Twenty-one patients dependent on prescription opioids were treated by 21-day detoxification followed by psychotherapeutic counseling (D/C), and 21 patients were detoxified 21 days and provided opioid maintenance if detoxification was unsuccessful (D/M). Only five of 21 (23.8%) patients in the D/C group compared with 20 of 21 (95.2%) in the D/M group completed three weeks of treatment. No patient initially perceived that chronic pain due to a medical condition would be an impediment to withdrawal from opioids, but pain that was masked by opioid dependency and that emerged during detoxification proved to be an insurmountable barrier to total withdrawal in the majority of patients. Treatment of outpatients with dependence on prescription opioids is best provided by opioid maintenance therapy and adjunctive pain therapy.