Painkiller / opioid dependence treatment

What is painkiller and opioid dependence treatment?

Opioids include prescribed painkillers such as codeine, dihydrocodeine, tramadol, morphine, oxycodone and fentanyl, and also illegal opioids such as heroin. With regular use your body adapts, so you can become dependent and get withdrawal if you cut down or stop. This can happen even when an opioid has been taken exactly as prescribed for pain.

Treatment is about reducing or stopping opioids safely. Depending on your situation this may mean a slow, planned taper of a prescribed painkiller, or a substitute medicine (such as methadone or buprenorphine) for opioid dependence, alongside support, talking therapy and better ways to manage pain. The aim is to reduce harm, ease withdrawal and keep you safe.

Opioid dependence is a recognised health condition, not a moral failing — including when it started with a prescription. Effective treatment exists, and many people recover or stabilise well.

IMPORTANT SAFETY POINTS: do not stop opioids suddenly — withdrawal is distressing and a sudden stop is not the safe way to come off. And after any time off opioids your tolerance drops, so going back to your old dose can cause a fatal overdose. Naloxone, a medicine that reverses opioid overdose, can be life-saving and is available free to people at risk.

Types, options & approaches

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

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your treatment

• Bring details of every opioid you take — prescribed and not — including how much, how often and for how long.
• Note what the opioid was first for (such as pain) and whether it still helps that.
• List other substances and medicines you use, including alcohol, benzodiazepines, sleeping tablets, and the nerve-pain medicines pregabalin or gabapentin, as these add to overdose risk.
• Write down any withdrawal you have had when missing or reducing doses.
• Ask about a free take-home naloxone kit and how to use it.
• Do not stop suddenly on your own before this discussion, and never return to a high dose after a gap.

What happens

You will usually start with a free, confidential assessment through your GP, a local drug and alcohol service, or a charity such as We Are With You or Turning Point. A clinician asks about your opioid use, your pain, and your physical and mental health, without judgement.

You then agree a plan together. For prescribed painkillers this is often a slow taper, with daily doses typically reduced by roughly a tenth every one to two weeks, adjusted to how you cope, while your pain is managed in other ways. For opioid dependence, including heroin, a substitute medicine such as methadone or buprenorphine may be used to stabilise you and reduce cravings, withdrawal and harm.

Alongside the medicine, you get key-working, support and usually a free naloxone kit with training. The team monitors progress, your mood and your safety, and can involve specialists where needed.

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 most dangerous risk is overdose from lost tolerance: after any time off opioids — a few days clean, a detox, prison or hospital — your old dose can be fatal. Mixing opioids with alcohol, benzodiazepines, sleeping tablets, or the nerve-pain medicines pregabalin or gabapentin sharply raises this risk too, because together they can dangerously slow your breathing. Ask your clinician about overdose warning signs, get a free naloxone kit and make sure people around you can use it, and agree how withdrawal and pain will be supported and who to contact if you struggle.

Published figures to discuss

Outcomes and risks depend on which opioid you use, how much and for how long, your pain, your other substance use, and your support. The most important risk — overdose death — rises sharply after any loss of tolerance and when opioids are combined with alcohol or sedatives, but a single reliable percentage does not capture an individual's risk. Substitute treatment and naloxone are well-evidenced to reduce harm. Because individual risk varies so much, we describe it in plain words rather than precise figures.

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

There is no physical procedure to recover from. 'Afterwards' means the weeks to months of reducing opioids or stabilising on a substitute, as your body adjusts and you build support. Withdrawal is distressing but, with the right plan, it can be made much more bearable.

• Flu-like withdrawal — aches, sweating, chills, runny nose, cramps — that eases over days to weeks
• Disturbed sleep, restlessness and low mood while adjusting
• Temporary return of pain that needs other management
• Cravings that come and go, often around stress or old triggers

Aftercare

• Follow your agreed taper or substitute plan and never go back to an old, higher dose after a break.
• Keep a naloxone kit, know the overdose signs, and make sure people around you can use it.
• Never mix opioids with alcohol, benzodiazepines, sleeping tablets, or pregabalin or gabapentin (nerve-pain medicines) without medical advice — together they can dangerously slow your breathing.
• Use the agreed ways to manage pain, and tell your team if pain is driving you back to opioids.
• Tell your clinician if withdrawal is hard so the plan can be adjusted.
• Keep your appointments and report any drop in mood or thoughts of self-harm.
• Treat a lapse as a reason to get back in touch, not to give up.

• Naloxone kit obtained and you (and a trusted person) trained to use it
• Written taper or substitute plan and your clinician's contact details
• Plan for managing pain without escalating opioids
• Clear note never to return to an old dose after a gap
• Trusted person aware, in case of overdose
• Crisis numbers saved (999 for overdose; Samaritans 116 123; FRANK 0300 123 6600)

⚠ Get urgent help if…

• Signs of opioid overdose in yourself or someone else — very small pupils, extreme drowsiness, slow, shallow or stopped breathing, blue lips, unresponsive — call 999 and give naloxone if available
• Thoughts of suicide or self-harm, or feeling unable to keep yourself safe — get urgent help now
• Severe or worsening low mood, anxiety or panic
• Withdrawal so severe you cannot keep down fluids or function
• A strong urge to return to your previous high dose, especially after a break
• Mixing opioids with alcohol, benzodiazepines, sleeping tablets, or pregabalin or gabapentin, or feeling unable to stop doing so

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

A good outcome is reducing or stopping opioids safely, or stabilising on a substitute, with pain managed and overdose risk reduced. Many people do well, although it can take time and the plan often needs adjusting. For some, staying stable on a substitute medicine is the right, safe goal rather than stopping all opioids quickly.

Treatment cannot guarantee no withdrawal, no cravings or that pain will disappear. It reduces harm, supports change and saves lives, especially when naloxone and overdose awareness are part of the plan. Lapses are common and do not mean treatment has failed.

Staying well is usually an ongoing process. Some people reduce off opioids fully; others stay safely on a substitute for a long time, which is a legitimate, protective choice. Cravings and pain can return under stress, and overdose risk rises again after any break, so a relapse-prevention plan, ongoing pain management and keeping naloxone to hand all matter for the long term.

Related tests, treatments or support

Opioid dependence treatment is often combined with proper pain management (including non-opioid options and pain programmes), talking therapies, and support for alcohol, benzodiazepines, pregabalin or gabapentin, or other substances — combinations that sharply raise overdose risk and need careful joint management. Mental-health treatment is offered alongside where needed.

Follow-up & long-term care

Expect regular reviews with your clinician or keyworker to check progress, adjust the taper or substitute dose, manage pain, and watch your mood and safety. Good follow-up keeps naloxone and overdose awareness current, makes it easy to get more help, and welcomes you back without judgement if you lapse.

• A current naloxone kit and people around you who can use it
• Ongoing pain management that does not rely on escalating opioids
• Regular reviews of any substitute medicine and your overall plan
• A relapse-prevention plan and an easy way to re-access help
• Ongoing mental-health or peer support where it helps

Repeat, follow-on and what comes next

• Plans are commonly adjusted — slowing a taper, changing a substitute dose, or switching approach — and this is normal.
• Lapses and returns to treatment are common and expected, not a failure.
• For many people, staying on a substitute medicine long term is a safe, protective outcome rather than a failed detox.
• Re-accessing help quickly after a break is important because overdose risk is high then.

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

• A take-home naloxone kit and training for you and people around you
• Clear overdose-prevention advice, including the danger of lost tolerance and mixing
• Pain managed in ways that do not rely on escalating opioids
• Regular reviews of the taper or substitute, mood and safety, with a named contact
• An easy, non-judgemental way to re-access help after a lapse

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 you use free NHS or charity services, or pay for private care
• Whether treatment is a taper, a substitute medicine, or both, and how long it runs
• Whether specialist pain or addiction input and talking therapy are included
• Whether dependence involves other substances (alcohol, benzodiazepines) too
• The amount of monitoring, key-working and follow-up needed
• Provision of naloxone and overdose-prevention training (free through NHS and many services)

• Who leads your care and their relevant experience in opioid treatment
• Whether the plan is a taper, a substitute medicine, or both, and what it includes
• Whether pain management and talking therapy are included
• Whether a naloxone kit and overdose training are provided
• How withdrawal, overdose risk and a mental-health crisis are handled
• The cancellation policy and the cost of any extra appointments or medicines

On the NHS? Opioid and painkiller dependence treatment, including substitute medicines and naloxone, is available free and confidentially on the NHS and through charities; private care is optional, and you do not have 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.

• Is a taper or a substitute medicine right for me, and why?
• How will my pain be managed as opioids are reduced?
• How do I get a naloxone kit, and how do I use it?
• What are the overdose warning signs, and why is my old dose dangerous after a break?
• What should I avoid mixing with opioids, and what do I do in an emergency?
• How easy is it to come back if I lapse, and how is my mental health supported?
• 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 painkiller / opioid 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 — Drug addiction: getting help NHS England — Reducing long-term opioid use NHS England — Patient safety alert: inappropriate doses of naloxone in long-term opioid treatment NICE NG215 — Medicines associated with dependence or withdrawal symptoms FRANK — Heroin We Are With You — drug and alcohol support MHRA — gabapentinoids, benzodiazepines and Z-drugs: dependence and withdrawal update MHRA — gabapentin (Neurontin): risk of severe respiratory depression MHRA — pregabalin (Lyrica): reports of severe respiratory depression

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.