The role of detoxification using methadone reduction in a drug treatment service (2003)

ENGLISH :
Introduction and Methods. Drug treatment services in the UK are currently being encouraged to reduce their waiting lists for treatment. This paper describes the reorganization of the services offered by an inner-city community drug team in order to offer immediate access to detoxification, and so reduce overall waiting times for assessment and treatment. In describing the outcomes of the first year of the service, we aimed to determine the degree of effectiveness of methadone reduction as a detoxification technique, and to highlight some of the sociodemographic and drug-related factors that predict detoxification success. Results. A total of 19 out of 82 (23.2%) participants were opiate-free at the end of the detoxification period, confirmed by both self-report and urinary drug screen. Completion rates were lower for participants opting to continue methadone reduction below 10 mgs per day than for those opting for lofexidine or dihydrocodeine. The rate of reduction of methadone made no difference to the likelihood of completing the detoxification, but being female, having a drug-using partner, having current financial difficulties and committing crime in the month prior to detoxification were predictive of noncompletion of the programme. Conclusions. The reorganization of the service reduced the waiting times for treatment and was acceptable to both participants and staff. Methadone reduction doesn't appear to be the optimum detoxification strategy, and even within a reduction programme of fixed duration there was a tendency for the period of detoxification to become extended. (Review' s abstract)