Opiates

Opiates and Opioids

Introduction: Understanding Opioids in the UK 😊

This guide is written to help you understand opioid use in the UK today. We know this topic can feel complex or worrying, whether you’re looking for information for yourself, for someone you care about, or for professional reasons. You are not alone, and learning more is a positive first step.

Opioids range from prescription pain medicines to illegal drugs like heroin, as well as very strong synthetic opioids such as fentanyl and nitazenes. These substances touch many lives in different ways – they can be essential for pain relief in medical settings, but they can also lead to dependence and have contributed to a tragic rise in drug-related deaths in recent years across the UK.

In this guide, we’ll explain what opioids are and how they affect the body and mind. We’ll discuss the signs of opioid dependence, their relative strengths, and most importantly, the paths to staying safe and recovering. You’ll find practical harm reduction tips (like using naloxone to reverse overdoses, safer injecting advice, and drug checking services) and an overview of treatment options available on the NHS and other UK services – including Medication-Assisted Treatment (MAT) and talking therapies.

Our goal is to give you information that is easy to understand, hopeful, and helpful. We also highlight support available here in Nottinghamshire and across the UK. No matter how challenging things might feel, with the right information and support, positive change is always possible.

What Are Opiates and Opioids? ❓

Getting to grips with the language and different types of these substances is a great first step toward understanding their impact and how support works.

Defining the Terms 📖

  • Opioid – This is a broad term for any substance (natural or man-made, and even the ones our own bodies produce) that binds to opioid receptors in the brain and body. When something attaches to these receptors, it usually reduces pain (produces analgesia) in a way similar to morphine. In fact, our bodies make their own natural opioids (such as endorphins) that fit into the same receptors.
  • Opiate – This term technically refers to the opioids that come directly from the opium poppy plant (Papaver somniferum). Morphine and codeine are well-known examples of natural opiates extracted from opium. In everyday conversation, people often use “opioid” and “opiate” interchangeably. However, healthcare professionals prefer the word opioid as the broader term – it covers all substances that act on opioid receptors, whether they come from a plant or are completely made in a lab. In short, all opiates are opioids, but not all opioids are opiates.

Types of Opioids 🗂

Opioids are usually grouped by their source and how they are made:

  • Natural Opiates: Found naturally in opium poppies. Examples include morphine, codeine, and opium itself.
  • Semi-Synthetic Opioids: Made by chemically modifying natural opiates. Common examples in the UK are heroin (diamorphine, made from morphine), oxycodone, hydrocodone, hydromorphone, and buprenorphine.
  • Synthetic Opioids: Fully created in labs with no direct plant source. Examples include fentanyl, methadone, tramadol, pethidine, and newer synthetics like the nitazenes (e.g. isotonitazene, metonitazene). Because these don’t rely on poppy crops, they can be produced secretly in illicit labs.

Common Opioids Found in the UK (Including Street Names) 📋

Here are some opioids particularly relevant in the UK context:

  • Heroin: A widely used illegal semi-synthetic opioid. Common street names include “smack,” “gear,” “H,” “brown,” or “junk.” It is typically sold as a powder (varying from white to brown) or as a sticky substance (“black tar” in some cases). Heroin is usually injected or smoked.
  • Fentanyl: An extremely potent synthetic opioid prescribed for severe pain (for example, in cancer care) but also found in the illicit drug supply. Illicit fentanyl may be mixed into heroin or pressed into fake tablets sold as other pills. Because fentanyl is about 50 times stronger than heroin, even a tiny amount can cause an overdose. This makes its presence in street drugs especially dangerous.
  • Nitazenes: A newer group of powerful synthetic opioids that have emerged in the UK drug supply in the past few years (around 2021–2023). Examples include isotonitazene, metonitazene, and protonitazene. These have been found mixed into heroin or in counterfeit pills (for example, fake oxycodone or benzodiazepine tablets). Nitazenes are extremely potent – some may be as strong or stronger than fentanyl – which greatly increases the risk of overdose when they are present.
  • Methadone: A long-acting synthetic opioid used legally in treatment (Medication-Assisted Treatment, see below). It is usually dispensed as a green or blue sugary liquid (methadone mixture) or sometimes tablets. When used in treatment, methadone is taken orally under supervision to help people stop using heroin.
  • Buprenorphine: A semi-synthetic opioid also used in Medication-Assisted Treatment. It comes as sublingual tablets or film that dissolves under the tongue (brand names include Subutex® and Espranor®). There’s also a version combined with naloxone to prevent misuse (Suboxone®), and a long-acting injectable form (Buvidal®). Buprenorphine in treatment helps to reduce cravings and prevent withdrawal.
  • Prescription Opioids: These are medications prescribed for pain that sometimes end up misused or sold on illegally. In the UK, common examples include codeine (often in combination products like co-codamol), dihydrocodeine (DHC, known by the old brand name DF118s), tramadol, oxycodone (OxyContin®/OxyNorm®), morphine, and others. While these medicines are helpful for pain when used correctly under medical supervision, they can cause harm if taken in higher doses than prescribed or by people they weren’t prescribed for. Some people develop dependence on prescription opioids, and there is a risk of overdose if they are taken improperly or combined with other depressant drugs.

Appearance, Supply Routes, and UK Legal Status ⚖️

Appearance: Opioids can appear in several forms:

  • Powders: For example, heroin is usually a white or brown powder. Illicit fentanyl or nitazenes can also be found as powders (sometimes with a distinctive color like yellow or off-white for certain nitazenes).
  • Tablets/Capsules: Many prescription opioids (codeine, dihydrocodeine, tramadol, oxycodone, etc.) come as pills or capsules. Be aware: counterfeit tablets made to look like prescription painkillers are a known danger – they may actually contain fentanyl or nitazenes, which can easily cause overdose.
  • Liquids/Syrups: Methadone is provided as a thick liquid (often green or blue) for people in treatment. Codeine linctus (cough syrup) was once available over the counter in pharmacies, but due to abuse it is now prescription-only in the UK.
  • Patches: Fentanyl for medical use often comes as adhesive skin patches that release the drug slowly (commonly prescribed for chronic pain). Illicit users sometimes misuse these patches by extracting the fentanyl.
  • Injectable Solutions: Some opioids are available for injection in medical settings (e.g., morphine injections for hospital use, or buprenorphine in pre-filled syringe form for long-acting treatment). On the street, people who use heroin mix the powder with water to inject it.
  • Cutting Agents: Illicit drugs like heroin are often “cut” (mixed) with other powders to add bulk. Common cutting agents include sugars, caffeine, paracetamol, or quinine. More worryingly, potent synthetic opioids like fentanyl or nitazenes are sometimes used as adulterants to increase potency – this means someone might think they are using “pure” heroin at their usual dose, but if it contains fentanyl or similar, that same dose can suddenly be fatal. Even a very small amount of these additives can greatly raise overdose risk.

Supply Routes:

  • Legitimate Supply: Prescription opioids are dispensed legally via pharmacies when prescribed by a doctor or other qualified prescriber. Methadone and buprenorphine for addiction treatment are provided through NHS or commissioned services, often with supervised dosing (especially at the start of treatment) to ensure safety.
  • Illicit Supply: Non-prescribed opioids (like heroin or illegally obtained prescription opioids) are sold on the street or through dealers. Unfortunately, some prescription opioids make it to the illegal market through “diversion” – for instance, someone might sell their own medication or obtain multiple prescriptions by visiting different doctors (“doctor shopping”). Increasingly, opioids (and other drugs) are also sold via online platforms or social media, which is illegal and very risky. Some synthetic opioids not common in the UK medicine supply might be imported from abroad or even produced in clandestine labs domestically. Law enforcement and public health authorities work to curb these illegal supplies, but they persist. Safe prescribing practices, patient education, and monitoring (like prescription databases) are important to prevent medication diversion, alongside efforts to disrupt illicit drug production and importation.

UK Legal Status: Opioids are classified as controlled substances under the Misuse of Drugs Act 1971. This law divides drugs into Classes A, B, and C (with Class A being those considered most harmful). The class determines the legal penalties for possession, supply, or production without proper authority. Below are the typical classifications for opioids:

  • Class A: This includes the most harmful opioids. Heroin is Class A, as are fentanyl and its analogues, methadone, morphine, oxycodone, pethidine, and others like dipipanone. In fact, in January 2024 the UK government added a number of new synthetic opioids to Class A (including about 14 nitazene-type substances) due to their high potency and risk. Penalties for Class A drugs are severe – for example, possession can lead to up to 7 years in prison and an unlimited fine, while supply or production can result in up to life in prison. (Note: Naloxone, discussed later, is a legal medication that anyone can carry and use to reverse opioid overdoses – it’s an important exception designed to save lives.)
  • Class B: This class includes opioids that are somewhat less potent or less widely misused. Codeine and dihydrocodeine are Class B when prepared at higher strengths or in injectable form. (Many codeine products are lower strength and combined with other ingredients – those were historically available as pharmacy medicines, but with restrictions. Any preparation for injection is treated as Class A due to the higher risk.) Other Class B drugs (for context) include cannabis and amphetamines, but those are outside the opioid family.
  • Class C: Tramadol and buprenorphine are notable Class C opioids. Tramadol was reclassified to Class C in 2014 because of rising misuse. Buprenorphine, despite being used in treatment, is Class C under misuse laws. (Interestingly, some medicines often used alongside opioids, like many benzodiazepines, as well as gabapentin and pregabalin, are also Class C controlled substances.) Penalties for Class C, while lower than Class A, can still be up to 2 years for possession and 14 years for supply.
  • Legitimate Medical Use: The law does allow opioids to be used in medicine. Most opioid medications are Prescription Only Medicines (POM), meaning you can only get them with a prescription. There used to be some over-the-counter availability for very low-dose codeine (in combination products for short-term use), but regulations have tightened: pharmacy pack sizes are limited (to 32 doses), and the packaging carries prominent addiction warnings and advises a maximum 3-day use without doctor advice. In fact, as of February 2024, codeine cough syrup (codeine linctus), which some were abusing, was moved to prescription-only to prevent misuse. In medical settings, these drugs are carefully regulated – for example, hospitals and pharmacies keep opioids in special controlled drug safes and maintain strict records.

UK Opioids Overview: key examples and legal classifications:

  • Morphine & Codeine (Natural Opiates): Used medically for pain (morphine injections or oral solutions, codeine in tablets/liquid). Morphine is Class A; codeine is Class B (in its higher-dose forms). Low-strength codeine products that were once sold in pharmacies are now more restricted.
  • Heroin (Diamorphine): Semi-synthetic opioid (processed from morphine). Used medically in some cases (as diamorphine for severe pain or palliative care), but any non-medical use is illegal. Found as powder (“white/brown”) on the illicit market. Class A.
  • Oxycodone, Hydrocodone, Hydromorphone: Semi-synthetic prescription opioids (usually tablets or capsules for pain). Oxycodone is used in the UK for severe pain (brands OxyContin®, OxyNorm®) but has also been misused. All are Class A when outside medical use.
  • Buprenorphine: Semi-synthetic. Used in treatment (MAT) and for pain. Forms include Subutex® tablets, Suboxone® (with naloxone), and Buvidal® injections. Class C under law, though provided legally via prescription for treatment.
  • Fentanyl: Fully synthetic. Medically, comes as patches, lozenges, or injectable for anesthesia. Illicitly, seen as powders or pressed pills. Extremely potent. Class A.
  • Nitazenes (e.g. isotonitazene, etonitazene): Synthetic. No medical use in UK; found in illicit opioid supplies as adulterants or sold as “fake” pills. Class A (recently controlled due to their danger).
  • Methadone: Synthetic. Used in opioid substitution treatment (as a liquid or tablet). When used correctly via prescription it’s legal, but any other possession/supply is Class A.
  • Tramadol: Synthetic. Commonly prescribed for moderate pain (capsules/tablets). Classified Class C (due to misuse potential). Only legal with a prescription.
  • Pethidine: Synthetic. An older painkiller (formerly popular in maternity for labour pain). Given by injection or tablets in medical settings. Class A.

▶️ (Watch:) Drugs being cut with deadly synthetic opioids stronger than heroin – Sky News – This short news clip explains how extremely potent opioids like fentanyl and nitazenes are appearing in the UK drug supply and the dangers they pose.

The Effects of Opioid Use ✨

Opioids cause powerful changes in the body and mind. They can provide important medical benefits (especially pain relief), but they also come with many side effects and potential risks. It’s helpful to look at their effects both in the short term (immediate effects when someone uses opioids) and over the long term (with ongoing use).

Immediate Effects (Short-Term) ⏱️

When someone takes an opioid, it acts fairly quickly on the brain’s opioid receptors and produces a range of short-term effects:

  • Pain Relief and Euphoria: Opioids are very effective painkillers – they can significantly reduce physical pain. They also often produce feelings of intense pleasure or well-being (a euphoric “rush” or high), a deep sense of relaxation, and drowsiness. People on opioids may feel very calm or even nod off to sleep. (Some opioids, like codeine, can also stop coughing – which is why they’re sometimes in cough medicines.)
  • Common Side Effects: Along with those desired effects, opioids typically cause some unpleasant effects. It’s very common to feel nauseous or vomit (opioids easily upset the stomach). They also slow down the bowels, often causing constipation (difficulty pooing). Other common side effects include itchiness, dizziness or confusion, dry mouth, and tiny pinpoint pupils (the black part of the eye becomes very small). These side effects can range from mild to quite uncomfortable.
  • Respiratory Depression (Slowed Breathing): A very serious effect of opioids is that they slow down breathing. Opioids affect the brainstem area that controls respiration, causing breaths to become slower and shallower. In an overdose, breathing may slow to a dangerous level or stop completely. This is the primary way opioid overdoses cause death – lack of oxygen due to stopped breathing. It’s important to note that all opioids can cause respiratory depression, especially in high doses or in combination with other sedatives.
  • ▶️ Patient Story: Faye’s Story – Faye’s parents describe the sequence of events that led to her death from respiratory depression.
  • Why Effects Vary: The immediate effects can differ a lot from person to person or situation. Factors include which opioid is taken (some are far stronger than others), how much is taken (dose), how it’s taken (injecting or smoking tends to cause a faster, more intense effect than swallowing a pill), the person’s tolerance (if your body is used to opioids, the effects are less pronounced), and whether other substances are used at the same time. For example, fentanyl is roughly 50 times stronger than heroin and about 100 times stronger than morphine – so a very tiny dose of fentanyl can have the same effect as a much larger dose of heroin. Newer synthetic opioids like some nitazenes might be even more potent. This variability means people who use opioids must be extremely cautious, especially with unfamiliar supplies. (See the section on Opioid Equipotency below).
  • Overdose Risk: The most dangerous immediate effect is overdose. This happens when an opioid dose is so high that breathing slows down to a critical level or stops. Without enough oxygen, a person will lose consciousness, can suffer permanent brain damage, or die. Signs of an opioid overdose include being unresponsive, very slow or no breathing, snoring/gurgling sounds, and bluish lips or fingertips (due to low oxygen). The risk of overdose is highest with very potent opioids (like fentanyl or nitazenes), injecting (which delivers the drug quickly to the brain), taking a high dose (especially if someone misjudges purity), using opioids after a break (when tolerance has dropped, for example after detox or prison), or mixing opioids with other central nervous system depressants like alcohol or benzodiazepines. (We discuss overdose prevention and the antidote naloxone in the harm reduction section.)

Long-Term Physical Health Consequences ⏳

Using opioids regularly over a long period can lead to a range of persistent health problems throughout the body. Some of the most common long-term physical effects include:

  • Chronic Constipation (OIC): Opioids notoriously cause constipation, and unlike some side effects, this often does not improve over time. This condition is called Opioid-Induced Constipation (OIC). Opioids slow down movement in the intestines, reduce digestive fluids, harden stools, and increase anal sphincter tone – a recipe for difficult, infrequent, and painful bowel movements. OIC can become severe, leading to complications like impacted stool (blockages), haemorrhoids (piles), or anal fissures (tears). Ordinary over-the-counter laxatives may not relieve OIC well because they don’t counteract opioids’ specific effects on the gut. It’s important for anyone on long-term opioids to discuss bowel management with a doctor; there are treatments specifically for OIC, and healthcare providers can help prevent serious issues.
  • Hormonal Changes: Long-term opioid use can disrupt the body’s hormonal balance – a condition sometimes called opioid-induced endocrine dysfunction or hypogonadism. Opioids interfere with the brain’s regulation of stress hormones and sex hormones. Over time, people on long-term opioids often develop low levels of sex hormones (like testosterone or oestrogen).
  • In men, this may present as reduced libido (sex drive), difficulty getting or maintaining erections (erectile dysfunction), lowered fertility, fatigue, depressed mood, loss of muscle mass, and even weaker bones (increasing osteoporosis risk).
  • In women, it can cause irregular or stopped menstrual cycles, reduced fertility, low libido, fatigue, depressed mood, and possibly bone density loss. These hormone-related issues tend to depend on the opioid dose and duration of use. They can sometimes be overlooked because their symptoms (tiredness, low mood, sexual dysfunction) might be attributed to other causes like chronic pain or depression. It’s worth raising these issues with a doctor, as treating the hormonal imbalance (or adjusting the opioid regimen) can greatly improve quality of life.
  • Dental Health Problems: Long-term opioid use can be hard on your teeth and gums, both directly and indirectly. Some factors include:
  • Dry Mouth: Opioids often cause a dry mouth by reducing saliva production. Saliva is important because it naturally cleans teeth and neutralises acids. With less saliva, there’s a higher risk of tooth decay and gum disease.
  • Sugar Cravings: Some people on opioids experience cravings for sugary foods and drinks. Consuming a lot of sugar, especially with a dry mouth, accelerates tooth decay and can lead to cavities.
  • Neglect of Oral Hygiene: Dealing with addiction or chronic pain can make self-care routines harder to maintain. Brushing and flossing regularly may fall by the wayside, which leads to plaque build-up and dental issues.
  • Masked Dental Pain: Opioids can hide the pain of a dental problem (like a cavity or infection), so the issue might become severe before it’s noticed. For example, an abscessed tooth might not ache as much as it normally would, delaying a trip to the dentist. Protecting dental health: If you’re using opioids long-term (whether for chronic pain or otherwise), it’s extra important to take care of your mouth. Try to brush twice a day with fluoride toothpaste and floss daily. Stay hydrated and consider sugar-free lozenges or artificial saliva products to combat dry mouth. Limit sugary snacks and drinks. And make sure to see a dentist regularly – NHS dental care is available to help prevent small problems from becoming big ones.
  • Injecting-Related Risks: This applies to people who inject opioids (like injecting heroin). Long-term injecting drug use carries its own set of health risks:
  • Blood-Borne Viruses (BBVs): Sharing needles, syringes, or other injecting “works” (spoons, filters, water) can transmit viruses such as HIV, Hepatitis C (HCV), and Hepatitis B (HBV). In the UK, hepatitis C is especially common among people who inject drugs, though many may not realise they have it. The good news is that free testing for BBVs (especially HCV and HIV) and free HBV vaccination are available through drug services, needle exchanges, and sexual health clinics. Regular testing and early treatment can greatly improve health outcomes.
  • Skin and Soft Tissue Infections: Using non-sterile injecting equipment or not cleaning the injection site can introduce bacteria under the skin. This can cause local infections like abscesses (painful, pus-filled lumps), cellulitis (spreading skin infection that makes the skin red, hot, and swollen), or ulcers at injection sites. Repeated injecting in the same spot or missing the vein can worsen this. If not treated, these infections can become serious.
  • Vein Damage: Repeated injections irritate and damage veins. Over time, veins can collapse or scar (becoming hard and cord-like) or develop clots with inflammation (thrombophlebitis). This makes it increasingly difficult and painful to find a usable vein, leading some people to attempt riskier injection sites. Damaged veins also impair circulation in that area. Rotating injection sites and using proper technique (see safer injecting tips later) can help reduce this damage.
  • Systemic Infections: Bacteria introduced via a needle can travel through the bloodstream and cause life-threatening deep infections. Two of the most dangerous are endocarditis (infection of the heart’s inner lining/valves) and sepsis (a body-wide inflammatory response to infection, also called “blood poisoning”). Symptoms can be subtle at first (fever, chills, fatigue) but these conditions require urgent medical treatment.
  • Accidental Arterial Injection or Other Injuries: Injecting into an artery by mistake (instead of a vein) is extremely dangerous – it can cause intense pain, and the area might lose blood supply, leading to tissue death (gangrene) and possible limb amputation. Injecting improperly can also damage nerves, leading to numbness or weakness in parts of the body. Harm reduction services (like needle exchanges) offer education on safer injecting practices to help people avoid these outcomes – it’s not just about providing clean needles, but also teaching techniques for safer use, like how to tell a vein from an artery, and how to spot early signs of infection or other problems.
  • Other Long-Term Effects:
  • Tolerance: Over time, the body adapts to opioids. This means a person needs a higher and higher dose to get the same effect they used to get. Tolerance develops to many effects of opioids (especially the euphoria and pain relief). Importantly, tolerance to the life-threatening effects (like respiratory depression) develops more slowly than tolerance to the euphoric effects – which is one reason why someone might take what used to be a high but survivable dose to chase a high, only to find that dose is now enough to cause an overdose.
  • Physical Dependence: The body comes to rely on the presence of opioids to feel “normal.” If someone who is physically dependent significantly reduces their dose or stops taking opioids, they will experience withdrawal symptoms (covered in detail in the next section). Physical dependence by itself is not the same as addiction – it can happen even to patients taking opioids exactly as prescribed for pain – but it is one component of opioid use disorder.
  • Opioid-Induced Hyperalgesia (OIH): It sounds counterintuitive, but long-term use of opioids can sometimes make a person more sensitive to pain. OIH is a phenomenon where the nervous system starts responding more intensely to pain signals (or even non-painful stimuli) as a result of prolonged opioid exposure. This can mean someone’s original pain worsens or they begin to feel generalised achy pain. If OIH occurs, reducing or tapering off opioids under medical guidance can improve the pain.
  • Immune System Effects: Some studies suggest that chronic opioid use might suppress the immune system, potentially making it easier to get infections. This link is still being researched, but it’s another reason to manage opioids at the lowest effective dose for the shortest time necessary in pain treatment.
  • Falls and Fractures: Opioids can cause sedation, drowsiness, and unsteadiness. In older adults especially, long-term opioid use is linked to a higher risk of falls. Additionally, as mentioned, opioids can lower sex hormones and lead to bone density loss over time, which means bones may fracture more easily. The combination of feeling woozy and having more fragile bones increases the risk of serious falls and broken bones in people on long-term opioids.

Opioids, Mental Health, and Wellbeing 🧠

There is a strong, two-way link between opioid use and mental health. Each one can profoundly affect the other. Opioid use can influence mood and psychological state, and mental health issues can influence why someone uses opioids in the first place. Understanding this relationship is important because it highlights the need for joined-up support – treating just the addiction or just the mental health problem in isolation is often less effective than addressing both together.

Impact on Mood, Anxiety, and Thinking (Cognition) 😟

In the short term, taking opioids can make a person feel very good – they might experience a rush of pleasure or a deep calm. However, long-term opioid use is often associated with negative effects on mental wellbeing:

  • Mood and Depression: Over time, opioids can actually dampen the brain’s ability to experience pleasure from normally enjoyable activities. People often find that when they are not high on opioids, they feel a lack of pleasure or motivation (this is called anhedonia – an inability to feel joy). Long-term use is linked to a higher risk of developing depression or worsening an existing depression. Mood swings can also occur, especially if a person is fluctuating between intoxication and withdrawal. It’s not uncommon for someone dependent on opioids to feel emotionally low or numb when the drug isn’t in their system.
  • Anxiety: Some individuals begin using opioids in an attempt to cope with anxiety or stress, because opioids can initially produce a calming effect. But using opioids as a crutch for anxiety often backfires. Over time, opioid use can make anxiety disorders worse. The person may feel increasingly anxious when not on the drug, and withdrawal itself can cause intense anxiety and even panic attacks. It becomes a vicious cycle – they use opioids to quell anxiety, but the opioid dependence creates more anxiety in the long run.
  • Cognition (Thinking and Memory): Opioids are sedating, so they can cloud one’s thinking. People on opioids often experience drowsiness, mental fog, and difficulty concentrating or remembering things. They might describe feeling “slow” or “in a haze.” At very high doses or with long-term heavy use, opioids may even affect more complex brain functions – things like decision-making, planning, or understanding others’ perspectives can be impaired. These cognitive effects can interfere with everyday life: maintaining a job becomes harder, relationships may suffer due to forgetfulness or lack of attention, and it can be challenging to engage in therapy or recovery activities that require clear thinking. (For example, participating in Cognitive Behavioural Therapy (CBT) might be difficult if someone is nodding off or can’t concentrate due to opioids.) It’s important for treatment providers to be aware of this – sometimes adjustments (like scheduling therapy sessions for times when medication effects are smallest, or focusing on more concrete counselling approaches early on) can help until the person’s cognition improves.

Self-Medication and Co-occurring Conditions in the UK 🔗

It’s very common for people to use substances like opioids as a way to cope with emotional or psychiatric problems – this is often called self-medication. At the same time, many people who develop problematic opioid use also have underlying mental health conditions. When someone has both a substance use issue and a mental health issue, it’s referred to as a co-occurring condition or dual diagnosis. Here’s what this looks like:

  • Self-Medicating with Opioids: Some individuals turn to opioids without medical guidance to numb emotional pain or distress. For example, a person struggling with depression, anxiety, post-traumatic stress (PTSD) or even overwhelming life stress might use heroin or painkillers in an attempt to escape their feelings. Opioids can temporarily produce a warm, euphoric calm that seems to wash away stress and trauma. However, this relief is short-lived and comes at a high price. Using opioids to cope with mental health issues usually ends up worsening those issues over time. The original problems remain (or even escalate), and now the person can also develop tolerance, dependence, and opioid use disorder. In other words, the opioid might mask pain or sadness for a few hours, but it doesn’t solve the cause of that pain – and when it wears off, the feelings often rebound even stronger, leading to more use. It becomes a destructive cycle.
  • Dual Diagnosis (Co-occurring Mental Health Conditions): When people seek help for opioid use in the UK, the majority also report mental health problems. Recent data from the Office for Health Improvement and Disparities (OHID) shows that around 70% of adults starting drug or alcohol treatment report needing support for their mental health. This holds true across all substance groups, including those primarily using opioids. Common co-occurring conditions include depression, anxiety disorders, bipolar disorder, PTSD, and some personality disorders. These overlapping issues can make recovery more challenging, because each condition can exacerbate the other (for example, unmanaged anxiety can trigger drug cravings, and ongoing drug use can fuel more anxiety). (A simple way to visualise it: two problems intertwined like threads – you need to untangle both to really free someone.)
  • Chart perspective: Think of a pie chart of everyone in drug treatment – about two-thirds of that pie also represents people dealing with mental health issues. This means integrated care is crucial. Services are increasingly aware that treating the addiction and the mental health condition together (through a “dual diagnosis” approach) gives the best chance of success.
  • The Complex Relationship: Mental health and opioid use can interact in complicated ways. For instance, having an existing mental health disorder (like severe anxiety or unresolved trauma) might make someone more likely to misuse opioids or become dependent if they are exposed to them – perhaps they were prescribed opioids for pain and found it also soothed their emotional pain, leading to misuse. On the flip side, long-term opioid use itself can cause symptoms of depression and anxiety as discussed. It can be hard to tell which came first, and often each problem feeds into the other. What’s clear is that addressing only one piece of the puzzle is usually not enough. If a person’s depression is left untreated, it may pull them back toward using opioids for relief; if their opioid use continues unchecked, it may undermine progress in therapy for their depression. That’s why UK drug treatment services strive to either provide mental health support directly or make strong links to mental health services (like connecting clients to NHS Improving Access to Psychological Therapies (IAPT) programmes or Community Mental Health Teams). In many areas, there are protocols so that a person doesn’t get bounced between services – instead, professionals collaborate on a plan. Remember: needing help for both mental health and substance use is common and okay. Good services will understand this and offer or coordinate appropriate help for both. Getting this kind of comprehensive support can make a huge difference in achieving lasting recovery. Trying to tackle an opioid problem without addressing underlying depression, anxiety, or trauma (or vice versa) often makes things much harder than they need to be.

Accessing Treatment Services 🚪

Although many people in the UK live with opioid dependence, a significant number are not currently engaged with formal treatment services. There is hope and help available – reaching out for it is a brave and important step. Let’s look at the current picture and why some people hesitate to access services:

  • How Many People Get Help: Between April 2023 and March 2024, about 310,863 adults in England were in contact with drug and alcohol services. This number has been slowly rising, suggesting that more people are seeking support (which is encouraging). Of those in treatment, the largest group is people primarily there for opioid problems. In 2023/24, roughly 137,965 people (around 44% of everyone in treatment) were being helped mainly for opiate use. Interestingly, this proportion has slightly decreased from a few years ago (it used to be about 48-49%). This could be due to rising numbers of people in treatment for other substances, or slight declines in new opiate users – it doesn’t necessarily mean fewer people need help for opiates overall. It’s worth noting that many people in the opiate treatment group also report using crack cocaine alongside opioids – a common pattern that services address with combined approaches.
  • Reaching Everyone Who Needs It: It’s estimated that the total number of people dependent on opioids in England is higher than the number in treatment. Some estimates put it in the range of 260,000 to 340,000 people who are opioid-dependent. Comparing that to the ~140,000 in treatment for opiates, it suggests that possibly only about half of those who could benefit from treatment are currently getting it. That leaves a lot of people still out there who might need support. Why might someone not access help? There are many reasons:
  • Stigma or fear of judgement: They might worry about being labelled an “addict” or fear how they’ll be treated by healthcare staff.
  • Denial or not feeling ready: Some don’t seek help because they’re not ready to stop or they don’t recognise the extent of the problem.
  • Logistical barriers: It can be practical issues – maybe the nearest service is hard to get to, or they have work and fear losing their job if they attend, or they have childcare responsibilities. Homelessness or unstable housing can also make it harder to engage with services.
  • Fear of the treatment process: Some people are anxious about what treatment involves – for example, they might be afraid of withdrawal symptoms, or worried they’ll be forced to do something they don’t want, or that methadone is “just another addiction.” There can be misunderstandings about treatment that deter people.
  • Prior bad experiences: If someone had a negative encounter (felt disrespected, or relapsed after treatment before), they may be discouraged from trying again.
  • Overcoming these barriers is a key focus for services. Efforts include community outreach, making clinics more welcoming and less clinical, offering flexible appointment times, providing peer mentors who have lived experience, and ensuring that people are met with empathy and understanding. Importantly, treatment is voluntary and collaborative – you won’t be forced into anything, and you can discuss options that suit your life. Modern approaches emphasise meeting people “where they’re at” and building trust. If you or a loved one is considering getting help, know that services truly want to support you, not judge you.

Opioid Dependence and Withdrawal 🔄

Using opioids regularly over time can lead the body and brain to adapt to their presence. This adaptation is what we call physical dependence. When you’re physically dependent on opioids, your body expects the drug to be there to function normally. If the level of opioid in your system drops, you will experience withdrawal symptoms – the body’s reaction to the drug being taken away.

It’s important to understand the signs of dependence and what withdrawal involves. Recognising these signs is not about labelling or stigma – it’s about understanding the condition so it can be managed safely. Dependence and withdrawal are medical issues, and help is available to get through them.

Recognising Dependence: Key Signs ✅

Opioid Use Disorder (OUD) is the clinical term for opioid addiction. It is defined by a set of symptoms and behaviours that indicate a problematic pattern of opioid use causing significant impairment or distress. Healthcare professionals often use criteria from the DSM-5 (a diagnostic manual) to determine if someone has OUD and how severe it is. You don’t need a formal diagnosis to know you’re struggling, but these signs can help you self-reflect on how opioids are affecting your life. Generally, if at least 2 of the following have happened in a 12-month period, it points to some level of opioid use disorder (the more criteria that apply, the more severe the disorder tends to be):

  1. Using more or for longer than intended: You often take opioids in larger amounts or over a longer period than you meant to. (For example, you plan to just take one pill but end up taking many, or you wanted to use heroin for only a month and find yourself still using it many months later.)
  2. Inability to cut down or stop: You have a persistent desire or made unsuccessful efforts to cut down or control opioid use. (You may have tried to quit or reduce use multiple times, but haven’t been able to.)
  3. Spending a lot of time on opioids: You spend a great deal of time obtaining opioids, using opioids, or recovering from their effects. (Perhaps a good portion of your day is occupied with getting money for drugs, meeting a dealer, being high, or feeling sick and trying to manage that.)
  4. Cravings: You experience strong urges or intense cravings to use opioids. These can be physical (feeling a pang in your stomach when you think about using) and mental (can’t get the thought of using out of your head).
  5. Neglecting obligations: Repeated opioid use has led to you failing to fulfill major role obligations at work, school, or home. (For example, you’ve missed work deadlines, your school performance has dropped, or you’re not taking care of your children or household because of use.)
  6. Social or relationship problems: You continue to use opioids even though it has caused ongoing interpersonal problems. (Maybe your partner or family have argued with you about your use, or you’ve lost friendships, yet you still feel unable to stop.)
  7. Giving up activities: You have given up or cut back on important social, occupational, or recreational activities because of opioid use. (Hobbies you once loved have fallen by the wayside, or you avoid going out with friends or family functions because of your drug use.)
  8. Using in dangerous situations: You repeatedly use opioids in situations that are physically hazardous. (For example, using opioids while driving, or in an unsafe environment, or using street pills without knowing what’s in them.)
  9. Use despite physical or psychological harm: You continue to use opioids even knowing that it’s causing or worsening a physical or mental problem. (For instance, you know that using is making your depression worse or that you developed an ulcer or lung infection from injecting, but you still feel compelled to use.)
  10. Tolerance: You need markedly increased amounts of opioids to achieve the desired effect, OR you find that the same amount of opioid has a much reduced effect than before. (In other words, over time it takes more and more to get the feeling you want.)
  11. Withdrawal: When you stop or cut down opioids, you experience the characteristic withdrawal syndrome (see next section), or you take opioids (or a similar substance like methadone) to relieve or avoid withdrawal symptoms.

If you read through these and find many of them sounding familiar, it’s a sign that opioid use has become a major problem in your life. The last two signs (tolerance and withdrawal) are evidence of physical dependence. It bears repeating: developing tolerance and withdrawal happens to anyone who takes opioids regularly over time – even someone using prescription morphine for chronic pain under a doctor’s orders can become physically dependent. By itself, physical dependence does not mean someone is addicted or out of control; it means their body has adapted. Opioid Use Disorder (addiction) is more about the behaviours and harms (criteria 1–9) that come with drug use.

Understanding this can reduce stigma. For example, a patient on long-term opioids for cancer pain might have tolerance and would get withdrawal symptoms if the drug stopped, but they may not have any desire to misuse the medication or any life dysfunction – they have dependence, but not addiction. On the other hand, someone buying street heroin is likely to have both dependence (tolerance/withdrawal) and the other features of OUD. Why does this distinction matter? Because confusing “dependence” with “addiction” can lead to pain patients feeling unfairly judged as addicts, or doctors abruptly stopping necessary pain meds out of fear, which can harm patients. The key is good communication between patients and healthcare providers: if you are prescribed opioids, discuss any concerns about dependence and ensure any reduction plan is done safely. And if you suspect you do have opioid use disorder, don’t be afraid to seek help – it’s a medical condition, not a moral failing, and it can be treated.

Understanding Opioid Withdrawal 🤒

Opioid withdrawal refers to the set of symptoms that occur when a person who is physically dependent on opioids drastically reduces their dose or stops taking them entirely. Essentially, the body has gotten used to opioids being around, and when they suddenly disappear, the body reacts – kind of like a rebound effect. Withdrawal is often extremely uncomfortable, like a severe flu combined with intense anxiety, though (unlike alcohol or benzodiazepine withdrawal) opioid withdrawal is typically not life-threatening in an otherwise healthy person. Nonetheless, it can be unbearable enough that people resume using just to make the sickness stop.

Here’s what to expect with opioid withdrawal:

  • What it Feels Like (Symptoms): People commonly compare opioid withdrawal to having a very bad case of influenza (“the flu”) – but often it’s even worse than a flu. Common symptoms include:
  • Physical symptoms: Aching muscles and bones (a deep, gnawing achiness or cramps), abdominal cramps, diarrhoea, nausea and vomiting (you feel sick to your stomach and may throw up), chills alternating with hot flushes, sweating, a runny nose and watery eyes (like a bad cold), excessive yawning, goosebumps on the skin (this is where the term “cold turkey” comes from – the goosebumps resemble a plucked turkey’s skin), and tremors (shaking). Pupils will enlarge (the opposite of the pin-point pupils when on opioids). You’ll likely feel utterly exhausted yet have trouble sleeping. Heart rate and blood pressure go up, so you might feel your heart pounding or have a headache.
  • Psychological symptoms: Very strong cravings for opioids (an intense desire to use to make the sickness and emotional despair go away), severe anxiety and agitation (you might feel extremely restless, panicky or irritable), and insomnia (difficulty sleeping despite feeling dead tired). People often feel profoundly uneasy, unable to get comfortable, and emotionally raw – some describe it as “my skin is crawling” or “I wanted to jump out of my own body.” Depression can also set in during withdrawal, and some people experience dysphoria (a general sense of misery).
  • Timeline: How quickly withdrawal starts and how long it lasts depend mainly on the specific opioid that was being used and its half-life (how long it stays active in the body):
  • For short-acting opioids (examples: heroin, many prescription painkillers like oxycodone or morphine, and even fentanyl which, despite its strength, leaves the body quickly): Withdrawal symptoms usually begin 8–24 hours after the last dose. They tend to peak around 48–72 hours (2–3 days) after the last use – this is often the worst phase, when aches, diarrhoea, vomiting, and anxiety can be at their height. After peaking, symptoms start to ease and generally subside over about 4–10 days in total. By one to two weeks out, the acute physical withdrawal symptoms are mostly gone.
  • For long-acting opioids (example: methadone, which stays in the body much longer than heroin): Withdrawal comes on more slowly. Symptoms might only start 12–48 hours after the last dose of methadone. The trade-off with a slow onset is that withdrawal lasts longer, but often it’s less intense at any given time than something like heroin withdrawal. Methadone withdrawal can last 10–20 days or more. It’s a drawn-out affair – people often feel milder symptoms stretching into two or even three weeks. Buprenorphine (Subutex/Suboxone) withdrawal is similar in that it tends to be a bit delayed and prolonged, but many report it’s slightly milder than methadone’s. Keep in mind these timelines can vary. Other factors (like how high the dose was, the duration of use, and individual differences) can shift the onset or length a bit.
  • Severity Factors: Several things influence how intense withdrawal will be. Higher daily doses and longer duration of use generally make withdrawal worse. Your overall health matters – if you’re strong and healthy, you might weather it better than someone who is frail or has other medical issues. Co-existing mental health conditions can amplify the distress. Being in a supportive environment versus being alone on the street can also make a difference in how you perceive and cope with symptoms. Clinicians sometimes use tools like the Short Opiate Withdrawal Scale (SOWS) or the Clinical Opiate Withdrawal Scale (COWS) to objectively measure withdrawal severity and guide treatment. These scales basically score the presence and intensity of symptoms (like heart rate, pupil size, sweating, tremor, etc.) to determine if medications are needed and at what dosage.
  • Post-Acute Withdrawal Syndrome (PAWS): After the initial acute withdrawal phase (the worst of the physical illness), some people enter a phase of prolonged, lingering symptoms that are more psychological in nature. This is often called PAWS (Post-Acute Withdrawal Syndrome). PAWS isn’t guaranteed – its duration and intensity vary – but it can last for months and occasionally up to a couple of years in some form. The symptoms of PAWS can come and go in waves. They often include:
  • Mood swings (one day you might feel okay, the next you’re down or irritable for no obvious reason).
  • Ongoing anxiety, and sometimes sudden panic attacks.
  • Irritability or hostility – little things might set you off.
  • Persistent tiredness and low energy, even after getting clean from opioids.
  • Sleep problems – some people have insomnia that comes and goes, others sleep too much or have disturbed sleep cycles for a while.
  • Difficulty concentrating or “brain fog” – it can be hard to focus or remember things even weeks after quitting.
  • Memory issues – feeling forgetful or that your short-term memory isn’t as sharp.
  • Stress sensitivity – feeling overwhelmed by small stresses that you used to handle fine.
  • Cravings that pop up especially during stress or when encountering reminders of using (people, places, paraphernalia).
  • Feeling down or unable to experience pleasure (that anhedonia we mentioned can persist into this phase). These PAWS symptoms slowly get better as your brain and body recalibrate, but it can be a bumpy road. It’s really important to understand PAWS if you’re in recovery, because people sometimes get blindsided by it – “I finished detox, why do I still feel awful or emotionally unstable weeks later?” They might mistakenly think “I’ll never feel normal again” and lose hope. In reality, PAWS is temporary and a sign that your brain is healing. Knowing this can help you stay motivated and seek support during this phase. Coping strategies for PAWS include ongoing counselling, support groups (talking to others who’ve been through it), exercise (even walks can boost mood and sleep), proper nutrition, and possibly medications for specific symptoms (like sleep aids or antidepressants if prescribed by a doctor). The good news: with time, the human body and brain do a remarkable job of recovering from opioid dependence – those receptors down-regulate, natural endorphins start working better, and mood and cognition do improve. Many people report that after a period of clean time, they begin to feel normal or even better than normal. The key is to make it through that rough post-acute period without giving up.

The Importance of Safe Detoxification 🏥

While opioid withdrawal is excruciating and exhausting, the withdrawal process itself is generally not life-threatening (unlike withdrawal from alcohol or benzodiazepines, which can cause seizures and be fatal if not managed). That said, going through opioid detox (detoxification) is extremely challenging to do on one’s own. The cravings and agony of withdrawal can drive even the most determined people back to using if they don’t have proper support. Moreover, there are serious risks associated with an unassisted detox – primarily the risk of overdose if a relapse occurs.

Never feel like you “just have to tough it out” alone. Medical detox exists for a reason, and seeking help to detox safely is a smart, potentially life-saving choice.

Here are key points about doing a safe detox:

  • “Cold Turkey” on Your Own: Suddenly stopping opioids without any medical help (“going cold turkey”) often leads to relapse not far into the withdrawal process because the sickness becomes too much to bear. The biggest danger of a solo detox followed by relapse is the loss of tolerance. After even a relatively short break from opioids, your tolerance drops. If you then go back to using your previous dose, your body may not cope and you could overdose. Many opioid overdose deaths happen to people who recently detoxed or were abstinent for a while (for example, individuals leaving rehab or prison). They use what used to be their normal amount, not realising their body is no longer adjusted to that dose.
  • Medically Supervised Detox: Because of those dangers, medically supervised detoxification is strongly recommended as the safest way to come off opioids. In a supervised detox, healthcare professionals help you through the withdrawal in a controlled manner. Detox can happen in different settings:
  • Community Detox: This means you detox while living at home or in the community, but with support. Typically, you would be under the care of a local drug and alcohol service or your GP. They might prescribe medications to ease withdrawal symptoms (for example, something for nausea or to help with sleep and anxiety). You would have regular check-ins – maybe daily or a few times a week – with a nurse or keyworker to monitor how you’re doing. You’d also likely be given advice, emotional support, and maybe peer support during the process. Community detox is usually suitable if your dependence is moderate, you have a stable home environment, and you’re motivated with some support around you.
  • Inpatient Detox (Detox Clinic or Hospital Ward): This involves staying in a specialised facility for the duration of the detox (usually anywhere from a week to a few weeks). You get 24-hour medical supervision. Inpatient detox is often recommended for people with very heavy opioid use, those who have other health complications (like serious mental health issues or other drug dependencies such as heavy alcohol use that also need managing), or those who have tried outpatient detox before and not succeeded. Being inpatient means you’re away from triggers and can receive intensive care, including IV fluids or nutrition if needed, and immediate help for any complications.
  • What Detox Involves: A proper detox is more than just “stop taking the drug.” It typically includes:
  • Assessment: First, a thorough assessment is done – checking what opioids you’ve been using, how much, for how long, and evaluating your overall health (physical and mental). They’ll also consider your living situation and support system. This helps them craft a detox plan tailored to you.
  • Stabilisation and Medication: In many cases, detox involves switching from the opioid you were using (say, heroin) to a prescribed replacement opioid (like methadone or buprenorphine) and then gradually tapering that down. This way, you avoid the extreme ups and downs of withdrawal. For example, a common approach is to start buprenorphine as soon as you’re in mild withdrawal and use it to alleviate the worst symptoms – then taper off buprenorphine over about 7-14 days. Some detox programmes use methadone in a similar way, doing a faster taper. Alternatively, if you’re already on methadone for maintenance, they might gradually reduce your dose over time in a controlled fashion. In a hospital detox, if someone can’t or doesn’t want to use methadone/buprenorphine, they might use other supportive meds (like lofexidine, a non-opioid med that eases some withdrawal symptoms, along with symptomatic relief for insomnia, aches, etc.).
  • Symptom Management: Expect that you’ll be offered medications to treat specific withdrawal symptoms. For example, a doctor may prescribe: an anti-nausea tablet, a muscle relaxant or pain reliever for aches, something like loperamide for diarrhoea, maybe a mild sedative or antihistamine at night to help with sleep and anxiety. These don’t eliminate withdrawal entirely, but they can take the edge off many symptoms.
  • Monitoring: Throughout detox, healthcare staff will regularly check on you – measuring things like blood pressure, pulse, how you’re feeling, and ensuring symptoms are managed. They’ll adjust your medication doses if needed. This monitoring provides safety (in case any medical issues arise) and support (it’s reassuring to have people there who know what you’re going through and can tell you it’s going to be okay).
  • Transition to Ongoing Treatment: Often, detox is just the first step. For many individuals, the plan after detox is to continue on Medication-Assisted Treatment (MAT) such as methadone or buprenorphine, but at a stable maintenance dose rather than tapering to zero. Detox in that context might mean getting them off illicit opioids and stabilising on a medication. For others, detox might be a taper to being completely opioid-free, especially if they were on opioids for pain and want to come off them. In either case, part of a good detox process is planning what happens next – because if you detox and then do nothing else, the likelihood of relapse is high (the brain cravings are strong even after the body feels better). Detox staff will typically connect you to follow-up care like a community drug service, counselling, or perhaps rehab/day programmes. It’s worth mentioning safety: if you have been using street opioids, being inducted onto methadone or buprenorphine under supervision during detox is much safer than abruptly stopping. These medications prevent the worst withdrawal symptoms, dramatically lowering your risk of relapse during detox, and they themselves have a much lower overdose risk when used as directed. For example, buprenorphine has a “ceiling effect” that makes it quite hard to accidentally overdose on, and methadone dosing in detox is carefully controlled by the medical team. Detoxing without these, while not impossible, leaves a person in agony and higher risk of giving in and using whatever dose they can get, which can be a dicey situation physically.
  • After Detox – What Next: Completing a detox (getting all opioids out of your system) is a big accomplishment, but it’s really the start of a new phase of recovery. The body begins to heal, but the psychological aspect of addiction needs ongoing attention. Ongoing treatment after detox can include MAT maintenance (staying on a low dose of methadone or buprenorphine for a while or long-term to prevent relapse), and definitely should include psychosocial support like counselling, group therapy, or support groups. We’ll discuss treatments and recovery pathways in the next sections, but keep in mind: detox alone has a high relapse rate – it’s the follow-up care that helps you stay off opioids. Many people need multiple attempts, and that’s okay. Each attempt is a learning process, and with each step you’re closer to success. The goal is to live a healthier life, and safe detox is one step on that journey, not the end point.

Opioid Equipotency: Understanding Relative Strengths ⚖️

Not all opioids have the same strength. Equipotency refers to the dose of one opioid needed to produce the same pain-relieving effect (analgesia) as a standard dose of another opioid, usually morphine. Knowing the approximate relative strengths is crucial, especially when switching between opioids or encountering unfamiliar ones, as using an equivalent weight of a stronger opioid can easily lead to overdose.

Morphine Equivalent Dose (MED): This is a way to standardise opioid doses by converting them to an equivalent dose of oral morphine per day. For example, guidelines might suggest caution above a certain daily MED.

Approximate Oral Morphine Equivalent Conversion Factors (UK):

The following table gives approximate factors for converting a daily dose of an opioid (taken orally, unless specified) to its equivalent daily dose of oral morphine. This table is for general information only.

Opioid Route Conversion Factor (Multiply drug dose by this to get Oral Morphine Equivalent) Notes
Morphine Oral 1 Baseline
Codeine Oral 0.1 (or divide by 10) Weak opioid, variable effect due to genetics
Dihydrocodeine Oral 0.1 (or divide by 10) Similar to codeine
Tramadol Oral 0.1 – 0.2 Also affects serotonin/noradrenaline, conversion is less predictable
Buprenorphine Sublingual 75 Very potent, partial agonist. Conversion complex, best guided by specialist
Buprenorphine Patch Varies by patch strength (e.g., 5mcg/hr ≈ 12mg oral morphine/day) Specialist calculation needed
Oxycodone Oral 1.5 – 2 Significantly stronger than oral morphine
Methadone Oral Highly variable (3-10+), depends on dose & duration Conversion MUST be done by specialist due to long half-life & risks
Fentanyl Patch Varies (e.g., 12mcg/hr patch ≈ 30-45mg oral morphine/day) Very potent, specialist calculation needed
Diamorphine (Heroin) Oral Approx 1.5 (Rarely used orally)
Diamorphine (Heroin) IV/IM/SC Approx 3 (Relative to oral morphine)
Hydromorphone Oral 5 – 7.5 Potent
Pethidine Oral 0.1 Weak, short-acting, not recommended for chronic pain

Important Caveats:

  • These conversions are APPROXIMATE. Individual responses vary greatly. Factors like age, kidney/liver function, genetics, and tolerance affect how someone responds.
  • Switching Opioids Requires Caution: When switching from one opioid to another, the calculated equivalent dose is usually reduced (often by 25-50%) to account for incomplete cross-tolerance (not being fully tolerant to the new opioid) and minimise overdose risk. This MUST be done under medical supervision.
  • Different Routes Matter: The route of administration (oral, injection, patch) significantly affects potency and duration. Conversions involving patches or injections are complex and require specialist guidance.
  • Methadone is Complex: Converting to or from methadone is particularly risky due to its long and variable half-life and accumulation. This should only be managed by experienced prescribers.
  • Illicit Drugs: Street drugs like heroin have unknown purity and may contain dangerous adulterants like fentanyl or nitazenes, making any dose calculation extremely unreliable and dangerous.

Never attempt to switch opioids or calculate equivalent doses yourself based on tables alone. Always consult with a healthcare professional.

Staying Safer: Harm Reduction Strategies in the UK 🛡

Not everyone who uses opioids is ready or able to stop right now. Harm reduction is a public health approach that says: even if someone is using drugs, we can still help them stay as safe and healthy as possible. It’s about meeting people where they are, without judgment, and taking practical steps to reduce the risks associated with drug use. Harm reduction does not encourage drug use – it acknowledges reality and tries to prevent death, disease, and other harms. In the UK, there are several crucial harm reduction strategies for opioids that have saved countless lives and improved health outcomes. Let’s go through the big ones:

Naloxone: The Overdose Reversal Drug 💉

Naloxone is a medication that can rapidly reverse an opioid overdose. If someone has overdosed on heroin or another opioid, naloxone can quite literally bring them back from the brink of death by blocking the effects of the opioid.

  • ▶️ Watch: Naloxone Saves Lives – Combines reenactments, family perspectives, nasal naloxone guide, and physician interviews on prevention.
  • How Naloxone Works: Naloxone is what’s called an opioid antagonist. It has a super high affinity for opioid receptors – meaning it sticks to those receptors more strongly than most opioids do – but it doesn’t activate them. When administered during an overdose, naloxone effectively knocks the opioids off the receptors and binds there instead, blocking any further effect. This restores breathing in a person whose respiratory drive was suppressed by opioids. It usually works within 2–3 minutes. However, naloxone’s effects are temporary (lasting about 20–40 minutes), so it buys time for emergency services to arrive. It’s like an “off switch” for opioids for a short period. Importantly, naloxone only works if opioids are present – it has no effect if someone overdosed on non-opioid drugs.
  • Availability in the UK: In recent years, there’s been a big push to make naloxone widely available as a Take-Home Naloxone (THN) kit for people who might witness or experience an overdose. You can obtain naloxone for free from most community drug and alcohol services. By law, drug services can supply naloxone without a prescription to people who use opioids, as well as to their friends or family or anyone in a position to rescue someone (this includes hostel staff, outreach workers, etc.). Some areas also have pharmacy naloxone schemes – participating community pharmacies will give out kits and training. The goal is that anyone at risk of opioid overdose (or those around them) has a naloxone kit on hand. Naloxone in the UK comes in two main forms:
  • Prenoxad®: A pre-filled syringe for intramuscular injection. You inject this type of naloxone into a person’s leg muscle (thigh or upper arm), through their clothes if you need to.
  • Nyxoid®: A nasal spray. You spray this type of naloxone into a person’s nostril.
  • ▶️ Watch: How to use Nyxoid  Both are effective. The kits come with instructions and are designed for anyone to use, not just health professionals.
  • Training and Legal Protection: Services that distribute naloxone will usually provide a quick training – it often takes just 5-10 minutes. They’ll show you how to recognise an overdose (signs include: person won’t wake up, very slow or no breathing, snoring/gurgling sounds, blue lips), how to perform basic first aid (like putting someone in the recovery position and doing rescue breathing if you know how), how to administer the naloxone (inject or spray), and what to do next (always call 999 for an ambulance immediately, even after giving naloxone). It’s stressed that naloxone is safe – if you give it to someone who wasn’t actually overdosing on opioids, it won’t harm them. If they were on opioids, it will just make them sober up and possibly go into withdrawal, which is not pleasant but is certainly better than not breathing. Legally, you are protected when administering naloxone to save a life – it’s considered acting in good faith, like any first aid. You cannot get in trouble for possessing or using naloxone to help someone (naloxone is not a controlled drug and has no abuse potential).
  • After Naloxone – Why Ambulance is Crucial: One dose of naloxone wears off in 20-30 minutes, but opioids like heroin or methadone can last much longer in the body. This means an overdosing person can return to an overdose state once the naloxone wears off. That’s why it’s vital to get emergency medical help. The paramedics may need to give additional doses of naloxone or provide breathing support until the opioids clear out. Sometimes multiple naloxone doses are needed, especially if a very potent opioid like fentanyl is involved – fentanyl can overpower a single naloxone dose or outlast it. Also, naloxone will often put someone into immediate opioid withdrawal (which, while not life-threatening, is very unpleasant). Paramedics can help manage that and ensure the person stays stable. Do not let fear of police stop you from calling an ambulance – the priority in an overdose is medical care, not law enforcement.
  • No Stigma – Naloxone Saves Lives: Carrying naloxone is like carrying an epinephrine pen for allergies or a fire extinguisher for emergencies – it’s a responsible precaution. Many families who have lost loved ones to overdose campaign for everyone who needs it to have naloxone. In the UK, various initiatives have expanded who can distribute naloxone (now even police and prison officers in some areas carry it). If you use opioids or know someone who does, getting a naloxone kit and learning how to use it is one of the most important harm reduction steps you can take. It doesn’t encourage drug use; it simply ensures that if an accident happens, there’s a significantly better chance of survival. Don’t hesitate to ask your local drug service or pharmacy about naloxone – they will be very happy to provide it and show you how it works. It can save a life.

▶️ Naloxone in action: Should heroin users be given naloxone? – BBC Newsnight – A discussion on making naloxone widely available to prevent overdose deaths.

Needle and Syringe Programmes (NSPs) ♻️

Needle and Syringe Programmes (often called needle exchanges) are another cornerstone of harm reduction, especially for people who inject opioids (and other drugs). The idea is simple: provide people with free, sterile injecting equipment and a place to safely dispose of used equipment. This has huge benefits:

  • Preventing Infections: The primary goal is to stop the spread of blood-borne viruses like HIV and Hepatitis C/B. When people share or reuse needles and syringes, these viruses can be transmitted via even tiny amounts of blood. By always using a new, sterile needle and syringe for each injection, the risk of transmission drops dramatically. The UK has seen relatively low HIV rates among people who inject drugs, largely thanks to wide NSP coverage, though Hepatitis C has been more common (yet still, many people have avoided it due to NSPs and those who have it can get treatment).
  • What NSPs Offer: At an NSP, you can anonymously (no need to give your name) pick up packs of clean injecting equipment. This typically includes needles of various gauges (sizes) and syringes, sterile water ampoules for mixing, clean cookers/spoons, filters, alcohol swabs to clean the skin, and a sharps container (a hard yellow bin) for used needles. Some programmes give out citric acid or vitamin C powder (used to help dissolve heroin if it’s in base form), as well as foil (to encourage smoking instead of injecting when possible, as smoking has lower risk of BBVs). Basically, they equip you to inject in the most hygienic way possible.
  • Safe Disposal: NSPs also crucially take back used needles/syringes for safe disposal (hence “exchange” – you bring back your sharps bin and exchange for a new one). This keeps used needles off the streets and protects the community (nobody wants children or anyone finding a discarded needle in a park). You can return full sharps bins to the NSP or participating pharmacy, and they will incinerate the contents safely.
  • More than Just Needles: A good NSP is often a gateway to other help. The staff (who might be specialist harm reduction workers, nurses, or pharmacists) usually offer advice and support. They can show you safer injecting practices: e.g., how to rotate injection sites, how to properly clean your skin and prepare drugs to minimise infection risk, how to avoid hitting arteries, etc. They can also provide wound care advice if you have an abscess or sore, and will urge you to get medical treatment if needed. Many NSPs provide on-the-spot testing for Hepatitis C and HIV with a quick finger-prick blood test, because knowing your status is the first step to getting treatment (note: Hep C is now curable with medication in most cases, which is a huge advance). They might also offer vaccinations, especially for Hepatitis B (a safe and effective vaccine is available and recommended for anyone at risk).
  • Link to Other Services: NSPs are often where people who use drugs first find out about other supports. The staff can refer or encourage you to engage with drug treatment services (like getting on methadone or buprenorphine, if you choose to), healthcare (if you haven’t seen a GP in a while, they might help you register or get an appointment), housing support, mental health services, or peer support groups. They sometimes host drop-in clinics where a nurse or worker from another agency (like a hepatitis nurse or a housing advisor) might come in to help clients. In short, NSPs can act as a vital bridge – even if you’re not ready for formal treatment, you stay connected to a caring service.
  • Access in the UK: NSPs are widely available across the UK. They are typically run out of:
  • Specialist drug treatment centres or charities: Many community drug and alcohol clinics have an NSP attached or specific drop-in hours for needle exchange.
  • Pharmacies: In many towns, local chemists (pharmacies) participate in needle exchange schemes. You might see a sign or symbol in the window indicating they do needle exchange. This can be very convenient, as pharmacies have long opening hours and are found in most areas.
  • Outreach/mobile units: Some areas, especially cities, have mobile NSP vans that park in certain areas at set times, or outreach workers who deliver supplies to people who can’t come in. There are even postal needle exchange services in some regions for people in very remote areas or who prefer maximum anonymity – you can request supplies by mail (usually coordinated through an online or phone service). To find an NSP near you, you can use the FRANK website (it has a search tool), check your local council’s website (usually under Public Health or Drugs/Alcohol services), or simply ask at any drug service or call FRANK. Staff at these programmes are friendly and non-judgmental – they truly just want to help you stay safe and healthy.

Remember, using sterile equipment EVERY SINGLE TIME you inject is one of the best things you can do for your health if you are injecting drugs. It’s also a responsible step to protect others. The UK, through NSPs, has likely prevented HIV epidemics among people who use drugs (as sadly happened in some other countries before NSPs were established). Harm reduction saves lives and also shows people that someone cares about them, which can itself be a catalyst for positive change down the line.

Safer Injecting Practices 💉

Besides using new needles and syringes from an NSP, how you inject can significantly impact your health. If you or someone you know injects opioids (or any drug), following safer injecting practices can reduce the risk of infections, vein damage, and overdoses. Here are key tips and habits for safer injecting:

  • Hygiene First: Treat every injection like a mini medical procedure – cleanliness matters. Always wash your hands thoroughly with soap and water before preparing your hit. Clean the surface you’re using to prep (if you’re outside, consider using an alcohol wipe on a makeshift surface). Use an alcohol swab to clean the injection site on your skin: wipe in one direction over the spot you plan to inject, and then let it air dry for about 30 seconds (don’t blow on it or wipe it off – let the alcohol do its job killing germs). Cleaning the skin helps prevent bacteria from entering when the needle goes in.
  • Use Sterile Equipment Every Time: This is worth repeating – never reuse or share needles or syringes. Even if it’s “your own” from earlier, once a needle has been used, it’s duller (so it will cause more vein damage and pain the next time) and it’s contaminated with blood. Use a fresh, unopened needle and syringe for each injection. The same goes for all other equipment: use a new sterile water ampoule for mixing (if you don’t have those, use the cleanest water possible – boiling water then letting it cool in a clean container is a backup), use a new cooker/spoon each time (if you have reusable spoons, sterilise them with boiling water), and use a new filter each time (cotton or wheel filters provided in packs). Used filters and water can harbour bacteria or viruses. By using new everything, you massively cut down infection risk.
  • Proper Drug Preparation: Make sure the substance is dissolved fully – undissolved particles can clog needles or cause complications. If using heroin base (common in the UK), add a pinch of citric or vitamin C powder (use the packets given by NSPs – only a small amount is needed) to help it dissolve in water, but don’t over-acidify (too much acid can irritate veins). Once you’ve cooked and drawn up the solution through a filter into the syringe, dispose of the used cooker and filter safely.
  • Choosing and Rotating Injection Sites: The safest veins to inject are generally in the arms – the veins in the crook of the elbow (median cubital vein) are large and less risky than small veins elsewhere. However, frequent use of the same spot will cause vein damage. Rotate between different sites to give veins time to heal. If you have to inject frequently, try to rotate arms and different veins (forearms have some usable veins, upper arms sometimes). Avoid very dangerous areas: never inject in your neck (risk of hitting arteries, nerves, causing aneurysm or serious infection near airways), groin (the femoral vein is large but hitting the artery or nerve can be catastrophic – plus high infection risk), hands or feet (tiny fragile veins, high infection risk and slower healing), or genitals/breasts (some people attempt these when other veins fail – extremely high risk of infection and injury). Also avoid injecting into areas that are already swollen, red, or infected – you’ll just worsen the situation. It’s better to take extra time to find a safer site than to rush into a risky one.
  • Injection Technique: Once your equipment and site are ready, apply a tourniquet (if you use one) above the injection site to help the vein swell (many people just use their hand or something like a belt or band – just don’t tie it too tight as to cut off arterial flow). When you think you’re in a vein, pull back on the syringe plunger slightly to register a bit of blood (“flashback”) into the syringe. Bright red, forceful blood might mean you’re in an artery – if so, stop immediately. Darker, slower blood indicates a vein. Once you see you’re in a vein, release the tourniquet before injecting (this is important to allow blood flow and reduce pressure). Then inject slowly and steadily. Injecting too fast can cause pressure blow-outs or missed hits. If you feel pain different from the usual or see swelling, stop – you might have gone out of the vein. After injecting, remove the needle and apply gentle pressure with a clean tissue or swab to stop bleeding. Do not immediately reinsert into another site with the same needle; use a fresh one if you need another shot.
  • Never Share Anything: As mentioned, any equipment used in injecting can carry blood. So even sharing a spoon, filter, or water can potentially transmit hepatitis or HIV. It might seem harmless to share the cotton, but it’s not. Use your own supplies and don’t let others use them after you. If you’re with someone else, give them their own set of gear. Many NSPs provide sufficient equipment for this reason.
  • Safe Disposal of Sharps: Right after you finish an injection, do not leave the needle lying around. If you have a sharps bin (yellow bin) with you, carefully put the needle and syringe in it (needle first). If you’re outside and don’t have your bin, use a thick plastic bottle with a screw cap as a temporary container. The idea is to ensure no one can accidentally get jabbed by that needle. Never toss a loose needle in the trash or on the ground. When your sharps container is full, seal it and bring it to an NSP or pharmacy for disposal – they’ll give you a new one.
  • Avoid Injecting Alone if Possible: Overdoses can happen even to experienced users (the drug supply can be unpredictable). If you inject alone and overdose, there’s no one to call for help or administer naloxone. If you have a trusted friend, it’s safer to have someone with you or at least someone you can phone who knows to check on you. Some people arrange to call a friend before and after using, so if they don’t call back, the friend can summon help. If you must use alone, consider using in a place where help is more accessible (for instance, not behind a locked door, or somewhere a family member might find you sooner). Also, keep naloxone visible and nearby – even if you’re alone, sometimes overdoses can be transient or you might go very shallow-breathing but not fully out; if you become short of breath or feel yourself fading, try to use a naloxone nasal spray on yourself (there are cases of people self-administering when they felt they were going over). It’s not ideal, but worth mentioning.
  • Test Dose and Being Cautious: Especially when you have new gear (new batch of drugs, new supplier, or returning to use after a break), do a tester shot. This means start with a much smaller amount than you typically use to gauge potency. If the drug is potent, that small dose might actually be enough or even hit you hard – better to be safe than sorry. You can always take more, but you can’t undo an overdose except with naloxone and luck. Many opioid users have inadvertently overdosed because a batch was stronger than expected or was adulterated (like fentanyl mixed in). Starting low each time you get a different supply is a life-saving practice.
  • Listen to Your Body: If you miss a vein and inject into tissue (“skin popping” by accident), the area will likely swell and be painful. Apply a clean warm compress later and keep it clean; monitor it for infection (redness, heat, pus). Don’t keep poking the same swollen area. If you notice signs of infection or bad pain, seek medical care early – it’s easier to treat an infection before it becomes severe. If you ever see streaks of redness going up your limb or have fever and feel ill after an injection, go to A&E or see a doctor immediately – those can be signs of serious infection like cellulitis or sepsis.

Practicing safer injecting can significantly reduce harm. However, no injecting is completely safe – there’s always some risk. Some people transition to smoking heroin (chasing the dragon) to reduce many of these risks, and while smoking has its own issues (respiratory problems), it eliminates needle-related dangers. If you’re open to it, consider non-injecting routes as a harm reduction step. And remember, help is available if you ever choose to reduce or stop injecting – for example, opioid substitution treatment can stabilise you so you don’t need to inject illicit drugs.

Drug Checking Services 🧪

Because the illicit drug market is unregulated, you can never be 100% sure what a powder or pill actually contains just by looking at it. This uncertainty can be deadly when it comes to opioids – for example, if what you think is heroin is actually laced with fentanyl, using your normal amount could cause an overdose. Drug checking services aim to analyse substances and inform people about what’s really in them. While still not widespread, there are notable drug checking initiatives available to UK residents:

  • Purpose of Drug Checking: The main goal is to give people more information so they can make safer choices. If you know a pill contains fentanyl or some unexpected potent opioid, you might choose not to take it at all, or at least you’d use a much smaller amount with extreme caution. Knowledge is power: it can prevent accidental overdoses and also alert public health authorities to dangerous batches circulating.
  • WEDINOS (Welsh Emerging Drugs & Identification of Novel Substances): WEDINOS is a well-established drug checking system based in Wales but open to anyone in the UK. It allows you to anonymously send a small sample of a drug to their lab for testing, free of charge (you just pay postage). You download a form from their website, fill in details like where and when the sample was obtained and what you think it is, then post it with your sample (they only need a small amount, e.g. a portion of a pill or a few grains of powder). After a week or two, they post the test results on their website (wedinos.org) using a reference code so only you know which result is yours. The results will list the substances found in the sample (for instance: “Heroin, caffeine, and fentanyl detected” or “no active opioid detected, only paracetamol and sugar” – whatever it may be). They won’t list exact purity or amounts, just what’s present. Still, that’s incredibly useful. If something dangerous is found (like a super potent opioid or unexpected drug), WEDINOS also works with healthcare and drug agencies to issue alerts. Note: WEDINOS currently does not test for the strength/potency and may not test certain categories like anabolic steroids or some novel substances beyond their scope. But for opioids, it’s a valuable tool. It’s confidential and you won’t get in trouble for sending drugs for testing – they operate with harm reduction intent, not law enforcement.
  • The Loop: The Loop is a non-profit organisation that pioneered drug checking at events in the UK. They run Multi-Agency Safety Testing (MAST) at some music festivals and occasionally in city centres during pilot projects. Essentially, at a festival, people could submit a sample of their drugs to The Loop’s temporary lab at the event and within a short time get the results along with personalized advice. The Loop’s testing is more rapid and often face-to-face – importantly, it’s coupled with a brief intervention (they talk to the person about the results and discuss harm reduction or support). They’ve detected pills that were much stronger than advertised, or pills sold as “Xanax” that were actually fentanyl, etc., and have managed to get word out on site to prevent many emergencies. Outside of festivals, The Loop has done city trials (like in Bristol and Durham in the past) where they had pop-up labs for the public. These services are limited by funding and local approval, but there’s hope they will expand. If you encounter The Loop at an event, definitely consider using their service – it’s free, anonymous, and purely about safety. Find out more at wearetheloop.org.
  • Reagent Testing Kits: You can purchase simple at-home drug testing kits known as reagent kits. These involve liquids (reagents like Marquis, Mandelin, etc.) that change colour when a bit of your drug sample is mixed in, indicating what class of substance might be present. For example, the Marquis reagent might turn purple-black for heroin/morphine, or brown for amphetamines, etc. Pros: They are quick and cheap, can confirm the presence of some expected substances. Cons: They are not very precise – they can miss dangerous adulterants if those adulterants don’t trigger a distinct colour, and they don’t tell you purity. They might tell you something is an opioid (e.g. it turns dark indicating an opioid present), but it can’t distinguish between, say, heroin vs. fentanyl vs. oxycodone. Some specialised strips like fentanyl test strips can specifically check for fentanyl presence in a solution. Those strips are used by dissolving a bit of the drug in water and dipping the strip – they are sensitive to many fentanyl analogues. If the strip is positive, you know something from the fentanyl family is in there, which is a big red flag. However, a negative result doesn’t guarantee safety because the drug could still be potent in other ways (or the sample you tested may not be representative of the whole batch). So, reagent kits are a useful but limited tool. They’re certainly better than nothing: for instance, if a fentanyl strip shows positive, you may decide not to use that batch at all. If it’s negative, still exercise caution.
  • Limitations: It’s crucial to understand that no drug checking can tell you a drug is “safe.” They can only tell you what’s in it. Knowing the contents helps you avoid especially dangerous situations, but using any opioid still carries risk (overdose, dependence, etc.). Also, just because a sample was tested doesn’t mean every pill or powder from that batch is identical – there could be hot-spots in a batch. So always err on the side of caution even if results are as expected.
  • Harm Reduction Advice: Regardless of whether you get drugs tested, always apply other safety strategies: use a small test dose first, don’t use alone, have naloxone around, etc. Drug checking is just one piece of the harm reduction puzzle – it should be combined with those other pieces.

Drug checking services empower users with information and also give public health workers data to issue warnings (like when The Loop found pills with PMA, a deadly adulterant, they got the word out fast). If you have access to these services, they are worth using. As of now, WEDINOS is accessible to everyone by post, and some local areas might have their own initiatives. Keep an ear out via local drug services or peer networks for any drug alert or testing opportunities. Knowledge of what you’re really taking can save your life.

The Dangers of Mixing Opioids with Other Substances ⚠️

Using opioids on their own is risky enough, but when combined with other drugs, the dangers often multiply. Many overdose deaths involve a mix of substances rather than just one. Different drugs can interact in ways that greatly increase the chance of severe harm. This kind of using multiple substances is known as poly-drug use. Here are some particularly hazardous combinations with opioids:

  • Opioids + Alcohol: Both opioids and alcohol are central nervous system (CNS) depressants. This means they both slow down brain activity, including the drive to breathe. When you take them together, the effects aren’t just additive – they can be synergistic (the combined effect is greater than each alone). A person who might be okay after a moderate amount of heroin, and separately okay after a few drinks, could stop breathing if they do those same amounts at the same time. The risk of respiratory depression (dangerously slow breathing), extreme sedation, loss of consciousness, and accidental death shoots up. Many tragic overdoses happen when someone uses heroin or methadone after drinking, because alcohol can make you more susceptible to overdosing on a dose of opioid that you might normally tolerate. If you or someone you know uses opioids, it’s best to avoid alcohol altogether or keep it very limited. If you do drink, be extremely cautious about using any opioids on top – even hours later, alcohol can linger in your system and vice versa.
  • Opioids + Benzodiazepines (“Benzos”): Benzodiazepines (like diazepam/Valium®, alprazolam/Xanax®, temazepam, clonazepam, etizolam, etc.) are medications typically for anxiety or insomnia, and they are also CNS depressants. Unfortunately, mixing benzos with opioids is a common combination – sometimes people take benzos to boost the “nod” or to ease anxiety when heroin isn’t available. This combination is extremely dangerous. Both depress breathing and sedate you; together, they can cause profound respiratory depression. It’s one of the deadliest combos. In fact, a large proportion of opioid overdose fatalities also involve a benzodiazepine. Another issue is that illicit benzos (the kind sold on the street or dark web) are often of unknown strength or might be research chemicals like etizolam, which can be even stronger. So you might unwittingly take a huge dose of benzo along with your opioid. The safest advice is do not mix benzos and opioids. If you are prescribed a benzodiazepine by a doctor, be honest that you use opioids as well – doctors will try to find alternatives or adjust doses because of this interaction. If you find yourself using benzos to cope (for example, with withdrawal or anxiety), talk to your drug service – there might be safer ways to handle those issues.
  • Opioids + Gabapentinoids (Pregabalin/Gabapentin): Gabapentin (Neurontin®) and pregabalin (Lyrica®) are medications for nerve pain, epilepsy, or anxiety. In recent years, these drugs have often been misused alongside opioids. They also have depressant effects on the CNS, particularly pregabalin which can cause sedation. People sometimes take gabapentinoids to enhance the effect of opioids or to self-treat withdrawal symptoms. The combo of an opioid with pregabalin/gabapentin can increase sedation and breathing suppression similarly to how benzos do. There’s evidence that having pregabalin in your system significantly raises the risk of a fatal opioid overdose. The UK has seen a worrying rise in deaths involving pregabalin especially (it was made a Class C controlled drug in 2019 due to this). An additional danger: some users report that taking pregabalin makes them feel less opioid-tolerant – i.e., it might reduce your tolerance, so an opioid dose you usually handle could overdose you if you’ve taken pregabalin. If you are prescribed these meds for pain or other reasons, use caution and make sure your prescriber knows about any opioid use. If you’re using them recreationally, be aware you’re adding another depressant that could silently contribute to an overdose.
  • Opioids + Other Opioids: It might seem obvious, but taking more than one type of opioid at a time increases overdose risk because it increases the total opioid load on your body. Sometimes people on methadone or buprenorphine (in treatment) still use heroin on top – this is risky because the protective effect of being in treatment is reduced if you’re adding extra opioids. In some cases, people think “I’m on methadone, so I won’t overdose if I use heroin on top” – that’s not true; if your methadone dose isn’t blocking the heroin high, it’s also not blocking the respiratory depression fully. In other cases, someone might take an opioid pill (like codeine or oxycodone) together with heroin to boost effects – again, more opioids equals more risk. One special note: Buprenorphine has a unique effect – if you take buprenorphine too soon after another opioid (like heroin or methadone), it can displace that opioid from receptors and cause a rapid withdrawal (called precipitated withdrawal). That’s not life-threatening, but it’s very unpleasant. So mixing opioids can not only increase overdose risk, but with bupe in particular, timing matters or you could feel very sick. Generally, stick to one opioid at a time, or better yet, if you’re on prescribed methadone/bupe, try not to use illicit opioids on top – it defeats the purpose and puts you at risk.
  • Opioids + Stimulants (Speedballing): Some people use a stimulant like cocaine or crack together with an opioid (classic “speedball” is heroin + cocaine). This combination is hard on the body in a different way. The stimulant raises heart rate and blood pressure, while the opioid lowers breathing. The stimulant can mask how high you are on the opioid – you might not feel as sleepy, giving a false sense of security, so you might think you can handle more heroin and inject a dangerous amount. Also, when the stimulant wears off, the full depressant effect of the opioid can hit suddenly. Meanwhile, the poor heart is getting mixed signals – speedballing is notorious for causing cardiac stress, arrhythmias, even heart attacks or strokes, because the push-pull on the cardiovascular system can be extreme. Many famous individuals (and countless others) have died from speedballs. Mixing crack or cocaine with heroin increases risk of overdose, heart failure, and respiratory arrest. The best harm reduction advice here is to avoid simultaneous use; if you do mix, use smaller amounts of both than you normally would alone, and never use stimulants to “offset” an opioid overdose – it doesn’t work, you’re just adding more risk (yes, people have tried to give someone coke to wake them up from an overdose – this is dangerous and ineffective compared to using naloxone and rescue breathing).

Bottom line: Combining drugs magnifies danger. If you are using opioids, it’s safest to only use opioids and nothing else on board. Of course, the ultimate goal is not to use any non-prescribed substances at all, but understanding these risks might inform your choices. Many overdose survivors say they didn’t realise how lethal these combos could be. Now you do. Take-home tips for safety if you ever face these situations:

  • Try to plan so you’re not drinking or taking other sedatives if you know you’ll be using opioids.
  • If you are on prescribed meds that depress the CNS, talk with your prescriber about how to manage the overlap (they may adjust doses or timing).
  • Always keep naloxone around, especially if mixing depressants (naloxone won’t reverse alcohol or benzo effects, but it will tackle the opioid part of an overdose).
  • Tell a trusted person what you’ve taken if you feel at risk, so they can monitor you.
  • If you ever feel too sedated after mixing substances, get help right away – an ER can support breathing until you’re safe.

Staying safe might mean making the hard choice to use less or not use one of the substances. It might not feel as “intense,” but it significantly improves the odds of staying alive and healthy. Remember: you can’t enjoy a high if you’re not alive to experience it. Reducing harm is about extending your life to see a hopefully better day.

Pathways to Recovery: Treatment for Opioid Dependence 🛣

The good news is that effective treatment for opioid dependence exists and is available across the UK. Many people have rebuilt their lives with the help of treatment services. The approach to treating opioid use disorder typically involves a combination of medication and psychosocial support – often referred to as a “whole-person” approach.

In the UK, local drug and alcohol services (usually NHS-funded or provided by charities under NHS contracts) are the main avenue for treatment. These services are free to use and confidential. The philosophy is to tailor treatment to each individual’s needs and goals – whether that’s complete abstinence, reducing harm, or stabilising health and lifestyle.

  • ▶️ Patient Story: Sean’s Story – Sean describes the impact of strong opioid prescribing and the life-changing benefits of non-drug therapy.
  • ▶️ Patient Story: Mark’s Story – Mark shares his experience working with a pharmacist to reduce pain medication.

Accessing Treatment in the UK 🗺

Getting into treatment might feel daunting, but the process is straightforward and designed to be welcoming. Here’s how you can access help:

  • Starting Point – Local Drug Services: The primary way to get support for opioid issues is through your local community drug and alcohol service. Every local authority (council area) in the UK has at least one service (sometimes multiple agencies working together). These services often have names like “CityName Recovery Service” or may be run by national charities (e.g., Change Grow Live, We Are With You) under contract. You can usually refer yourself – which means you can phone them up directly and say, “I’d like help for my drug use,” and they will book you in. In many places, you can also just walk in during certain hours and be seen, or fill out an online referral form. You do not need to be sent by a GP (though GPs or hospitals can refer you too). If you’re unsure who your local service is, you can: use the FRANK website (search “find a drug treatment service” on Frank), search on the NHS service finder (type in your postcode and “drug treatment”), or call your local council’s public health department. You can also ask your GP, who will definitely know who to contact in your area.
  • Other Referral Routes: While self-referral is common, you might also be referred by various professionals. For instance, if you end up in hospital due to an overdose or related issue, the hospital might link you with the drug service upon discharge. Social workers, probation officers, or even pharmacists (if they notice something) can suggest referral. There are also pathways from prisons – if someone is incarcerated, they can continue treatment inside and get referred to community services on release. The key thing to know is that however you come in, the aim is to connect you to the support, not to punish you.
  • Finding Your Local Service: Quick recap on finding it:
  • Use Talk to Frank (either the website or the 24/7 helpline 0300 123 6600) – they can direct you to local help.
  • Use the NHS website – the service finder or just search “drug and alcohol service in [Your Town]”.
  • Local Council Website – often under sections like Public Health, Adult Social Care, or Community Support, they’ll list the commissioned provider and contact info.
  • GP – simply ask your doctor, “Where can I get help for a heroin problem?” They’ll refer or give you the contact.
  • Initial Assessment – What to Expect: When you first contact the service, they’ll set up an assessment appointment (often pretty quickly – some aim to do it within a day or two if urgent). This is basically a conversation with a keyworker (who might be a nurse, a drug worker, or other professional) about your situation. They’ll ask about your drug use history (what you use, how much, how often, etc.), your physical health (any conditions, any current medications, issues like liver health, etc.), your mental health (depression, anxiety, etc.), and your social situation (housing, family, children, employment, legal issues). They’ll also ask what goals you have – some people say “I want to get on methadone and stabilise,” others say “I want to detox and get completely clean,” others might say “I’m not sure, I just know I need to change something.” There’s no wrong answer; it’s your plan. Everything you share is confidential within the healthcare team (unless there’s a serious immediate risk issue like you planning to harm someone, etc.). They might also do a quick drug test (urine or saliva) to confirm what substances are in your system, but don’t worry, you won’t be turned away if, say, other drugs show up – it’s just information to help guide treatment.
  • Care Plan and Keyworker: After assessment, you and the staff will develop a personalised care plan. This outlines what the service will offer and what you aim to achieve. It may include starting a medication like methadone or buprenorphine, attending 1:1 counselling sessions or group therapy, getting help from a peer mentor, addressing housing or employment needs, etc. You’ll also be assigned a keyworker (sometimes called a recovery coordinator or care coordinator) – this is your main point of contact who will support you through treatment. You’ll likely see or talk to them regularly (weekly or biweekly at first, maybe). They are there to encourage you, track your progress, help solve problems, and coordinate with doctors or other services for you. Building a good relationship with your keyworker can really enhance your experience – remember, they’re on your side.
  • Quick Access to Treatment: Services try to start treatment promptly. National guidelines suggest that people should ideally start treatment (like get their first prescription, etc.) within 2-3 weeks of referral at most, and sooner if high risk (like pregnant women or those at high overdose risk are prioritised). Many areas actually manage it within a week or so. During any wait, they might offer interim support (like phone check-ins or a few group sessions). Don’t be discouraged if you don’t get a script day 1 – sometimes they need to do medical checks (like a blood test or get GP summary) before prescribing. But things like naloxone are often given at assessment if you’re at risk, and advice to stay safe until formal treatment starts.
  • No Judgment: It’s worth emphasising: these services understand drug use and will not judge you. You won’t shock them or tell them anything they haven’t heard. They see past the stigma – you’re a person who deserves help. People often say, “They were so much nicer and more understanding than I expected.” So if fear of being judged is holding you back, hopefully knowing this helps reduce that worry.

Medication-Assisted Treatment (MAT): An Overview 💊

One of the most effective tools for treating opioid dependence is Medication-Assisted Treatment (MAT), historically known in the UK as Opioid Substitution Therapy (OST). This involves prescribing a safer opioid medication in a controlled way to replace the illicit opioids someone is using. The two main medications used are methadone and buprenorphine. These medications, when taken as prescribed, can prevent withdrawal, control cravings, and block or dull the effects of any illicit opioids taken on top. Coupled with psychosocial support, MAT allows individuals to stabilise their lives – they’re not constantly sick or chasing drugs, so they can focus on other aspects of recovery (health, housing, relationships, work, etc.).

Key points about MAT:

  • What is MAT? – MAT means you take a prescribed opioid medicine daily under medical supervision instead of a street opioid. For example, instead of injecting heroin multiple times a day of uncertain purity, you might drink a dose of methadone once a day that’s measured exactly for you. Or you dissolve a buprenorphine tablet under your tongue. These medications occupy your brain’s opioid receptors, so you feel normal (not high, not in withdrawal) and won’t crave illicit opioids as much. MAT is usually long-term treatment – some people stay on it for years, some taper off after months; it depends on individual needs. Importantly, MAT is combined with psychosocial support – meaning the service will also offer counselling, group therapy, or other support while you’re on the medication. It’s treating both the physical and psychological sides of addiction.
  • Goals of MAT:
  • Prevent Withdrawal: You shouldn’t have to go through the cycle of getting sick every few hours. A proper dose of methadone or buprenorphine will keep you feeling stable 24/7, so you’re not constantly distracted by withdrawal symptoms.
  • Reduce Cravings: At the right dose, these medications greatly reduce (and sometimes eliminate) the hunger for heroin or other opioids. You might still think about using out of habit or triggers, but the physical compulsion eases up a lot. This frees up mental space to focus on other things in life.
  • Block or Diminish the High from Other Opioids: Especially with buprenorphine (and methadone to a degree when dose is high enough), if you do try to use heroin on top, you either won’t feel much effect or it won’t give you the euphoria you expected. Buprenorphine has a blocking effect at moderate to high doses – it kind of “occupies the field” so additional opioids can’t have much effect. This can discourage the impulse to use on top, because you know it’s pointless (and a waste of money).
  • Reduce Overdose Risk: Being in MAT is protective. Studies show that people on methadone or bupe have a much lower rate of fatal overdoses than those using illicit opioids. The medication doses are controlled, and you’re not getting unknown adulterants. Also, engagement in treatment means someone’s monitoring your wellbeing. It’s not a guarantee (overdoses can still happen if you misuse other substances heavily or take more than prescribed), but overall it’s one of the best safeguards. In fact, staying on MAT significantly lowers the chance of dying from any cause, not just overdose, because your life stabilises.
  • Improve Health and Function: With cravings and withdrawal out of the picture, people on MAT can start to eat better, sleep regularly, and attend to health issues. The chaos and danger of daily illicit use diminishes. This often leads to improvements in mental health, the ability to work or study, reconnect with family, and so on. It’s like switching off the constant “need” alarm in your body, allowing you to rebuild.
  • Reduce Injecting and Blood-borne Virus Risk: If you’re not chasing heroin, you’re likely not injecting (or doing so way less). This means you’re much less likely to contract or spread HIV or Hep C, and you’ll have fewer injection-related health problems.
  • Evidence and Endorsements: MAT (with methadone or buprenorphine) is backed by decades of research. It’s considered the “gold standard” for opioid dependence treatment worldwide. In the UK, the Department of Health’s clinical guidelines (often called the Orange Book) strongly recommend offering MAT. The National Institute for Health and Care Excellence (NICE) also supports it. These guidelines emphasise that treatment should be person-centred – MAT can be maintenance (no fixed end date) or time-limited, depending on the person. Some might use it as a stepping stone to detox; others might need it indefinitely like any chronic condition treatment. Both approaches are valid. The bottom line from research: people on MAT are more likely to stay in treatment and less likely to relapse compared to people who go through detox without MAT.

To summarise, Medication-Assisted Treatment is a tool that can help you regain stability. It’s not “trading one addiction for another,” as some critics say – it’s trading a dangerous, unregulated, destructive addiction for a monitored, safer medical dependency that allows you to function and heal. It’s similar to how someone with diabetes uses insulin – yes, they’re “dependent” on insulin, but it’s a proper treatment, not an addiction. Many people on MAT will tell you it gave them their life back: they could wake up and go to work instead of waking up sick and panicking about scoring.

Of course, MAT is voluntary – you will discuss and decide with the clinic what you want. If you prefer not to be on these meds, they won’t force you (except rare situations like court orders or pregnancy where it’s strongly advised). But knowing the benefits, most opioid users opt to try MAT when offered, at least as a first step.

Comparing MAT Options ⚖️

Let’s talk about the two main medications – Methadone and Buprenorphine – and their differences. Both are effective, but they have some distinct characteristics. In recent years, Buprenorphine also comes in an extended-release injection form (Buvidal® in the UK), which is another option. Deciding which to use is usually a joint decision between you and the prescriber, considering your preferences, any medical conditions, and practical factors.

  • Methadone (usually given as a syrupy liquid, e.g., Methadose or Physeptone):
  • How it works: Methadone is a full opioid agonist. This means it fully activates opioid receptors in the brain, similar to heroin, but it does so more slowly and steadily. It doesn’t have the rush of heroin when taken orally. It has a long half-life, so one dose can last about 24-36 hours.
  • Pros: Methadone is very effective at eliminating withdrawal and cravings when the dose is optimised. It tends to “hold” people even if they were very heavy heroin users – for those with high tolerance, methadone is often preferred because you can go to fairly high doses if needed. It’s been used for treatment since the 1960s, so we have a lot of experience with it. Many people feel “normal” on methadone and can function well. It can be started quickly – you don’t have to be in withdrawal to start methadone (in fact, it’s often started while someone is still using heroin, gradually building the dose as they reduce heroin).
  • Cons: Methadone has a higher overdose risk than buprenorphine, especially during the initial weeks before tolerance to methadone builds. If someone were to take extra methadone or use other depressants, it could suppress breathing significantly. Because it’s a full agonist, one can still feel effects if they decide to use heroin on top (particularly if their methadone dose is on the lower side), which might be a temptation for some. Also, methadone can have side effects like sweating, constipation (though those side effects are common to all opioids), and in high doses it can affect heart rhythm (a rare side effect causing QT prolongation in ECG). But in a monitored setting, that’s usually not a big issue unless you have other risk factors.
  • Buprenorphine (traditionally tablets like Subutex®, or film like Suboxone® which includes naloxone, taken daily under the tongue; also new weekly or monthly injection formulations like Buvidal®):
  • How it works: Buprenorphine is a partial opioid agonist and also a partial antagonist. What that means is it activates opioid receptors but only up to a certain level (ceiling effect) and beyond that, higher doses don’t produce more effect. It also binds very tightly to receptors, displacing other opioids. At sufficient doses (around 12-16 mg and above sublingually), it effectively blocks other opioids from getting you high. Buprenorphine’s effect plateaus – so taking more beyond a moderate dose doesn’t increase respiratory depression much, which is why it’s safer in overdose context.
  • Pros: Lower overdose risk – it’s very hard to fatally overdose on buprenorphine alone because of that ceiling effect (though mixing with heavy sedatives could still be dangerous). If you take an extra tablet, it usually doesn’t give you a “high” after a point, so there’s less incentive to misuse it. Many people feel less sedated or foggy on buprenorphine compared to methadone – some prefer that clarity. Buprenorphine also causes less physical dependence in terms of withdrawal severity (withdrawal from bupe is still not fun, but generally milder than methadone’s). It’s easier and faster to taper off if someone chooses to detox eventually. Because of its safety profile, take-home doses (once stable) might be given more quickly than with methadone.
  • Cons: Buprenorphine can precipitate withdrawal if started too early. You must be in mild-moderate withdrawal already before the first dose; otherwise, it can knock off the existing opioids (like heroin) from receptors abruptly and make you feel terrible. This means if you’re seeking treatment, you have to endure a short period of withdrawal to induct onto bupe, which some find hard. Also, some people who have been using very high amounts of opioids don’t feel “held” by buprenorphine at first – they might still feel some withdrawal or craving unless the dose is optimised. Buprenorphine can provide very good suppression of cravings at adequate doses (like 16mg+), but a minority of individuals report they just feel better on methadone (perhaps due to subtle differences in how it affects them, or because methadone can be more sedating which some equate with satisfaction). So, it might not be the first choice for someone with a massive habit or who has not done well on bupe before. Also, some people don’t like dissolving a tablet under the tongue daily (it can take 5-10 minutes of not talking or swallowing until it dissolves).
  • Buprenorphine/Naloxone (Suboxone): This is basically the same as above, but naloxone is added to deter injection misuse (if someone tries to inject their tablet, the naloxone would cause immediate withdrawal). When taken sublingually as intended, naloxone isn’t absorbed well and doesn’t affect you. Some services use Suboxone by default now because of perceived safety if diverted, etc., but the effect on the patient is essentially the same as plain buprenorphine.
  • Long-Acting Buprenorphine Injections (Buvidal® weekly or monthly):
  • How it works: Buvidal is an injection given either once a week or once a month (different doses for each schedule). It deposits buprenorphine in a slow-release form under the skin, creating a reservoir that steadily releases the medication over that period. It achieves a stable blood level of buprenorphine, so there are no daily ups and downs.
  • Pros: No need for daily supervised dosing at a pharmacy, which can be a game-changer for people who have jobs or commitments that make daily pickups hard. It offers a lot of freedom – you only need to visit the clinic for your injection weekly or even just monthly. This also means no chance of forgetting doses or losing take-home meds, etc. It provides very stable opioid coverage, often preventing even slight withdrawal fluctuations that some get before their next daily dose. It carries the same low overdose risk of buprenorphine. Many patients report that it’s very convenient and they feel well on it. It can reduce stigma because you’re not going to the chemist every day (people might not even know you’re on treatment).
  • Cons: You generally need to be stable on sublingual buprenorphine first before transferring to the injection, to ensure you tolerate it and have the right dose. Also, once you get the shot, it’s in your system for a long time – if you have an adverse effect or decide you want to stop buprenorphine, you can’t just skip tomorrow’s dose; you have to wait weeks for it to clear, which could be uncomfortable if you changed your mind. That said, most adverse effects of buprenorphine are mild (maybe headache, or injection site irritation). Another consideration is cost – Buvidal is more expensive for services than methadone or bupe tablets, so not every area is offering it to everyone yet (though its use is expanding). If you prefer it, you might have to advocate for it unless your service already suggests it.
  • Choosing Methadone vs Buprenorphine: During your assessment, the clinician might recommend one or the other based on your situation. Generally speaking:
  • If you have a very high tolerance, or have had success with methadone before, or you prefer a once-daily liquid, methadone might be suggested.
  • If you have a lighter habit, or are young and wish to avoid long detox later, or have risk factors for methadone (like certain heart issues), or simply want to avoid the heavy sedation, buprenorphine might be the first pick.
  • If you are especially concerned about daily pharmacy visits or diversion issues, they might fast-track you to Buvidal injections if available. You have a say in this. If you strongly want one over the other, discuss it. Some people try bupe and if it doesn’t feel enough, they switch to methadone (or vice versa). Services can accommodate that flexibility typically.
  • Both meds require induction period: for methadone, they usually start at a lower dose (like 20-30mg) and then increase over days/weeks to reach a dose that holds you (commonly 60-120mg for many, but it varies). For bupe, they usually start once moderate withdrawal is present (maybe 6-12+ hours after last heroin, longer after methadone) at 4mg or 8mg, and then adjust upward over a few days (most stabilise between 12-24mg daily).
  • Supervised Dosing: At the beginning of treatment, your doses of methadone or buprenorphine will likely be supervised, meaning you have to consume them under the pharmacist or nurse’s observation each day. This is for safety – to ensure you take it and don’t accidentally or intentionally misuse it or have someone else take it. As you engage with treatment and things stabilise (often after a few months of negative drug tests for other opioids and good attendance), services often grant take-home doses, so you might only go to the pharmacy 3 times a week, then weekly, etc. Buprenorphine tends to get take-homes faster (some places allow take-homes in a couple of weeks if all is well), whereas methadone might have longer supervision period. Each area has guidelines, but they also tailor to individual progress. The long-acting bupe injection kind of skips this issue since you’re only coming weekly and not handling the med yourself day to day.

Ultimately, both methadone and buprenorphine are life-saving medications. The choice can be revisited over time, and some people even switch from one to the other after years, if their needs change. For instance, someone stable on methadone might decide to try buprenorphine or the monthly shot later for convenience. Or someone on bupe who keeps lapsing might try methadone to see if it holds them better.

The important part is being on some form of MAT if you are opioid-dependent and not ready for abstinence. It significantly increases your chances of staying alive and improving your quality of life. Think of it as a foundation; once you’re not sick or craving, you can start working on other parts of your recovery plan.

▶️ Related Video: Daniel Ahmed: Why I set up a Heroin Assisted Treatment clinic – A look at an innovative UK clinic where medical-grade heroin (diamorphine) is prescribed to a small number of people who didn’t benefit from methadone or buprenorphine, showing how a compassionate, supervised approach can help those with the most severe dependence.

The Role of Talking Therapies, Peer Support, and Pain Self-Management 💬

Medication can greatly assist with the physical side of opioid dependence, but recovery is about more than just not being ill or not using. There are often underlying reasons why someone started using drugs, or problems that arose during their addiction (including persistent pain), that need addressing. Also, recovering from addiction involves learning new ways to cope with stress, emotions, and life challenges, including managing pain effectively. This is where psychosocial support and self-management strategies come in.

Most drug services offer a variety of psychosocial supports, or will refer you to specialist ones. Engaging in these can significantly improve your outcomes: people who combine MAT with regular psychosocial interventions and self-management skills tend to do better than those who just pick up a prescription. It helps you build motivation, skills, and a support network for long-term recovery.

Some key forms of support and self-management resources:

  • One-to-One Therapy/Counselling: Meeting with a substance misuse practitioner or psychologist can give you a safe space to explore issues in your life. A common approach is Cognitive Behavioural Therapy (CBT), which helps you identify the triggers (people, places, things, feelings) that lead to cravings or using, and develop healthier responses. For example, if you normally use heroin when you feel anxious and alone, therapy might help you recognise those feelings and practise alternative ways to soothe yourself or reach out to others instead of using. CBT also helps in relapse prevention – planning for high-risk situations and how to handle them. You might work on challenging negative thoughts like “I’ll never get better” and replace them with more hopeful, realistic thoughts. Many people find CBT gives them useful tools they can use daily in recovery.
  • Contingency Management (CM): This approach uses positive reinforcement to encourage change. For instance, a programme might reward you with supermarket vouchers or privileges when you meet targets like consistent attendance or providing drug-free urine samples. The rewards are small but meaningful; over time they can boost your confidence (“I can do this”) and encourage you to stick with the healthy behaviours. Some UK clinics use elements of CM – for example, giving a voucher after 4 consecutive negative drug tests for illicit opiates. Research shows it can improve engagement and outcomes.
  • Counselling/Therapy: Beyond structured CBT, having a one-to-one counsellor or therapist gives you a safe, confidential space to dig into deeper issues. You can explore underlying reasons for your substance use – such as past trauma, grief, or low self-esteem – and work through them with support. Counsellors also help you develop healthier coping strategies for stress, set goals, and build up your self-worth. Sometimes simply talking regularly to someone who listens and understands is incredibly healing. If you’ve experienced depression or anxiety, therapy can address those as part of your recovery plan (and you can be referred to mental health services like IAPT if needed).
  • Motivational Interviewing (MI): Many keyworkers use an MI approach – this is a collaborative, non-judgmental conversation style that helps you find your own motivation for recovery. Instead of telling you what to do, they’ll ask open questions: “What are some things you value in life? How does opioid use fit or conflict with those values?” This guided self-reflection can strengthen your resolve to change. MI is great if you’re feeling ambivalent – it helps sort out those mixed feelings and builds confidence and commitment to your goals.
  • Pain Self-Management Resources: Learning to manage persistent pain without relying solely on opioids is often crucial for recovery and improved quality of life.
  • Peer Support Groups: Connecting with others who have lived experience of addiction and recovery can be incredibly powerful. There are mutual aid groups where people come together and support each other, share stories, and offer hope and practical advice. Two major examples in the UK:
  • Narcotics Anonymous (NA): NA is a 12-step fellowship (similar to AA but for drug users, including opioids). Meetings are free and everywhere – in communities and online (ukna.org). In NA, people at all stages of recovery (from a few days clean to decades clean) meet regularly to share and encourage one another. It’s a spiritual programme (not tied to any religion; “higher power” as you understand it) focusing on total abstinence from drugs. Many find a sense of belonging and purpose in NA. There’s a saying, “The therapeutic value of one addict helping another is unparalleled.” Even if the 12-step approach isn’t your style, trying a few meetings can introduce you to a supportive network of folks who understand what you’re going through.
  • SMART Recovery: SMART is an alternative mutual aid group that is science-based and secular (non-religious). It stands for Self-Management and Recovery Training. SMART Recovery meetings focus on four key areas: building motivation, coping with urges, managing thoughts/behaviours, and living a balanced life. The meetings often involve discussions and exercises drawn from CBT and REBT (Rational Emotive Behaviour Therapy). It’s more of a training/support group than a share-and-confess format. SMART can be great if you prefer a peer group that isn’t 12-step. These meetings are also widely available online (smartrecovery.org.uk).
  • Other groups: There are also local support groups, faith-based groups, or online forums that might resonate with you. The key is finding a community so you realise you’re not alone. Many people make lifelong sober friends through support groups, which helps fill the void that quitting drug-using friends might leave.

Remember, since a lot of people in opioid treatment also have mental health challenges (around 70%, as mentioned earlier), good services will aim to treat the whole person, not just the addiction. That might mean you have access to a mental health worker in the team or get referred to therapy for trauma, etc. Don’t hesitate to use these supports. Recovery is not just about quitting drugs; it’s about building a fulfilling life. Medications like methadone/buprenorphine can stabilise you, but therapy, groups, and support will help you grow and find meaning, which keeps you going in the long term.

In summary, Medication-Assisted Treatment + Psychosocial Support + Self-Management Skills = your best chance at a strong recovery. Take advantage of what’s offered – from learning coping skills in CBT, to earning a voucher in a contingency programme, to venting to your counsellor on a bad week, to attending a peer support meeting, to using pain self-management guides. All of these pieces together rebuild the puzzle of a healthy life.

UK Resources for Information and Support 🤝

Finding help and accurate information can feel overwhelming, especially when you’re in crisis or supporting someone who is. The good news is there are many excellent organisations in the UK dedicated to helping people affected by opioids – whether you are using opioids yourself or you’re a family member or friend. Below is a handy list of key resources. These can provide free advice, a listening ear, and practical support.

Helplines and Online Advice ☎️

  • FRANK: “Talk To Frank” is the national drug information and advice service. It’s known for providing friendly, confidential, and non-judgemental information about all kinds of drugs, including opioids. You can contact FRANK 24/7 for factual information on drug effects and risks, guidance on what to do in a crisis (like an overdose), and importantly, they can help you find local treatment services anywhere in the UK.
  • Freephone Helpline: 0300 123 6600 (available 24 hours a day, 7 days a week). You can call anytime and speak to a trained advisor.
  • Text: You can text a question to 82111 and FRANK will text you back. This might be useful if you’re not comfortable talking or don’t have credit for a long call.
  • Email & Live Chat: Via the official website (talktofrank.com), you can send an email question or use their live chat service during certain hours. It’s all confidential.
  • Website: talktofrank.com – The FRANK site has a wealth of easy-to-read info on drugs (including a page on heroin/opiates), plus a tool to locate local support by postcode. It also has advice for parents and for young people. (Remember, FRANK is for anyone – whether you’re using drugs or just seeking knowledge.)

Support for Families and Friends 👪

Loving someone who is struggling with opioid use can be incredibly stressful, heartbreaking, and isolating. It’s important for families and friends to get support for themselves, too – both for their own wellbeing and so they can best help their loved one. There are UK charities specialising in family support:

  • Adfam: Adfam is a national charity dedicated to supporting families affected by drugs or alcohol. They provide information, training, and guidance, and also work to improve family support services. On Adfam’s website (adfam.org.uk) you can find resources and search for local family support groups. Adfam also runs an online forum where you can anonymously share and get advice from other family members who “get it.” They campaign for the needs of families to be recognised by government and treatment providers.
  • DrugFam: DrugFam offers telephone and email support to those affected by someone else’s drug or alcohol use, including those who have been bereaved by addiction. They have a helpline (0300 888 3853 – check the DrugFam website (drugfam.co.uk) for current hours, which are usually weekday and Sunday afternoons/evenings). DrugFam’s trained volunteers can listen, advise on coping strategies, and connect you with support groups. Their website also has helpful literature and links. Many people have found solace in DrugFam’s befriending and support after feeling very alone in dealing with an addicted loved one.
  • Al-Anon Family Groups UK & Eire: Al-Anon isn’t specifically about drugs – it’s for anyone whose life is affected by someone else’s drinking – but many principles apply and some members have loved ones with multiple addictions (alcohol and drugs). Al-Anon provides a 12-step fellowship for families and friends of alcoholics, which often is relevant if your loved one uses alcohol along with opioids. They also have Alateen meetings for young people (12–17) living with adults who drink. Al-Anon has a free helpline (0800 0086 811, 10am-10pm daily) where you can talk anonymously with a volunteer who likely has been in similar shoes. They also have many local meetings where you can find understanding and support. Website: al-anonuk.org.uk.
  • Nacoa (National Association for Children of Alcoholics): Although aimed at children of alcohol-dependent parents, Nacoa extends support to children affected by parental drug use as well. Kids and young adults can contact Nacoa’s helpline (0800 358 3456) for advice and someone to talk to. If you’re a parent struggling with opioid use, Nacoa can indirectly support your children by giving them a space to express their feelings. (Website: nacoa.org.uk)

The bottom line: if you’re a parent, partner, child, sibling, or friend of someone using opioids, don’t suffer in silence. Reaching out to family support groups like the above can give you strength, tips for coping (e.g., setting boundaries, dealing with enabling guilt, etc.), and simply a compassionate ear. You may also learn how to support your loved one’s recovery without losing yourself. Many family members say, “I wish I had sought support sooner.”

Treatment Service Providers (National Organisations) 🏢

Local drug and alcohol services in your area might be run by large charities that operate across the country. It can be useful to know their names:

  • We Are With You (formerly called Addaction): One of the UK’s largest drug and alcohol treatment providers, operating services for adults and young people in many regions. They offer free, confidential support – from one-to-one keywork, group programmes, to harm reduction services. They also have an online webchat service where you can talk to a trained worker via their website if you have questions about drug use (great if you’re not in treatment yet and want initial advice). Website: www.wearewithyou.org.uk
  • Change Grow Live (CGL): Another major nonprofit that runs numerous community-based treatment services throughout England and Wales. CGL services typically include things like prescribing (MAT), counselling, needle exchanges, outreach, and links to social support (housing, employment advice, etc.). They also work in criminal justice settings (like drug rehabilitation requirements, prison inreach). If your local service is run by CGL, you’ll see their logo around. Website: www.changegrowlive.org

(Note: There are other providers too – e.g., Turning Point, Mind in some areas, local NHS trusts in some regions run services directly, etc. Regardless of who runs it, all these services work toward the same goals. The staff from whichever organisation will focus on helping you recover.)

You don’t usually contact these big providers directly for help – instead you go through your local service – but knowing who they are can be reassuring (they are experienced organisations) and their websites have additional resources and stories of recovery that can inspire.

Legal Advice and Advocacy ⚖️

Opioid use can sometimes lead to legal problems – maybe an arrest for possession, or issues around housing or employment rights, or child custody if social services become involved. It’s important to know your rights and get proper advice:

  • Release: Release is the UK’s national centre of expertise on drugs and drugs law. They offer free, confidential legal advice for people who use drugs on matters such as drug possession charges, police searches, what to expect if you go to court, and also on related issues like benefits, housing, or discrimination. Release runs a telephone Legal Helpline (020 7324 2989 – usually available weekdays) where you can speak to a knowledgeable advisor. They can also sometimes take on cases or refer you to appropriate legal help. Additionally, Release campaigns for evidence-based drug laws and humane policies. Their website (release.org.uk) has excellent information on your legal rights (for example, what’s the law on handing in drugs found on someone who OD’d, etc.) and on how to deal with police or the criminal justice system. If you’re ever in a situation where you need legal clarity related to drug use, Release is the go-to resource.

Peer Support Organisations 🤗

We touched on NA and SMART Recovery above, which are grassroots peer-led groups. In addition to those, there are other peer-led or user-led initiatives that might exist in your area – for example, local Recovery Cafés or social enterprises run by people in recovery. These can provide a sense of community and purpose.

To re-emphasise two big ones:

  • Narcotics Anonymous (NA): Helpline 0300 999 1212 (10am-midnight daily) to find meetings or just talk to a member. UK NA’s website (ukna.org) has a meeting finder for face-to-face and online meetings. NA isn’t professional therapy; it’s peers sharing experience, strength, and hope. Many find that sponsorship (having a mentor in the programme) and working through NA’s 12 steps greatly support their personal growth and ability to live drug-free.
  • SMART Recovery UK: Check smartrecovery.org.uk for meeting listings and online resources. SMART also has an online forum and various tools (like worksheets to challenge thoughts, etc.). It’s a bit more of a “workshop” vibe, with trained facilitators (often peers who have been through the programme). If a structured, self-empowering approach appeals to you, SMART is worth trying.

Both NA and SMART are free and you can attend as often as you like. Some people go to both and use what they need from each.

Finding Local Treatment Services 📍

To quickly find the drug and alcohol service in your area (for yourself or someone else), you can:

  • Use the FRANK website or Helpline – as mentioned, they have a service finder. Just input your town or postcode.
  • Search the NHS website (www.nhs.uk) – search “drug treatment [your area]” or go to the “Find addiction services” section and filter by location.
  • Contact your GP or local health authority – GP surgeries will know, and councils typically list the commissioned service on their site.
  • Ask a local pharmacy – pharmacists often know which service operates locally, especially if they supervise methadone/buprenorphine consumption for patients.

Usually, the local service will have a name like “[Town] Recovery Service” or “[County] Drug and Alcohol Team”. Don’t worry if you’re not sure – just reach out to any health professional and they’ll guide you to the right place.

Naloxone Access Points 💉

As discussed earlier, naloxone (the opioid overdose antidote) is freely available – if you’re at risk of opioid overdose or in contact with someone who is, please get a kit! Places to obtain naloxone and training in the UK include:

  • Local drug treatment services: Almost all community drug services provide Take-Home Naloxone kits. When you enrol in treatment, they will likely offer you one (and if they don’t, you should ask!). Even if you’re not in treatment, you can usually walk into the service and request naloxone – they’ll be happy to give it and show you how to use it. This applies to family members too: services are allowed to supply naloxone to anyone in a position to assist in an overdose.
  • Pharmacies: Some areas have pharmacies that participate in naloxone distribution schemes. For example, certain chemists might give out nasal naloxone kits without a prescription – especially in Scotland, Wales, and some parts of England with pilot programmes. You can ask your local pharmacist if they stock naloxone or know where you can get it nearby.
  • Outreach programmes and hostels: Needle exchanges (fixed sites or mobile vans) often carry naloxone kits to give out. Homeless shelters or hostels that serve people who use drugs might also have arrangements to supply kits on-site.
  • Emergency services initiatives: Increasingly, police and paramedics carry naloxone. While you wouldn’t get a kit from police, some forces run community events or work with charities to hand out naloxone at public awareness days (for example, on International Overdose Awareness Day events). Keep an ear out locally.

In Scotland and Wales, naloxone provision is very widespread – local drug services, pharmacies, and even some community groups will provide it due to government funding and strong harm reduction policies. In England, it’s a bit more patchy by region, but coverage is improving year by year.

If you’re unsure, FRANK or your local drug service can tell you exactly where to get naloxone in your area. There is NO cost, and NO catch. You don’t have to be in treatment or committed to stop using – it’s a no-strings life-saving resource. Also, don’t worry about legal issues – naloxone is legal for anyone to carry and use in an emergency to save a life.

A quick recap on using naloxone: If you suspect an opioid overdose, call 999 immediately, administer naloxone (inject into muscle of thigh/upper arm, or spray into nose, depending on type), and perform basic life support (recovery position, rescue breaths if needed) until help arrives. Naloxone can revive someone in minutes, but always get medical backup because the effects can wear off. Many communities credit naloxone with reducing fatal overdose rates – having it handy truly can be the difference between life and death in those critical moments.

Looking Forward: Hope, Recovery, and Support ⭐

Recovery is a journey, not a sprint. With naloxone to prevent overdose, harm reduction to stay safer, MAT to stabilise, and talking therapies, peer groups & self-management to rebuild, you can reclaim your life. Services across Nottinghamshire and the wider UK stand ready to help—simply reach out. Positive change is always possible. You are not alone on this journey.