Opioid therapy can help whether your goal is to cut down, to stop, or to understand what the drug is doing for you. We will discuss how to manage your safety while you decide what you want.
What this covers
Opioids include heroin and painkillers such as morphine, whether prescribed or not. Heroin is a Class A drug. Dependence can start with a prescription for pain as easily as with street drugs, and it says nothing about your character. For codeine and tramadol, see prescription medicines.
Signs use may be becoming a problem
- Needing more to get the same effect
- Taking it for longer, or in larger amounts, than you meant to
- Feeling unwell, anxious or restless when you have not had it
- Spending a lot of time, money or energy getting it and using it
- Using it to cope with stress, pain or low mood beyond what it was prescribed for
- Hiding how much you take, or feeling ashamed about it
- Problems with work, money, health or relationships
Overdose and safety: read this
- Opioids slow your breathing, and slowed breathing can be fatal. The risk goes up if you mix them with alcohol, benzodiazepines or similar medicines; see polydrug use.
- Your tolerance drops quickly after even a few days without using. Taking your usual dose after a break can cause an overdose.
- Street heroin can be cut with much stronger synthetic opioids, so you can never be sure what a dose contains.
- Ask your local drug treatment service or a pharmacist about take-home naloxone, a medicine that can reverse an opioid overdose in an emergency. Family and friends can get it too.
- Call 999 if someone is extremely sleepy, breathing slowly or cannot be woken, and tell the crew what you think they have taken.
Treatment you can get alongside therapy
The NHS offers treatment for opioid dependence, including substitute medicines such as methadone or buprenorphine, supervised detox, and talking therapies. You do not have to go through your GP: you can approach your local drug treatment service yourself, and FRANK on 0300 123 6600 can talk you through the options. I am not a medical service and cannot prescribe.
What therapy can offer
- A place to talk honestly about your use without being lectured
- Working out what the drug does for you (relief, numbness, pain, sleep) and what else could do some of that work
- Practical strategies for cutting down or stopping, at a pace you can manage
- Support alongside any prescribed treatment you are on; therapy works with medical care, not instead of it
- Space to decide your own goal, and to change your mind
Confidentiality
Worried about your job or your driving licence? What I report, and what stays between us.
If it is someone you love
If someone you love is affected, you can have support of your own, whether or not they get help. Support for families and loved ones.
Short answers to common questions
Can I have therapy while I am on methadone or buprenorphine?
Yes. Medicines like these are often combined with counselling and support, and therapy can sit alongside your prescribed treatment.
Is it dangerous to use again after a break?
Yes, it can be. Your tolerance drops quickly, so a dose you used to take can now overdose you. This is one of the reasons to talk to a drug treatment service about naloxone and a plan.
Should I see a doctor before I change how much I use?
If you use regularly, talk to a drug treatment service before making big changes.
Does naloxone work on fentanyl and other strong opioids?
GOV.UK describes naloxone as the emergency antidote for overdoses caused by heroin and other opiates or opioids, and lists methadone, morphine, nitazenes and fentanyl as examples. It counters the slowing of breathing. Drug treatment services and some trained professionals can supply it without a prescription. GOV.UK’s training guidance stresses that it does not replace calling 999, and says to stay with the person.
What happens at a first appointment with a drug service?
The NHS says staff will ask about your drug use, work, family and housing, and you may be asked for a urine or saliva sample. You then agree a treatment plan, which may combine several approaches, and you are given a keyworker. The NHS says most treatment is provided by charities and the NHS. I can help you think through what you want to say beforehand.
How long do people stay on methadone?
The NHS says that for maintenance, people usually take methadone long term, as a substitute for heroin. For a detox, it says the dose is lowered gradually, usually over up to 12 weeks, or more quickly in hospital or residential rehab. It is possible to become dependent on methadone; if you are worried, your GP, prescriber or keyworker can agree a plan to reduce slowly. Do not stop suddenly.
Can I drive if I am on methadone?
The NHS says not to drive while taking methadone until your doctor tells you it is safe, and that your licence may be suspended until you are on a stable dose. It also says you must tell the DVLA if you have used illegal drugs or misused prescription medicines. Police can ask for a saliva sample even if your driving seems unaffected. Your doctor, pharmacist or keyworker can advise on your situation.
Why is it so hard to stop using heroin?
FRANK says heroin is highly addictive: its effects on the brain can cause cravings and a strong urge to keep using, and tolerance builds so people take more. The NHS says substitute medicines such as methadone or buprenorphine replace the street drug, so you can focus on treatment without constantly managing withdrawal or sourcing drugs. FRANK says these treatments are meant to be combined with counselling and support, which is where I can help.
How can I help someone addicted to heroin or painkillers?
Stay in touch, keep judgement out of it, and focus on safety. GOV.UK says take-home naloxone can be given to a family member or friend of someone using opiates, so ask a local drug treatment service about it. FRANK says overdose can bring heavy sleepiness and slow breathing; call 999 and tell the crew what you know. FRANK’s helpline is 0300 123 6600. GOV.UK on naloxone