Cynthia Iglesias, professor of health economics at the University of York, who led I-WOTCH's economic analysis, said: "Strong opioids, even when used at the dosage prescribed by a medical professional, can cause dependency, and without structured support, some people can struggle to cut them down or stop altogether."

How does the program work?

I-WOTCH does not simply tell patients to take fewer pills. It combines gradual, medically supervised dose reduction with training in long-term self-management, so patients learn to handle their chronic pain day to day. The goal is to reserve strong opioids for short-term acute pain episodes rather than continuous use.

The trial's results suggest this approach works. Patients in the support group were roughly four times more likely to be entirely off strong opioids after a year than those receiving usual care — and critically, they achieved this without any worsening of their health-related quality of life.

Iglesias said the trial, "which was conducted at general practitioners' offices across England, demonstrates just how effective support programs can be."

What about the costs?

The economic analysis found a clear pattern: I-WOTCH raises health care costs during the first year, because patients need extra medical support while tapering off their medication. But that early investment may pay off over the longer term.

"By helping patients build lifelong habits to manage their chronic pain using strong opioid painkillers only during short-term acute pain episodes, the program significantly reduces the risk of long-term health complications and premature death," Iglesias said.

She added that the scheme "offers a promising, cost-effective way to enhance NHS efforts to reduce strong opioid prescriptions in England."

As with any trial, questions remain. The study followed participants for one year, so researchers do not yet know whether the new habits truly last a lifetime, or whether patients can freely use, taper or quit strong opioid painkillers at will years later. The team now wants to observe people with nonmalignant chronic pain over a longer period to answer those questions.

The findings appear alongside a companion publication of the trial's effects and costs in the journal Health Technology Assessment.

What happens next?

If longer-term follow-up confirms the results, I-WOTCH could become a template for NHS efforts to reduce strong opioid prescriptions in England — turning a difficult, risky process of quitting into one that patients can manage with structured, professional support.

For now, the evidence points one way: with the right help, a substantial share of long-term opioid users can come off the drugs safely, without sacrificing their quality of life.