Home > Updated community detoxification protocols for methadone and benzodiazepines.

Lyons, Suzi (2017) Updated community detoxification protocols for methadone and benzodiazepines. Drugnet Ireland , Issue 62, Summer 2017 , p. 31.

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The Ana Liffey Drug Project has produced updated community detoxification protocols for both methadone and benzodiazepines.1,2,3 One of the main changes is the removal of the need for the mandatory broker role in the community detoxification structure. Key to the detoxification process is a named key worker or healthcare professional to provide psychosocial support and a GP to provide the necessary initial assessment and medical support throughout the process. There is an emphasis on psychosocial support and the key work process in the updated documents. The issues of dual diagnosis and mental health in community detoxification are discussed. Other updates relate to suggested detoxification schedules for methadone. 

Methadone detoxification schedule 1

  • After stabilisation, dosage should be reduced every 1−2 weeks, which will bring the person down to zero in approximately 12 weeks, typically a reduction of 5 mg. While some people may prefer to detox more quickly at the beginning, there is currently no evidence to support whether this is more effective than that of a slowly tapered dose. 

Methadone detoxification schedule 2

  • Reduction of dosage by 10 mg per week down to 40 mg per day, after which the dosage should be reduced by 5 mg per week. The reduction in dosage should be decided upon with the person, and there should not be more than one dosage change per week. 

Timeframe for detoxification from methadone

The rate and pace of dosage reduction for detoxification should be decided on a case-by-case basis, depending on the needs and wishes of the person. For people with dual addiction with a hypnotic (e.g. benzodiazepines or Z-drugs) and methadone, the protocols recommend that they should be detoxified off the hypnotic first, then methadone. There are no updates to the suggested detoxification schedules for benzodiazepines.

 

The aim of the protocols is to improve service delivery and ensure best possible practice for each person seeking a detoxification. This in no way precludes healthcare professionals providing additional supports to meet the needs of person based on their particular circumstances: ‘The Steering Committee fully recognises, and wishes to emphasise, the importance of local knowledge and expertise in ensuring successful delivery of services. There is nothing to prevent services mandating an individual or agency locally to promote and/or coordinate the new guidelines’ (p. 11).

 

1   Ana Liffey Drug Project (2016) National community detoxification: methadone guidelines. Dublin: Ana Liffey Drug Project. https://www.drugsandalcohol.ie/26888/

2   Ana Liffey Drug Project (2016) National community detoxification: benzodiazepine guidelines. Dublin: Ana Liffey Drug Project. https://www.drugsandalcohol.ie/26889/

3   For further information on community detoxification, visit: http://www.drugs.ie/resources/community_detox/information_for_drug_users

Item Type:Article
Issue Title:Issue 62, Summer 2017
Date:August 2017
Page Range:p. 31
Publisher:Health Research Board
Volume:Issue 62, Summer 2017
EndNote:View
Subjects:B Substances > Sedatives or tranquillisers (CNS depressants) > Benzodiazepine
B Substances > Opioids (opiates) > Opioid product > Methadone
HJ Treatment method > Substance disorder treatment method > Substance replacement method (substitution)
HJ Treatment method > Substance disorder treatment method > Substance replacement method (substitution) > Methadone maintenance
HJ Treatment method > Substance disorder treatment method > Detoxification method
J Health care, prevention and rehabilitation > Patient care management
J Health care, prevention and rehabilitation > Health care programme or facility > Community-based treatment (primary care)
T Demographic characteristics > Doctor
VA Geographic area > Europe > Ireland

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