Home > Post-detoxification outcomes in opioid-dependent patients.

Millar, Sean (2018) Post-detoxification outcomes in opioid-dependent patients. Drugnet Ireland , Issue 64, Winter 2018 , p. 13.

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There are currently in excess of 10,000 opioid-dependent patients receiving substitution therapy in Ireland,1 with the majority of those attending detoxification receiving methadone. Given the weak evidence base with regard to the efficacy of detoxification, many clinicians opt to continue substitute-prescribing or may even dissuade opioid-dependent persons from detoxifying.

 

A small number of international studies have examined problem drug users in detoxification treatment. Follow-up studies have noted discernible reductions in heroin use as well as significant reductions in criminality, psychopathology, and injection-related health problems following treatment exposure.2,3,4 Nevertheless, the majority of these studies are limited to two time points and fail to take into account longitudinal changes. Importantly, no studies to date have focused on aftercare post-detoxification.

 

Recent research conducted in Ireland examined outcomes in a cohort of opioid-dependent patients post-detoxification.1 In this study, which has been published in the journal Drug and Alcohol Review, patients completing detoxification in the three major Drug Dependency Units in Ireland during a 14-month period were examined (n=143). Subjects opting for one of the three pathways post-detoxification (inpatient aftercare, outpatient aftercare, or no formal aftercare) were assessed in the final week of detoxification and followed up after three, six and nine months. The primary outcome was abstinence following detoxification.

 

Results

An adjusted Cox regression model indicated that participants who opted for outpatient aftercare treatment had a lapse/relapse rate that was 52% higher than the inpatient aftercare group (hazard ratio [HR] 1.52, 95% confidence interval [CI] 0.75–3.08), although this difference was not statistically significant. Time to first use of drugs was considerably shorter for the no formal aftercare group (HR 7.68, 95% CI 4.30–13.73) when compared to those who received inpatient aftercare, highlighting that any aftercare is significantly better than no aftercare. Furthermore, patients who attended any form of aftercare were more likely than the no formal aftercare group to be abstinent at nine-month follow-up. Abstinence rates for outpatient aftercare and inpatient aftercare were found to be equal after nine months.

 

Conclusions

The authors concluded that patients who opt for aftercare post-detoxification have significantly better outcomes at follow-up when compared to no formal aftercare. In addition, the marginal benefit that the study demonstrated for inpatient aftercare over outpatient aftercare should be taken into account when planning services, as it is almost as effective and cheaper to provide.

1  Ivers JH, Zgaga L, Sweeney B, Keenan E, Darker C, et al. (2017) A naturalistic longitudinal analysis of post‐detoxification outcomes in opioid‐dependent patients. Drug Alcohol Rev [forthcoming].

2  Ross J, Teesson M, Darke S, Lynskey M, Ali R, Ritter A, Cooke R (2005) The characteristics of heroin users entering treatment: findings from the Australian treatment outcome study (ATOS). Drug Alcohol Rev, 24(5): 411–18.

3  Teesson M, Ross J, Darke S, Lynskey M, Ali R, Ritter A, Cooke R (2006) One year outcomes for heroin dependence: findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Depend, 83(2): 174–80.

4  Teesson M, Mills K, Ross J, Darke S, Williamson A, Havard A (2008) The impact of treatment on 3 years’ outcome for heroin dependence: findings from the Australian Treatment Outcome Study (ATOS). Addiction, 103(1): 80–88.

Item Type:Article
Issue Title:Issue 64, Winter 2018
Date:February 2018
Page Range:p. 13
Publisher:Health Research Board
Volume:Issue 64, Winter 2018
EndNote:View
Accession Number:HRB (Electronic Only)
Subjects:B Substances > Opioids (opiates)
HJ Treatment method > Substance disorder treatment method > Detoxification method
HJ Treatment method > Treatment outcome
J Health care, prevention and rehabilitation > Patient care management
J Health care, prevention and rehabilitation > Residential facility
VA Geographic area > Europe > Ireland

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