What are opioids? A guide for South African patients and families

Opioids are a class of drugs that act on opioid receptors in the brain and spinal cord to dull pain. What puts a drug in this class is that shared mechanism rather than where it comes from or how a person gets hold of it. The class covers:

• Hospital and prescription medicines, including morphine, fentanyl, oxycodone, pethidine, and tramadol
• Pharmacy painkillers and cough syrups containing codeine
• Illegal street drugs, including heroin and nyaope
• Medicines used to treat opioid addiction itself, such as methadone and buprenorphine

Most people in South Africa who take opioids get them from a doctor or a pharmacist rather than a dealer: on prescription after surgery, or over the counter in a codeine painkiller or cough syrup. Opioid dependence therefore develops in plenty of people who would never describe themselves as drug users.

This article covers what opioids are, how dependence develops, and where to find help in South Africa.

What are opioids, and how do they work?

Opioids relieve pain by binding to opioid receptors, which sit on nerve cells throughout the brain, spinal cord, and gut. Binding to those receptors dampens the pain signals travelling upward and changes how the brain interprets whatever gets through. Pain that would otherwise demand attention fades into the background.

The same receptors also sit in the parts of the brain that regulate mood and breathing, and along the gut wall. Opioids act on all of them at once, which is why pain relief arrives together with other effects:

• A sense of calm or wellbeing, which at higher doses becomes euphoria
• Drowsiness and slowed thinking
• Constipation, nausea, and dry mouth
• Slowed breathing, which is what makes an overdose life-threatening

These drugs work because the body already has an opioid system of its own. Endorphins are the natural opioids the body releases to damp down pain and to register reward. A pharmaceutical dose hits the same receptors far harder than any endorphin does, which is why opioids control severe pain so well, and why the brain adapts to them quickly.

Opioids and opiates: What’s the difference?

The two words get used as though they mean the same thing, and in everyday conversation little turns on the difference. In pharmacology, “opiate” refers only to substances derived directly from the poppy plant, including opium itself, morphine, and codeine. “Opioid” is the umbrella term that covers those, plus everything made in a laboratory to act on the same receptors.

Opioids fall into three groups by origin:

• Natural opiates, extracted from the opium poppy, including morphine and codeine
• Semi-synthetic opioids, made by modifying a natural opiate, including heroin, oxycodone, hydrocodone, and buprenorphine
• Fully synthetic opioids, built from scratch in a laboratory, including fentanyl, methadone, tramadol, and pethidine

Origin doesn’t predict risk. Morphine is extracted from the poppy, heroin is made by chemically altering it, and fentanyl is built from scratch in a laboratory. Both heroin and fentanyl are considerably more potent than morphine itself. Clinically, the questions are the dose, the potency, and how fast the drug reaches the brain. Throughout this article, “opioid” covers the whole class.

Where opioids come from: A short history

Every major opioid of the past two centuries arrived as a safer version of the one before it, and each turned out to carry the same risk. Knowing that sequence makes the current picture easier to read.

Opium, the dried sap of the poppy, has served as a medicine and an intoxicant for thousands of years. Modern opioid history starts in 1804, when the German pharmacist Friedrich Sertürner isolated morphine from opium. Sertürner expected that a purified compound, given in far smaller quantities, would prove less habit-forming than opium itself. He went on to document his own morphine addiction.

Bayer began marketing heroin in 1898, selling it as a cough remedy and a substitute for morphine that it promoted as less addictive. Oxycodone followed in 1916, developed with the same hope, by which point Bayer had stopped mass-producing heroin because of the addiction it caused. The Belgian chemist Paul Janssen synthesised fentanyl in 1960, creating a drug many times stronger than morphine but with a wider safety margin in surgery, where anaesthetists still rely on it.

The sequence repeated in December 1995, when the United States Food and Drug Administration approved OxyContin, a controlled-release oxycodone tablet taken twice a day rather than every four to six hours. Its manufacturer promoted the slow-release format as carrying a low risk of addiction. What followed became the American opioid crisis.

The opioid crisis: How the South African problem differs from the American one 

Opioids make international headlines largely because of the United States, where opioid overdoses have killed around 806,000 people since 1999. The US Centers for Disease Control and Prevention describes that crisis arriving in three waves. Deaths involving prescription painkillers climbed from the late 1990s, after aggressive marketing and liberal prescribing put strong opioids into wide circulation. Heroin deaths rose from 2010, as people already dependent on prescriptions turned to a cheaper and more available drug. Deaths involving illicitly manufactured fentanyl took off from 2013 and now account for most American opioid deaths.

Prescribing practice sits behind all three waves. Tightening the supply of prescription opioids did not undo the dependence that earlier decades had created. Interviews with people who moved on to street drugs describe doctors stopping their medicine abruptly, with heroin and later fentanyl filling the gap. Only a small share of patients prescribed opioids ever move to illegal drugs, and researchers dispute how much of the current death toll traces back to prescribing, but the sequence itself is well documented.

South African prescribing looks nothing like that. A 2026 systematic review in Health Policy and Planning records morphine consumption across the whole of Africa at 1.4 metric tons in 2022, against more than 20 metric tons in the United States, and argues that the region’s problem is untreated pain rather than oversupply, driven by restrictive regulation and caution among prescribers that leaves many patients without adequate relief. In 2018, the national essential medicines committee declined to add slow-release oxycodone to the primary healthcare medicines list, citing concerns about addiction.

While South Africa never had the wave of opioid prescribing that began the American crisis, dependence is steadily gaining ground here. Opioid admissions logged by the South African Community Epidemiology Network on Drug Use (SACENDU), which collects data from treatment centres for the South African Medical Research Council, rose from about 12% of all admissions in 2012 to nearly 18% a decade later. Estimates of daily heroin use point the same way, at between 215,000 and 425,000 people in 2020 against roughly 110,000 in 2015.

Two drugs account for most of the opioid dependence in South Africa, namely heroin and codeine. While heroin comes in several forms — including nyaope in Gauteng and whoonga in KwaZulu-Natal — codeine reaches an entirely different group of people, most of whom buy it legally at a pharmacy counter and have never bought a drug illegally. Emerging evidence suggests fentanyl may also be establishing itself in the local supply, which this article returns to later.

Which South African medicines contain opioids?

Opioids reach people in South Africa through three routes. The first is prescription, for drugs everyone recognises as strong painkillers. The second is the pharmacy counter, where ordinary household remedies carry a small opioid dose alongside other ingredients, and that group catches people out, because nothing about a familiar branded box signals what is inside. The third is the illegal market.

Prescription opioids used in South African hospitals and pain clinics include:

• Morphine, for severe pain and palliative care
• Oxycodone, prescribed for moderate to severe pain
• Fentanyl, given as a patch or an injection
• Pethidine, used mainly in hospital settings
• Tramadol, sold on its own as Tramahexal and Tramazac, and combined with paracetamol as Tramacet and Ultracet

Tramadol is the one most South Africans encounter. The SAHPRA-approved professional information for a locally registered product describes the drug as a centrally acting opioid analgesic and lists it as Schedule 5, which means a doctor’s prescription.

The household group is mostly codeine, which turns up in cough syrups, sinus remedies, and combination painkillers sold from behind the pharmacy counter. Familiar examples include:

• Gen-Payne
• Adco-Dol
• Myprodol
• Stilpane
• Synaleve

A pharmacist can sell some of these without a prescription. Our article on which South African medicines contain codeine lists every local product and the dose in each.

The illegal opioids on the local market are heroin and nyaope, a low-grade mixture smoked with cannabis or tobacco and sold mainly in Gauteng townships. Our article on what heroin is and how addiction to it develops covers both in detail.

Common opioid drugs explained

Doctors in South African hospitals prescribe some of these drugs daily, while others are familiar mainly from American news coverage. Knowing them by name helps, because the risks differ considerably from one to the next.

Morphine

Morphine is the reference point against which other opioids are measured, and it remains one of the most important medicines in hospital care. Doctors prescribe it after major surgery, for cancer pain, and in palliative care. Morphine is also what heroin becomes once the body metabolises it, which is why a urine test cannot always distinguish the two.

Fentanyl

Fentanyl is a fully synthetic opioid roughly 30 to 50 times as potent as heroin. Anaesthetists use it during surgery and childbirth, and doctors prescribe patches for chronic pain that weaker medicines can’t control. Potency is what makes illegally manufactured fentanyl lethal. Only a tiny margin separates a dose that produces a high from one that stops breathing.

Oxycodone, OxyContin, and Percocet

Oxycodone is a semi-synthetic opioid prescribed for moderate to severe pain, and is registered in South Africa as a Schedule 6 substance. OxyContin is the slow-release version at the centre of the American crisis, and Percocet combines oxycodone with paracetamol. Local prescribing volumes are nothing like those in the United States, though oxycodone carries the same dependence risk wherever it is taken.

Vicodin and hydrocodone

Vicodin is an American brand name for hydrocodone combined with paracetamol, and it appears constantly in reporting on opioids in the United States. No hydrocodone products are registered in South Africa, and codeine and tramadol combinations cover the same clinical ground here. Anyone bringing hydrocodone into the country on a foreign prescription should check the import rules first, since it is a controlled substance.

Methadone and buprenorphine

Methadone and buprenorphine are long-acting opioids prescribed to treat addiction rather than pain. Both occupy the same receptors without the rapid peaks that drive compulsive use, which keeps withdrawal and cravings steady. The medication-assisted treatment section later in this article covers how each one works, along with Suboxone and naltrexone.

Is fentanyl a problem in South Africa?

Fentanyl is an established part of South African medicine, used during surgery and childbirth, and prescribed as a patch for severe chronic pain. The open question is whether illicitly manufactured fentanyl has entered the local drug supply, as it did in North America. Early evidence suggests it has arrived here, though how far it has spread is unclear.

The clearest signal so far comes from drug testing reported by GroundUp in December 2024. Dr Alanna Bergman, a nursing scientist funded by Johns Hopkins University, used imported urine tests at clinics in East London, Gqeberha, and Durban. Of the first 100 patients tested, 32 were positive for fentanyl, and none had a prescription for it. The rate held between 25% and 33% as the sample grew to around 320 people.

Keep in mind that the research was preliminary and still under way when reported, and that the patients tested were people in treatment for drug-resistant tuberculosis, whom nurses already suspected of using substances. A sample selected that way says nothing about how common fentanyl use is among South Africans generally. Separately, a 2021 study of opioid compounds in Gauteng wastewater treatment plants found traces of fentanyl at every plant sampled, which suggests use beyond what pharmacies dispense.

Fentanyl is present in South Africa, though nothing yet points to the saturation of the drug supply seen in North America. The practical danger lies in how fentanyl behaves inside powdered heroin. The drug doesn’t blend evenly, and its particles clump together, which means two bags from the same batch can carry very different amounts. A dose someone tolerates one day can kill them the next. 

Limited naloxone access in South Africa leaves fewer chances to reverse an overdose in time. Families affected by heroin or nyaope use should treat overdose as a real risk and call emergency services at the first sign of one, rather than waiting to see whether the person sleeps it off.

Which medicines are not opioids?

People often ask about medicines that feel strong, carry a prescription-only label, or get mentioned in the same conversation as painkillers. Several of them are not opioids at all, and the distinction changes what the risks are.

Is ketamine an opioid?

No. Ketamine is an anaesthetic that works by blocking NMDA receptors, a different mechanism entirely. Ketamine carries its own risks, including dependence, bladder damage with heavy use, and dissociation. The distinction has practical consequences: Naloxone will not reverse a ketamine overdose, and opioid withdrawal management doesn’t apply.

Is Lyrica an opioid?

No. Lyrica is a brand of pregabalin, which belongs to a group called gabapentinoids. The drug treats nerve pain, epilepsy, and anxiety by calming overactive signalling. Pregabalin can cause dependence and withdrawal symptoms, and taken alongside opioids it raises the risk of dangerously slowed breathing. On its own, though, pregabalin is not an opioid.

Is Synaleve an opioid?

Synaleve isn’t an opioid as such, though it contains one. Each capsule combines paracetamol, meprobamate, and 8 mg of codeine phosphate, which is an opioid. Synaleve is a Schedule 5 medicine and needs a prescription. The same logic applies to every combination painkiller of this kind:

• Adco-Dol
• Gen-Payne
• Myprodol
• Tramacet
• Ultracet

While the product itself isn’t classed as an opioid, one of its active ingredients is.

Is ibuprofen or paracetamol an opioid?

No. Ibuprofen (Brufen, Nurofen) is an anti-inflammatory, and paracetamol (Panadol) works through a different mechanism again. Neither one acts on opioid receptors or produces dependence. Both appear as the other half of combination painkillers that do contain codeine, which is where the confusion usually starts. Reading the ingredient list on the box is the quickest way to settle the question.

How opioid dependence develops

Where the opioid comes from makes no difference to the body. A tablet from a pharmacy and a bag bought on a corner set off the same adaptation, though not at the same speed. What takes months with a prescription painkiller can take weeks with heroin, nyaope, or fentanyl, which reach the brain rapidly and in unpredictable strengths.

Opioid dependence can be described as having three stages. These are:

• Tolerance: Receptors stop responding as they did, and within a few weeks the dose that worked at first no longer has the same effect.
• Physical dependence: The body needs the drug in order to feel normal, and going without it brings on withdrawal.
• Addiction: Drug use becomes compulsive and carries on even when it’s damaging someone’s health, work, or relationships, with the person spending more of each day working out how to get the next dose.

Tolerance and physical dependence develop in anyone taking opioids regularly, whether from a prescription followed exactly or from a dealer. Addiction is a further step, and it doesn’t always follow. A patient on morphine for cancer pain can be physically dependent and never addicted, while someone smoking nyaope every day is usually both.

Telling dependence and addiction apart is difficult, particularly for the person living it. If you’re taking opioids for pain, withdrawal turns up looking like the pain returning, and the next dose settles it. Our article on how codeine dependence develops traces that loop. With heroin or nyaope it moves faster and the harm shows sooner, though life still revolves around avoiding withdrawal.

Signs of an opioid problem

Opioid dependence that starts with a prescription looks nothing like the stereotype. Someone can hold down a job, run a household, and keep relationships going while taking far more medicine than any doctor intended. The signs are mundane rather than dramatic:

• Taking more than the label states, or spacing doses closer together than prescribed 
• Buying the same medicine from different pharmacies, or seeing more than one doctor for scripts
• Running out of medicine before a repeat is due
• Feeling achy, restless, or irritable when a dose is late, as though flu is starting
• Continuing to take the medicine after the injury, operation, or illness has healed
• Worrying about where the next dose will come from, or planning the day around it

When the opioid is heroin or nyaope, the signs arrive sooner and show up elsewhere:

• Drowsiness that comes and goes, including nodding off mid-conversation
• Money and valuables disappearing from the house
• Long unexplained absences, and pulling away from family
• Weight loss, poor appetite, and dental or medical problems left untreated
• Marks on the arms or hands, or long sleeves worn in hot weather
• Flu-like illness that lifts soon after the person has been out

No single item on either list confirms an addiction, and most have innocent explanations. Several appearing together, particularly sickness that arrives whenever a dose is late, is a reason to act. Where a doctor has prescribed the opioid, that means an appointment with the prescribing doctor rather than stopping abruptly. Where it’s heroin or nyaope, our team can talk you through the options, whether you’re asking for yourself or about someone in your family.

Opioid withdrawal

Opioid withdrawal is rarely life-threatening on its own, though it’s physically punishing. The discomfort is one of the main reasons people keep taking opioids long after they want to stop. Symptoms begin as the drug clears the system, which takes 8 to 12 hours with shorter-acting opioids such as codeine, morphine, and heroin, and closer to 30 hours with methadone.

Early symptoms include:

• Restlessness, anxiety, and irritability
• Sweating, a runny nose, and watery eyes
• Difficulty sleeping

From there, they build into:

• Muscle and bone aches
• Stomach cramps, nausea, vomiting, and diarrhoea
• Goosebumps and dilated pupils

Symptoms peak between the first and third day with shorter-acting opioids, then ease over roughly a week. Poor sleep, low mood, and cravings usually last longer.

Two exceptions apply to the rule that withdrawal isn’t dangerous. South African guidance flags pregnancy, where withdrawal carries risk to the pregnancy itself, and patients whose health is already compromised. Prolonged vomiting and diarrhoea can also leave anyone dangerously dehydrated.

A supervised detox treats those symptoms with medication rather than leaving a patient to endure them, which makes completing withdrawal far more likely. Our medical detox programme runs under the care of our on-site clinical team.

Opioid overdose

An opioid overdose kills by suppressing breathing. Receptors in the brainstem control the automatic urge to breathe, and a high enough dose slows that reflex until it stops. The risk rises sharply when someone combines opioids with alcohol, benzodiazepines, or sleeping tablets, because those drugs suppress breathing too.

The signs of an opioid overdose are:

• Breathing that is very slow, shallow, or has stopped
• Unresponsiveness, meaning the person cannot be woken by shouting or a firm shake
• Blue or grey lips, fingertips, or skin
• Pinpoint pupils
• Gurgling or snoring sounds, which indicate a blocked airway

Call 10177 or 112 immediately if you suspect an overdose. While waiting, place the person on their side in the recovery position so that vomit cannot block the airway, and stay with them.

Naloxone reverses an overdose by displacing the opioid from its receptors, usually within minutes. Access here is limited. Naloxone is only available as an injection, it requires a prescription, and no community distribution programmes operate of the kind found in other countries, according to harm reduction researchers studying three South African cities. For most families, emergency services remain the realistic response.

Opioid addiction treatment in South Africa

Treatment for opioid addiction usually starts with medically managed withdrawal, then moves into the psychological work of understanding what the drug was doing for the person and building a life that doesn’t need it. Detox alone has a high relapse rate, because withdrawal resolves the body’s dependence and leaves everything else untouched.

Medication has a substantial role in that process, both during withdrawal and for months or years afterwards, and the medication-assisted treatment section of this article covers which medicines doctors use and how availability differs between South Africa and the United States.

Houghton House offers inpatient treatment for opioid addiction, starting with medically supervised detox and continuing into a 30-day primary programme of individual therapy, group work, and family involvement. Houghton House is a licensed psychiatric hospital, and our on-site medical staff monitor patients throughout withdrawal. Our dual diagnosis programme treats addiction and a co-occurring mental health condition at the same time. 

Recovery continues after the primary programme ends. Our continuous care and aftercare supports patients through the months when relapse risk peaks, which is a particular concern with opioids. Tolerance falls quickly during abstinence, and a dose that was previously manageable can cause a fatal overdose after a period without use.

Medication-assisted treatment for opioid addiction

Medication-assisted treatment, sometimes shortened to MAT, combines medicine with counselling and psychological support. The medicines fall into three groups. Agonists such as methadone occupy opioid receptors and satisfy the body’s expectation of a dose. Partial agonists such as buprenorphine do the same thing with a built-in ceiling on their effect. Antagonists such as naltrexone block the receptors entirely, so that taking an opioid produces nothing.

The clinical detail in this section follows the South African Guidelines for the Management of Opioid Use Disorders, the national guidance for doctors treating opioid dependence. Prescribing decisions belong with a doctor who has assessed the patient, and nothing in this article is a substitute for that.

Methadone

Methadone is a full opioid agonist with a half-life of 24 to 36 hours, which means a single daily dose holds withdrawal off around the clock. Two formulations exist locally, and the distinction between them is important. Equity Methadone, an elixir free of sugar and alcohol, is registered for treating opioid use disorder. Physeptone, a methadone cough syrup, is neither registered nor suitable for that purpose.

Being a full agonist, methadone carries a significant overdose risk, particularly during the first days of treatment and at higher doses, where it can also affect heart rhythm. South African guidance therefore recommends cautious low-dose starts, supervised consumption, and considerable care with take-home doses. Methadone tends to sit with specialist services rather than general practice.

Buprenorphine, Subutex, and Suboxone

Buprenorphine is a partial agonist, which gives it a ceiling effect: Past a certain dose, taking more produces no further respiratory depression. That ceiling makes it markedly safer than methadone in overdose and suitable for office-based prescribing. Buprenorphine comes as a sublingual tablet, dissolved under the tongue, and its long action allows daily or even alternate-day dosing. Patients often describe feeling clearer-headed on it than on methadone.

Suboxone combines buprenorphine with naloxone in a four-to-one ratio. Taken as intended under the tongue, the naloxone is barely absorbed and does nothing. Injected, it triggers immediate and thoroughly unpleasant withdrawal, which is the point: The combination exists to deter injection and reduce the resale of prescribed medicine. Subutex is buprenorphine on its own.

Naltrexone

Naltrexone works in the opposite direction. As an antagonist, it blocks opioid receptors without activating them, which means a person who uses heroin or a painkiller on top of it feels nothing. A 50 mg oral dose blocks the receptors for around a day. Naltrexone suits patients who want an opioid-free approach and have support around them, and it is sometimes prescribed after detox to protect early recovery.

Two cautions come with naltrexone. The first is adherence. Protection lasts only as long as the patient keeps taking the tablets, and stopping is the most common reason this approach fails. The second is loss of tolerance. With the receptors blocked, no opioid reaches them, and tolerance fades over the weeks that follow. Someone who comes off naltrexone and returns to their old dose can overdose on an amount their body once handled without difficulty. A doctor prescribing it should set that risk out plainly before treatment begins.

Clonidine and symptom relief during detox

Not every detox uses an opioid. Where tolerance is low, or a patient would rather come off opioids entirely than transfer onto a substitute, doctors can manage withdrawal symptomatically. Clonidine, a blood pressure medicine that calms the overactive nervous system behind much of opioid withdrawal, is the usual backbone of that approach, given in small doses and tapered over four to six days.

Alongside it, doctors treat individual symptoms as they appear:

• Anti-spasmodics for stomach cramps
• Anti-inflammatories for muscle and bone aches
• Medicine to settle diarrhoea
• Medicine to control nausea and vomiting 

South African guidance warns specifically against benzodiazepines during opioid withdrawal, because combining the two drug classes raises overdose risk and invites a second dependence.

How South Africa differs from the United States

American coverage can leave the impression that Suboxone and methadone are readily available everywhere. In the United States, federally regulated treatment programmes dispense methadone, while buprenorphine moved firmly into ordinary medical practice after Congress removed the X-waiver requirement at the end of 2022, allowing any prescriber with a standard controlled-substances registration to prescribe it.

South Africa sits in a different position. Methadone and buprenorphine are registered here and the national guidelines cover their use, though public access remains narrow. The national essential medicines committee declined to list buprenorphine in December 2021, pointing to the risk of diversion and a health sector not yet equipped to deliver substitution at scale. In the state sector, methadone has mostly been available as a short course at district hospitals for patients in withdrawal rather than the months of maintenance the evidence supports. That leaves the private sector, where cost is the main barrier: A 2018 editorial in the South African Medical Journal found methadone priced here at up to 30 times the average in Ukraine and Georgia.

That position is starting to change. The government has committed to making opioid substitution available through state clinics, and in July 2024 the Department of Health advertised a 20-month pilot offering methadone at two public clinics, in Emalahleni and Madibeng. For now, though, South African treatment leans on inpatient detox followed by abstinence-based rehabilitation, with substitution prescribed less often than in the United States or Europe.

Medical aid cover for opioid addiction treatment

Substance use disorders are Prescribed Minimum Benefits in South Africa, which means every registered medical scheme must cover treatment for opioid addiction regardless of the plan you are on. Cover typically includes detoxification and a period of inpatient rehabilitation.

Houghton House holds both a rehabilitation licence and a psychiatric hospital registration. This means patients can claim for psychiatric services beyond the standard PMB, where a co-occurring condition qualifies under the psychiatric PMBs. Not all conditions do, and the details vary by scheme and plan. Our page on medical aid cover for rehab sets out how the process works, and our admissions team can check your benefits before you commit to anything.

Frequently asked questions about opioids

What are the most commonly used opioids in South Africa?

Codeine is the most widely used, because it appears in cough syrups and combination painkillers available from pharmacies. Tramadol and morphine are the most commonly prescribed for moderate to severe pain. Heroin, including the nyaope mixture sold in Gauteng, is the most commonly used illegal opioid. Heroin and other opiates accounted for 7% of treatment admissions nationally in the first half of 2025, according to SACENDU, the South African Medical Research Council’s monitoring network.

Are all opioids addictive?

Every opioid can produce tolerance, dependence, and addiction, though the risk varies with potency, how quickly the drug reaches the brain, and how long someone takes it. A strong, fast-acting opioid such as heroin or fentanyl produces dependence far quicker than a weak one. Codeine sits at the mild end of the scale and still creates dependence in thousands of South Africans who have never touched an illegal drug.

How long does it take to become dependent on opioids?

Physical dependence can develop within two to four weeks of daily use at ordinary therapeutic doses, and quicker at higher ones. Adapting this fast is a normal physiological response and not a sign of misuse, which is why doctors taper opioids instead of stopping them abruptly after extended use.

Can you become addicted to opioids a doctor prescribed?

Yes. A prescription controls the dose and the supply, and reduces risk considerably, though it doesn’t change how the body responds to the drug. Dependence developing under medical supervision is common, particularly when opioids continue for months after an injury or operation. Speak to the prescribing doctor rather than stopping suddenly, because abrupt withdrawal from a long-standing dose is unpleasant and, in some circumstances, dangerous.

What’s the difference between methadone and Suboxone?

Methadone is a full opioid agonist, while Suboxone pairs the partial agonist buprenorphine with naloxone. The practical differences are safety and setting. Suboxone has a ceiling on its effect, which lowers overdose risk and allows ordinary office-based prescribing, while methadone needs closer supervision and tends to sit with specialist services. Methadone suits some patients better, particularly those with high tolerance who don’t stabilise on buprenorphine. A doctor experienced in addiction medicine should make that call.

What should I do if I think a family member is dependent on opioids?

Start with a calm, private conversation about what you have noticed, focused on specific observations rather than accusations. Expect the first response to be defensive, particularly where a diagnosed pain condition sits behind the opioid use. If the conversation goes nowhere, our team can advise you on the options, including a family consultation. You can contact Houghton House on 011 787 9142 to talk it through in confidence.

Getting help for opioid addiction

Opioid dependence reaches people by very different routes, and treatment has to account for where it started. Where use began with a prescription, stopping raises the question of what happens to the original pain. Where it began with heroin or nyaope, recovery usually means distance from the people and places tied to the drug. Our clinical team works with patients from both starting points.

If you recognise this pattern in yourself or someone in your family, speak to our admissions team on 011 787 9142. 

Sources

• Centers for Disease Control and Prevention. (n.d.). Understanding the opioid overdose epidemic. Retrieved October 2, 2026, from https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html 
• Consolidated Appropriations Act, 2023, Pub. L. No. 117-328, 136 Stat. 4459 (2022).
• Copelyn, J. (2024a, December 9). Fentanyl is here: South Africans test positive for potent opioid. GroundUp. https://groundup.org.za/article/fentanyl-is-here-south-africans-testing-positive-for-potent-opioid/ 
• Copelyn, J. (2024b, November 15). Health department to take medical approach to heroin crisis. GroundUp. https://groundup.org.za/article/health-department-to-take-medical-approach-to-heroin-crisis/ 
• Copelyn, J. (2024c, April 17). SA is facing a fast-escalating heroin crisis – and it’s being misunderstood. Spotlight. https://www.spotlightnsp.co.za/2024/04/17/sa-is-facing-a-fast-escalating-heroin-crisis-and-its-being-misunderstood/ 
• Dickson-Gomez, J., Krechel, S., Spector, A., Weeks, M., Ohlrich, J., Green Montaque, H. D., & Li, J. (2022). The effects of opioid policy changes on transitions from prescription opioids to heroin, fentanyl and injection drug use: A qualitative analysis. Substance Abuse Treatment, Prevention, and Policy, 17(1), Article 55. https://doi.org/10.1186/s13011-022-00480-4 
• Gooding, S. W., & Whistler, J. L. (2024). A balancing act: Learning from the past to build a future-focused opioid strategy. Annual Review of Physiology, 86, 1–25. https://doi.org/10.1146/annurev-physiol-042022-015914 
• Hornsby, N., Erasmus, J., Moletsane, M. K., Johnson, K., Scheibe, A., Sibeko, G., & Harker, N. (2026). Monitoring alcohol, tobacco and other drug use trends in South Africa (July 1996 – January 2025) (SACENDU Research Brief, Vol. 29, No. 1). South African Medical Research Council. https://www.samrc.ac.za/sites/default/files/attachments/2026-05/SACENDU%20RESEARCH%20BRIEF%20Vol%2029%201%202026.pdf 
• Kamika, I., Azizi, S., Muleja, A. A., Selvarajan, R., El-Liethy, M. A., Mamba, B. B., & Nkambule, T. T. I. (2021). The occurrence of opioid compounds in wastewater treatment plants and their receiving water bodies in Gauteng province, South Africa. Environmental Pollution, 290, Article 118048. https://doi.org/10.1016/j.envpol.2021.118048 
• Kosten, T. R., & Baxter, L. E. (2019). Review article: Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment. The American Journal on Addictions, 28(2), 55–62. https://doi.org/10.1111/ajad.12862 
• National Department of Health. (2018). Oxycodone for chronic pain in adult patients requiring morphine tablets [Medicine review]. South African National Essential Medicine List. https://www.health.gov.za/wp-content/uploads/2025/09/Oxycodone-for-chronic-pain-in-adult-patients-requiring-morphine-tablets_PHC-Review-10-June-2018.pdf 
• National Department of Health. (2021). Buprenorphine or buprenorphine-naloxone for opioid substitution therapy compared to placebo, no opioid substitution treatment, or methadone [Medicine review]. South African National Essential Medicine List. https://www.health.gov.za/wp-content/uploads/2024/07/NDoH_EML_Buprenorphine_OST_PHC-Adults_Review_30November2021_Final.pdf 
• Nyarko, S., Atinga, R. A., & Mahama, J. C. (2026). Pain, policy, and the opioid dilemma in sub-Saharan Africa: A systematic review of access, regulation, and health governance from 1990 to 2024. Health Policy and Planning, 41(5), 898–912. https://doi.org/10.1093/heapol/czag035 
• Scheibe, A., Marks, M., Shelly, S., Gerardy, T., Domingo, A. K., & Hugo, J. (2018). Developing an advocacy agenda for increasing access to opioid substitution therapy as part of comprehensive services for people who use drugs in South Africa. South African Medical Journal, 108(10), 800. https://doi.org/10.7196/samj.2018.v108i10.13397 
• South African Health Products Regulatory Authority. (n.d.). Medicines online directory (MedsInfo). Retrieved October 2, 2026, from https://medsinfo.sahpra.org.za/ 
• South African Health Products Regulatory Authority. (2020, January 29). Codeine-containing medicines. https://www.sahpra.org.za/codeine-containing-medicines/ 
• South African Health Products Regulatory Authority. (2023). Tramadol Unimed 50 mg capsules [Professional information]. https://pi-pil-repository.sahpra.org.za/wp-content/uploads/2023/07/pi_tramadol-unimed_20230812.pdf 
• United Nations Office on Drugs and Crime. (2017). Recommended methods for the identification and analysis of fentanyl and its analogues in biological specimens (ST/NAR/53). United Nations. https://www.unodc.org/documents/scientific/Recommended_methods_for_the_identification_and_analysis_of_Fentanyl.pdf 
• U.S. Food and Drug Administration. (2026, August 28). Timeline of selected FDA activities and significant events addressing substance use and overdose prevention. https://www.fda.gov/drugs/food-and-drug-administration-overdose-prevention-framework/timeline-selected-fda-activities-and-significant-events-addressing-substance-use-and-overdose 
• Weich, L., Nowbath, H., Flegar, S., Mahomedy, Z., Ramjee, H., Hitzeroth, V., & Kramer, L. (2015). South African guidelines for the management of opioid use disorders (Amended ed.). http://sahivsoc.org/Files/South%20African%20Guidelines%20for%20the%20Management%20of%20Opioid%20use%20disorders.pdf 
• Wilson, M., Brumwell, A., Stowe, M. J., Shelly, S., & Scheibe, A. (2022). Personal experience and awareness of opioid overdose occurrence among peers and willingness to administer naloxone in South Africa: Findings from a three-city pilot survey of homeless people who use drugs. Harm Reduction Journal, 19(1), Article 17. https://doi.org/10.1186/s12954-021-00561-w