TOPLINE:

Fear, withdrawal symptoms, and a lack of professional support commonly hindered detoxification from opioid substitution treatment (OST), whereas life stability, psychological readiness, psychological interventions, inpatient facilities, and adjunctive medications served as key facilitators, according to a mixed-methods systematic review.

METHODOLOGY:

• Researchers conducted a mixed-methods narrative systematic review using 41 studies spanning nine countries, which were obtained by searching four databases until January 22, 2025.
• The included studies evaluated methadone (n = 28), buprenorphine (n = 5), both (n = 6), or unspecified OST (n = 2) across outpatient (n = 29), inpatient (n = 7), mixed (n = 4), and prison (n = 1) settings.
• The analysis transformed quantitative data into textual descriptions to integrate those with qualitative data.
• Researchers assessed the methodological quality of the included papers using Joanna Briggs Institute checklists, rating 54% of them as high quality and 37% of them as medium quality.

TAKEAWAY:

• Factors affecting detoxification occurred at individual and structural levels across eight overlapping themes, including fear, personal motivation, withdrawal symptoms, and sociodemographic factors, influencing the initiation and completion of detoxification.
• Fear was a major barrier to detoxification and manifested in multiple ways, including the fear of losing OST stability, fear of repressed emotion resurfacing, fear of relapse to illicit opioids, and fear of withdrawal symptoms.
• Physiologic withdrawal was a barrier cited in 32% of studies, and a lack of psychosocial support in the community or prison setting further hindered individuals during final tapering as fear and instability peaked.
• Detoxification was hindered by a history of polydrug use, higher methadone doses, psychiatric instability or challenges with pain management, poor housing, and unemployment but facilitated by lower doses, no history of injecting opioids, secure housing, and steady employment.

IN PRACTICE:

"Detoxification from OST remains a significant challenge with limited success, but clear pathways toward better treatment provision to support those undertaking this process can be facilitated," the authors wrote.

"The findings of this review indicate that several strategies should be urgently considered, by both patients and services, to optimise treatment outcomes in those who aspire to live an opioid-free life," they added.

SOURCE:

The study was led by Amy Bagshaw, Imperial College London, London, England. It was published online on June 17, 2026, in Addiction.

LIMITATIONS:

The study was limited by its mixed methodology, which posed challenges in merging codes; a bias towards the methadone detoxification literature; and a scarcity of treatment provider perspectives, representing fewer than 10% of eligible studies. It was further limited by qualitative studies lacking researcher statements situating themselves culturally or theoretically and quantitative studies failing to report strategies for incomplete follow-ups and confounding variables.

DISCLOSURES:

The study received support from the Economic and Social Research Council and Medical Research Council. Few authors disclosed receiving honoraria paid into their institutional funds for speaking and chairing engagements, research grants, fund support, and consultation fees from several pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.