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Home > ROSIE Findings 2: summary of detoxification treatment outcomes.

Fanagan, Sarah (2007) ROSIE Findings 2: summary of detoxification treatment outcomes. Drugnet Ireland, Issue 21, spring 2007, pp. 11-12.

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As reported in issue 19 of Drugnet Ireland, the Research Outcomes Study in Ireland (ROSIE) released Findings 1 in September 2006.  The study is being done by a team at the National University of Ireland, Maynooth, on behalf of the National Advisory Committee on Drugs (NACD). The aim of the study is to recruit and follow opiate users entering treatment and to document their progress after six months, one year and three years.

 

At baseline, the study recruited 404 opiate users aged 18 years or over entering treatment or, in the case of a sub-sample of 26 (6%), attending needle-exchange services. The participants were engaged in one of three different forms of treatment: methadone maintenance/reduction (53%, n=215), structured detoxification (20%, n=81) and abstinence-based treatment (20%, n=82).

 

The second paper in the ROSIE Findings series provides a summary of the outcomes for people in the detoxification modality one year after treatment intake.1

 

As the authors state, ‘structured detoxification is a process whereby individuals are systematically and safely withdrawn from opiates, under medical supervision’. In Ireland, the most common method of opiate detoxification is to use methadone and to reduce the dose slowly over time. Structured detoxification programmes are provided in both inpatient and outpatient settings and usually last between four and twelve weeks.

 

The majority of the ROSIE detoxification cohort (n=81) was recruited from inpatient settings (56%, n=45), with the remainder being treated in outpatient settings (27%, n=22) or in prison (17%, n=14). The analysis presented in Findings 2 is based on the 62 participants who provided valid answers to each individual question during their treatment intake and one-year follow-up interviews.   

 

The detoxification participants were typically male (77%) with an average age of 26 years and were largely dependent on social welfare payments (73%). Just less than half (47%) had children but the majority (62%) of these did not have their children in their care. Most had spent some time in prison (70%) and 11% had been homeless in the 90 days prior to treatment intake interview.

 

Treatment completion rates

The treatment completion rate was high, with 68% of participants successfully completing their detoxification programme (n=42). Just over one-quarter of the cohort (27%, n=17) dropped out of treatment and the remaining 5% (n=3) were transferred to another treatment type before completing the programme.

 

One year after treatment intake, 73% of participants (n=45) reported that they were in some form of drug treatment. Forty-two per cent (n=26) were on a methadone programme, 34% (n=21) were attending one-to-one counselling and 24% (n=15) were attending group work (Narcotics Anonymous (NA) meetings, aftercare programmes and structured day programmes).  

 

Drug-use outcomes

The number of participants who reported using heroin, non-prescribed methadone, non-prescribed benzodiazepines, cocaine, cannabis or alcohol in the 90 days prior to interview decreased between treatment intake and one-year follow-up. The most substantial reduction was in heroin use, both in terms of the proportion of participants using the drug (79% at treatment intake compared with 39% at one year) and the frequency of use (an average of 38 out of 90 days at treatment intake compared with an average of 14 out of 90 days at one year).

 

Reported illicit drug abstinence rates increased from 8% at treatment intake (n=5) to 45% at one year (n=28). Abstinence from all drugs (including prescribed methadone) increased from 5% at treatment intake (n=3) to 39% at one year (24).   

 

Crime outcomes

Overall, the proportion of participants who reported no involvement in crime had risen considerably at one year (75%) compared to treatment intake (19%). There was a reduction in the percentage of participants involved in acquisitive crime, from 35% (n=21) at treatment intake to 7% (n=4) at one year.

 

Risk-behaviour outcomes

Findings 2 reports a reduction in the number of participants who reported injecting drug use. At treatment intake 48% (n=30) of the cohort had injected a drug in the 90 days prior to interview, compared with 23% (n=14) at one year. A statistically significant decrease in injecting was reported for heroin and cocaine. There were no changes in participants’ injecting-related risk behaviours. The proportion of participants who reported an overdose within the previous 90 days reduced from 5% (n=3) at treatment intake to 0% at one year. However, one participant from the detoxification modality died before the one-year follow-up. This is thought to have been due to an overdose but the cause of death has not yet been independently confirmed.   

 

Health outcomes

Ten symptoms were used to measure the physical health of participants (see paper for details). The number of participants who reported seven of the ten physical health symptoms reduced between treatment intake and one year. As would be expected, there was a reduction in the number of participants reporting opiate withdrawal symptoms between treatment intake and one year.

 

Ten symptoms were also used to measure the mental health of participants (see paper for details). There was a reduction in the number of participants who reported suffering from any five of the ten mental health symptoms. Most of the reductions were in anxiety-related symptoms. While there were reductions in the remaining depressive-type symptoms, the results were not statistically significant.

 

Service contact

Findings 2 reports an increase in participants’ contact with three social care services between treatment intake and one year. The proportion of participants contacting social services increased from 2% to 10%, those using employment/education services rose from 13% to 35% and the proportion contacting housing/homeless services increased from 19% to 23%.

 

The authors state that the findings presented in this paper demonstrate that participation in a detoxification programme is followed by reduced drug use and injecting, decreased involvement in crime, improved physical and mental health and increased contacts with social care services. The outcomes for ROSIE participants in detoxification treatment are positive when compared with national and international research. As noted in the paper, detoxification is part of a process that enables individuals to engage in further treatment (such as residential rehabilitation). Additional analysis of the ROSIE data is required in order to determine the effects of aftercare or follow-on interventions on treatment outcomes for those who have successfully completed a detoxification programme.           

 

1.  Cox G, Comiskey C and Kelly P (2007) ROSIE Findings 2: Summary of 1-year outcomes: detoxification modality. Dublin: National Advisory Committee on Drugs.

 

Item Type
Article
Publication Type
Irish-related, Open Access, Article
Drug Type
Opioid
Intervention Type
Treatment method
Issue Title
Issue 21, spring 2007
Date
January 2007
Page Range
pp. 11-12
Publisher
Health Research Board
Volume
Issue 21, spring 2007
EndNote
Accession Number
HRB (Available)

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