Programme helping patients self-regulate strong-opioid use has potential for NHS, study shows
Posted on Thursday 8 October 2026
Funded by the National Institute for Health and Care Research (NIHR), the economic evaluation of the Improving the Well-being of People with Opioid Treated Chronic Pain (I-WOTCH) programme suggests that while costing more upfront, I-WOTCH’s long-term benefits mean it could be good value for money for the NHS.
More than 600 patients with non-malignant chronic pain took part in the year-long clinical trial of the programme, and 29% in the support group were off strong-opioids entirely after 12 months, compared to only 7% of those receiving standard care with no support.
In 2019, 5.6 million people in England received and collected a prescription for an opioid painkiller. Globally, around 60 million people used opioids at least once in the same year.
Severe risks
While strong-opioids are effective for managing sudden, short-term pain, experts warn there is little evidence their long-term use helps with chronic pain not caused by cancer. Continued use carries severe risks, including dizziness, severe falls, sleep apnoea, overdose, and early death.
Official guidance from the National Institute for Health and Care Excellence (NICE) recommends tapering or stopping strong opioids when risks outweigh benefits.
Cynthia Iglesias, Professor of Health Economics from the University of York, who led I-WOTCH’s economic analysis, said: “Strong opioids, even when used in the prescribed dosage by a medical professional, can cause dependency and without structured support some people can struggle to cut them down or stop altogether.
“The I-WOTCH programme was developed to help people safely reduce their doses while learning long-term self-management techniques.
“Our analysis of the trial’s outcomes, which was conducted at GP surgeries across England, demonstrates just how effective support programmes can be.”
Healthcare costs
The team also found I-WOTCH had an impact on people's ability to use and taper off - or self-regulate - strong opioids, without worsening their health-related quality of life.
The analysis, published in the journal Addiction, reveals that the programme initially increases healthcare costs over the first year, as patients require extra medical support while tapering off their medication, but the investment may pay off in the long-term.
Professor Iglesias said: “By helping patients build lifelong habits to manage their chronic pain using strong opioid based painkillers only during short-term acute pain episodes, the programme significantly reduces the risk of long-term health complications and premature death.
“The scheme offers a promising, cost-effective way to enhance NHS efforts to crackdown strong-opioid prescriptions in England.”
To understand if habits remain lifelong, and if individuals are able to use, tapering off or quit strong-opioid based painkillers at will, researchers now want to observe individuals with non-malignant chronic pain over a longer period.
