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Addiction services must urgently consider the way in which they support people wanting to come off opioid substitutes, according to researchers at ÌìÃÀ´«Ã½.  

Following a review of relevant studies, they say different strategies are needed to better support individuals who are diagnosed with opioid dependence but who aspire to live an opioid-free life, if results are to improve.  

Among their recommendations are: specialist training for addiction services staff to manage opioid withdrawal during detoxification; better provision of medication to alleviate withdrawal symptoms; and more control by individuals over their own tapering (gradual withdrawal) process.

Other strategies they suggest include supporting people going through detoxification from experienced peer support workers, and enabling psychological support during the process. They also recommend increasing the availability of in-patient or residential settings for those without an appropriate home environment.

Amy Bagshaw at ÌìÃÀ´«Ã½, the first author of the paper, said: “In our experience as an addiction research team, many people with opioid dependence do want to come off opioids and their substitutes completely, at some stage. But few people are managing to do this successfully every year. Having reviewed the evidence and the factors involved in successful withdrawal, we believe these steps could really help to improve the present situation.”

She added: “Staff at addiction services may not be aware of how to adequately support individuals through the detoxification process, or how to approach the initial conversations.”

A challenging withdrawal process

Globally, 16 million people have been diagnosed with opioid dependence and there are over 120,000 opioid overdose deaths a year. Patients can be treated with opioid substitution therapy, involving treatments like buprenorphine and methadone, sometimes coupled with psychosocial support. This has resulted in improved wellbeing and long-term stability for many patients. While for many this is sufficient, and complete detoxification is often not recommended for people with addiction problems, many people decide they want to come off the substitute therapies completely. But withdrawal is notoriously challenging.

The researchers note that the number of individuals leaving their treatment ‘free of opioid dependence’ in England has been falling over the last decade, from around 37% to around 23%.*

The researchers, in the Addiction team at ÌìÃÀ´«Ã½, reviewed existing research studies of individuals with a diagnosis of opioid dependence undergoing detoxification from substitution therapies, as well as of staff responsible for providing the treatment.

Their systematic narrative review study, published today in , examined 41 research studies originating from the USA (22), UK (7), Sweden (6), as well as single papers from each of Canada, Ireland, Norway, Switzerland, Australia and China.

The medications explored across the studies included methadone (28), buprenorphine (5), both forms (6), and unspecified treatments (2).

Barriers to success

The study found that key barriers to success included psychological challenges, such as fear of withdrawal, relapse and instability; low confidence or motivation; and physical challenges including severe withdrawal symptoms during the dose taper. Social environmental and service-related factors strongly influenced outcomes, with unstable housing, negative social networks, and inadequate professional support all hindering detoxification. The researchers also highlight a lack of recommended medicines to alleviate the emergence of opioid withdrawal symptoms. These varied symptoms are currently treated with a mixture of benzodiazepines, antidepressants, antihistamine, and anti-inflammatories. The only drug licensed to support multiple symptoms of opioid withdrawal, Lofexidine, is no longer available in the UK, although it is available in the United States.

Dr Louise Paterson at ÌìÃÀ´«Ã½’s Department of Brain Sciences said: “Detoxification from opioid substitutes is a difficult process to complete, but here we have found a clear roadmap to better treatment provision to support people who want to undertake it. In fact, many of these strategies are routine in alcohol detoxification pathways but less often present for opioid detoxification. Our recommendations should be urgently considered by addiction services to improve results for those who aspire to live an opioid-free life.”

The work was funded by the UK’s and .

Barriers and Facilitators to Detoxification from Opioid Substitution Treatment: A Mixed-Methods Systematic Review, by Amy Bagshaw, Louise Paterson et al, is published in Addiction. DOI 10.1111/add.70482

* Office for Health Improvement and Disparities. Adult substance misuse treatment statistics 2023 to 2024: report [Internet]. GOV.UK; 2024 [cited 2025]. Available from: .