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Dermody, Aoife and Lyons, Suzi (2012) The national community detoxification initiative. Drugnet Ireland, Issue 40, Winter 2011, pp. 19-20.

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The Community Detoxification Protocol was originally developed in response to a number of identified needs, including queries from some service users who found it difficult to access outpatient detoxification, and from medical professionals who noted some challenges in providing an outpatient detoxification in the absence of structured community support.1  

To address these issues, the Progression Routes Initiative brought together an interagency group in 2007 to develop a protocol, with members from the medical and community/voluntary sector as well as service user representatives. The protocol outlined the minimum standards for delivery of interagency support for outpatient detoxification. This included medical support provided by prescribing doctors and psycho-social supports provided by key workers. A key person was nominated as the local ‘broker’ to raise awareness of the protocol and support engagement of local professionals in community detoxification. The protocol was successfully implemented as a pilot in Dublin’s North Inner City in 2008 and 2009.2,3
In November 2010, the Community Detoxification Steering Group reconvened and was expanded. The group includes representation from service user groups, research bodies, and medical, community and voluntary service providers.4 The group reviewed and strengthened many aspects of the protocols, incorporating lessons learnt from the pilot in the North Inner City. 
One of the main changes was the division of the protocol into two separate sets of guidelines, one for methadone detoxification and one for benzodiazepine detoxification.5,6 The protocols outline a structured, step-by-step detoxification process for both benzodiazepines and methadone and clarify the roles of each stakeholder (service user, doctor and key worker) in the process. This includes guidelines on psycho-social supports and information to support prescribers to work under these protocols. 
While the minimum supports remain largely unchanged (weekly relapse prevention, care planning and regular medical appointments), certain areas of the protocols were bolstered to support the professionals who would work in line with them. Some of the changes include:
  • Separation of protocols: differences in risks, processes and structural contexts for benzodiazepine prescription and detoxification and for methadone prescription and detoxification are now reflected in two separate sets of protocol documents, one for each substance.
  • The detoxification process has been divided into four simple, logical steps with clear roles and responsibilities for each stakeholder in the process:
    • Brokering, preparation, detoxification, aftercare.
  • Roles of the service user, key worker, doctor and broker clarified:
    • Provision of a comprehensive guide to the role of the local broker in the initiative.
  • Inclusion of additional guidelines, information and resources for prescribing doctors.
  • Comprehensive FAQ section which includes information on common queries, blocks and challenges encountered during community detoxification.
  • Comprehensive, service-user friendly information on risks involved in detoxification are incorporated in to an agreement form which is included in the protocols.
Structured, supported out-patient detoxification should be one of a range of safe and accessible treatment options open to those seeking support with substance dependence. The evaluation of the North Inner City Community Detoxification Pilot revealed a successful initiative with promising retention rates and stakeholder satisfaction.3 Due to interest from a number of areas in implementing the protocols and increasing numbers of referrals from outside the North Inner City, the new protocols and implementation structure will be adopted in a number of areas around Ireland as part of the National Community Detoxification Pilot 2012. The pilot was officially launched at the National Drugs Conference of Ireland 2011 and has so far received great support from the community/voluntary and medical sectors. The sites for the national pilot are: Cork/Kerry, the South East Regional Drugs Task Force (RDTF), the North Eastern RDTF, the Midlands, Bray, Ballymun, Ballyfermot, North Inner City Dublin and South Inner City Dublin.
Individuals from a variety of professions were nominated by each local or regional drugs task force to be trained in the role of broker for their area. Progression Routes delivered training in October 2011 and will provide an ongoing programme of support for independent brokers in the pilot areas. Over the coming two years, an evaluation will be conducted with the support of the evaluation sub-group, which includes expert input from the steering group. 
It is hoped that ultimately the Community Detoxification Protocols will ensure that health services and community drug services across the country have the tools to collaborate to provide an accessible, timely, practical and consistent approach to detoxification for service users seeking to reduce benzodiazepine or methadone use. They present a cost-effective way of maximising existing resources in the community/voluntary and statutory sectors to ensure a realistic detoxification option is available for people when they are ready to change. By using the protocols, all stakeholders can work together to achieve a positive impact on the experiences of service users seeking out-patient detoxification.
For further information please contact Ms Aoife Dermody in Progression Routes at aoife.dermody@aldp.ie or at 01 878 6899
2. Health Research Board (2010) 2010 National Report (2009 data) to the EMCDDA by the Reitox National Focal Point. Ireland: new developments, trends and in-depth information on selected issues. Dublin: Health Research Board. https://www.drugsandalcohol.ie/14714
3. A copy of the protocol and pilot evaluation is available at:Protocols
4. The Steering Group consists of: Chair, Mr Tony Duffin (voluntary organisations representative, Ana Liffey); Dr Brion Sweeney (National Drug Treatment Centre Board); Dr Austin O’Carroll (Safetynet); Dr Íde Delargy (ICGP); Dr Suzi Lyons (HRB); Dr Joanne Fenton (Access Team); Ms Irene Crawley (voluntary organisations representative, HOPE); Mr Brian Friel (Peter McVerry Trust); Mr Ruaidhri McAuliffe (UISCE Service Users Union); Ms Aoife Dermody (Progression Routes Initiative) Ms Caroline Gardner (Progression Routes Initiative); Dr Des Crowley (HSE); Advisor, Mr Joe Doyle (HSE).
5. Progression Routes (2011) Community Detoxification Protocols: methadone. Dublin: Progression Routes. Available at https://www.drugsandalcohol.ie/16228/
6. Progression Routes (2011) Community Detoxification Protocols: benzodiazepines. Progression Routes: Dublin. Available at https://www.drugsandalcohol.ie/16229/

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