Home > Community detoxification pilot scheme.

Lyons, Suzi (2008) Community detoxification pilot scheme. Drugnet Ireland , Issue 26, Summer 2008 , p. 18.

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A series of seminars was held on 8 April with health care professionals and community and voluntary groups to introduce intra-agency community methadone detoxification protocols. It aimed to give opportunities for discussion around offering community detoxification as a viable alternative option for people. The then Minister of State Pat Carey TD also addressed the participants. 

 These protocols will be piloted in the North Inner City Drugs Task Force (NICDTF) area over the next 18 months. They aim to provide an option for people who find it difficult to take up a residential detoxification bed due to family or work commitments. The may also benefit individuals who want to reduce their methadone dosage in order to access a residential programme. They were developed in response to concerns voiced by the community and by drug users that people were being ‘parked’ on long-term methadone maintenance.
 
These protocols are based on best practice guidelines from the UK and input from Irish experts. They emphasise empowerment – drug users are empowered to choose what treatment option best suits them, but also to take responsibility for their treatment. The protocols are designed to address the concerns of GPs about the risk factors associated with the process, including integrating the necessary social support for their patient for a successful and safe detoxification.
 
Overview of process
Assessment – When the client expresses an interest in undertaking the programme, the process starts with an assessment (including history of drug misuse which may also require testing). The client needs to provide one month’s clean urine (free from opiates and illicit use of prescription drugs) and sign a consent form. 
 
Meetings are held with the client, their case manager and GP to explain the process, clarify roles and responsibilities, and provide education on the dangers of relapse and overdose in detoxification. If the urinalysis shows non-compliance, in special circumstances and on agreement between all parties, the detoxification may go ahead.
 
The case manager – The case manager’s role is important as it provides the social support essential for a successful and safe detoxification outside a residential facility, which the GP alone cannot provide. The case manager is responsible for assessing the client’s suitability for the programme and for ensuring that correct protocols are followed. He/she has primary responsibility for the client’s care plan. In consultation with the client, the case manager will develop a relapse-prevention and aftercare plan, and will work with the client during and after the detoxification (for a minimum of six months).
 
The client – Clients wishing to undergo a community detoxification also have responsibilities under the protocol. As well as providing clean urine samples, they must show willingness to engage regularly and reliably with their case manager and treatment agency. They must also commit to inform the case manager if they relapse or wish to stop the detoxification.
 
Contra-indications
  • Previous history of epileptic seizures while undergoing detoxification
  • Dual addiction, where both addictions are unstable or where a second addiction other than opiates is uncontrolled
  • Severe mental health problems that are currently untreated
  • Major medical illness
  • Active treatment for hepatitis C
  • Pregnancy
 Example of methadone detoxification schedule
  • Reduce methadone intake by 5ml per week until client reaches 50ml
  • Continue at 50ml for one month, then
  • Reduce by 3–5ml per week until client reaches 20ml
  • Continue at 20ml for one month (attempt to transfer to community pharmacist where possible), then
  • Reduce by 3ml per week until client reaches 10ml
  • Continue at 10ml for one month, then
  • Reduction from 10ml to zero may require:
    • Buprenorphine or lofexidine detox
    • Continued community detox as above
    • In-patient detox.
 Benzodiazepine detoxification – The aim of benzodiazepine detoxification is to become drug free, not to be maintained on lower doses. In this case, the client shows their commitment by attending four care planning meetings over a period of two to six weeks. They are also required to fill out weekly drug diaries1.
 
The future – This pilot project will be monitored for at least the next 18 months by the steering committee. Caroline Gardner is the Progression Routes Co-ordinator.
 
1. See Department of Health and Children (2002) Benzodiazepines: good practice guidelines for clinicians,  pp. 21–25. Available on the DOHC website at http://health.gov.ie/blog/publications/benzodiazepines-good-practice-guidelines-for-clinicians/.
Item Type:Article
Issue Title:Issue 26, Summer 2008
Date:2008
Page Range:p. 18
Publisher:Health Research Board
Volume:Issue 26, Summer 2008
EndNote:View
Accession Number:HRB (Available)
Subjects:HJ Treatment method > Substance disorder treatment method > Detoxification method
VA Geographic area > Europe > Ireland > Dublin
J Health care, prevention and rehabilitation > Health care programme or facility > Community-based treatment (primary care)

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