdose can be reversed with naloxone, and everyone using opioids should have a take-home naloxone kit. Overdose risk is much higher after any break in use — after a detox, a spell in hospital or prison, or simply a few days off — because your tolerance falls quickly. Using your old amount can then be fatal.

Treatment greatly improves safety and health but cannot guarantee you will never use again. Addiction is a health condition, not a moral failing, and recovery is very possible. You do not have to pay — free NHS and charity services are available across the UK, usually by self-referral.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Maintenance vs detox

Neither is 'better' for everyone. Many people benefit from maintenance for a long time before considering detox.

Preparing for your treatment

• Have a confidential assessment first; a urine or saliva test usually confirms opioid use before a substitute is prescribed.
• Be honest about everything you use, including alcohol and sedatives, as mixing these with opioids is dangerous.
• Tell the team about any overdoses and any recent break in use (after prison, hospital or detox your tolerance is lower).
• Ask for a take-home naloxone kit and training, and make sure people around you know how to use it.
• List your medicines and health conditions; some interact with methadone or buprenorphine.
• Decide, with your clinician, whether maintenance or detox suits you best for now.
• You can usually self-refer to a free NHS or charity service; you do not need to pay to get help.

What happens

Treatment starts with a confidential assessment of your opioid use, other substances, health and circumstances. A urine or saliva test usually confirms opioid use, and you are given a keyworker who coordinates your care.

If opioid substitution is right for you, methadone or buprenorphine is started carefully and the dose adjusted until withdrawal and cravings are controlled. Doses are often supervised at a pharmacy at first, for safety, before any take-home doses. Buprenorphine is started once you are in mild withdrawal, to avoid a sudden worsening; the team will explain the timing.

Alongside medicine, you have talking therapy such as CBT, harm-reduction support, and practical help. You should be offered take-home naloxone and trained to use it. If you choose a detox, the substitute is reduced gradually. Throughout, the team monitors your progress and safety and adjusts the plan with you.

Is this treatment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

The single most important danger is overdose, and it is highest after any break in opioid use because tolerance drops quickly — after a detox, hospital stay, or release from prison, your usual amount can be fatal. Never use alone, never mix opioids with alcohol or sedatives, store any take-home medicine locked away from children, and always carry naloxone. Ask your team how to recognise and respond to an overdose, and what to do in an emergency.

Published figures to discuss

Outcomes vary with severity, other substance use, mental and physical health and social support. The clearest and most important hard risk is overdose, which is well known to rise sharply in the period after any break in opioid use — including the weeks after detox, and after release from prison — because tolerance falls. Because precise figures depend heavily on the population studied, we describe this risk in plain, emphatic terms rather than quoting a single percentage, and stress naloxone and never using alone.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

Recovery from opioid dependence is a process, not a single event. For many people it includes a long period of stable substitute treatment before, or instead of, coming off opioids entirely.

• Cravings that come and go, especially around old triggers.
• Disturbed sleep, sweating and changeable mood, particularly during dose changes or detox.
• Mild, often settling side effects from the substitute medicine.
• Feeling more stable and clear-headed once the dose is right.
• Lapses or relapse — common, and a reason to get support rather than give up.

Aftercare

• Take your substitute medicine exactly as prescribed, and never add alcohol or other sedatives.
• Carry take-home naloxone, make sure those around you know how to use it, and never use opioids alone.
• Store any take-home medicine locked away and out of reach of children.
• Keep keyworker and therapy appointments, and be honest about lapses.
• Remember that after any break in use — detox, hospital, prison — your tolerance is lower and overdose risk is high.
• Get tested and, if needed, treated for hepatitis and HIV, and look after your physical and mental health.
• If you relapse, get advice quickly rather than struggling alone.
• Save crisis numbers: 999 for any overdose, Samaritans 116 123, and the FRANK drugs helpline 0300 123 6600.

• Assessment completed and substitute medicine plan agreed
• Take-home naloxone obtained, with training for you and those around you
• Safe, locked storage for any take-home doses
• Keyworker and therapy sessions booked
• Blood-borne virus testing arranged
• Relapse and overdose-safety plan written down
• Crisis numbers saved (999, Samaritans 116 123, FRANK 0300 123 6600)

⚠ Get urgent help if…

• Signs of opioid overdose in yourself or someone else: very drowsy or unresponsive, slow, shallow or stopped breathing, pinpoint pupils, blue lips — call 999 and give naloxone immediately.
• Overdose risk is especially high after any break in use (detox, hospital, prison) — treat the first use back as potentially dangerous.
• Thoughts of harming yourself or ending your life — call 999 if you are in immediate danger, or contact your GP or Samaritans on 116 123. For urgent advice you can also use NHS 111 in England, Scotland or Wales; in Northern Ireland, contact your GP out-of-hours service instead.
• Severe drowsiness or confusion after mixing your medicine with alcohol or sedatives — call 999.
• A fast, slow or irregular heartbeat, fainting, or severe dizziness (relevant with methadone).
• Signs of a serious injection-site infection: spreading redness, swelling, heat or fever.

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your psychiatrist gives you.

Results & realistic expectations

Good treatment, especially opioid substitution with methadone or buprenorphine, reduces street heroin use, lowers overdose and death, cuts injecting-related infections, and helps people rebuild stable lives. For many, a period of stable maintenance is itself a successful outcome, not a failure to 'get clean'.

Treatment cannot guarantee you will never use again, and relapse is common — it is part of the condition. The honest measure of success is improved health, safety and stability, with setbacks treated as something to learn from. Be especially wary of any provider promising a guaranteed cure or a fast, without risks detox, and never overlook the overdose risk after coming off opioids.

For opioids, staying well is an ongoing process. Many people remain on a stable substitute medicine for a long time — sometimes years — because it keeps them safer and more stable, and there is no need to rush a detox. Others reduce gradually when they feel ready. Therapy skills, peer support, naloxone and practical stability all help protect recovery. Relapse can happen, and after any reduction or break, overdose risk is higher, so a relapse plan and naloxone remain important long term.

Related tests, treatments or support

Opioid treatment is often combined with mental health support, because conditions like anxiety, depression and trauma frequently sit alongside opioid use. It is also combined with physical health care (including hepatitis and HIV testing and treatment), harm reduction such as naloxone and needle exchange, and support for family members. Where alcohol or other drugs are also used, these are treated together because combinations raise overdose risk.

Follow-up & long-term care

You will have a keyworker and regular reviews of your medicine, dose, progress and goals. Therapy continues over weeks to months. Take-home naloxone and overdose-safety advice are revisited, and any take-home dosing arrangements are reviewed for safety. If you relapse or your circumstances change, your plan is adjusted rather than withdrawn, and you can get back in touch at any time.

• Continue your substitute medicine and follow-up for as long as it helps, with regular review.
• Keep naloxone available, in date, and replace it when used.
• Store any take-home medicine safely and out of reach of children.
• Keep using therapy skills and peer support such as NA or SMART Recovery.
• Have a written relapse and overdose-safety plan, and ask for help early.

Repeat, follow-on and what comes next

• Substitute medicine and dose are commonly adjusted, and methadone and buprenorphine may be switched.
• Many people move between maintenance and attempts at detox over time.
• Relapse usually leads to a revised plan and re-stabilisation rather than discharge.
• A detox may be paused or reversed if it is not safe to continue.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• Take-home naloxone and overdose-safety advice, revisited regularly.
• A keyworker and clear plan, with regular review of medicine, dose and goals.
• Safe take-home dosing arrangements and storage advice.
• A written relapse and overdose-safety plan, and an easy route back into treatment.
• Ongoing therapy, peer support, blood-borne virus testing and treatment, and help with housing, work and family.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Whether opioid substitution (methadone or buprenorphine) is used and how dosing is supervised.
• The type and amount of psychological therapy provided.
• Level of keyworker and care-coordination support.
• Whether a detox or residential rehabilitation is involved, and for how long.
• Harm-reduction and health services included, such as naloxone and blood-borne virus testing.
• Seniority of the clinician (for example a consultant addiction psychiatrist).
• Aftercare, relapse support and family support included.

• The clinician's or service's fees and what the treatment plan covers.
• Whether the substitute medicine, supervised dosing and monitoring are included or charged separately.
• Whether take-home naloxone and training are provided.
• What psychological therapy and keyworker support is included.
• Aftercare and relapse support, and what happens if you relapse.
• Cancellation policy and what happens if the plan changes.
• Confirmation that free NHS and charity options have been explained.

On the NHS? Opioid dependence treatment, including substitute medicines and naloxone, is available free on the NHS and through charities across the UK, usually by self-referral; private treatment may be used for speed or choice, but you do not need to pay to get help.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the psychiatrist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good psychiatrist will welcome every one of these.

• Would methadone or buprenorphine suit me better, and why?
• Should I aim for maintenance or a detox right now?
• Can I have take-home naloxone and training today?
• How do I recognise and respond to an overdose, and how do I keep my tolerance risk in mind?
• How will my doses be supervised, and how do I store take-home medicine safely?
• What should I do if I relapse, and who do I contact?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the psychiatrist who carries out my treatment, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this treatment not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified psychiatrist for opioid / heroin dependence treatment

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Heroin addiction: get help NICE TA114 — Methadone and buprenorphine for opioid dependence NHS Specialist Pharmacy Service — Reversing an adult opioid overdose with naloxone FRANK — find drug treatment support near you Royal College of Psychiatrists — Addictions faculty resources We Are With You — free, confidential drug support nidirect — Urgent and emergency care services (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.