Opioid (opiate) detoxification

Opioid detoxification refers to the process by which the effects of opioid drugs are eliminated from dependent opioid users in a safe and effective manner, such that withdrawal symptoms are minimised

• opioid detoxification may be carried out by using the same drug or another opioid in decreasing doses, and can be assisted by the prescription of adjunct medications to reduce withdrawal symptoms

Methadone can be used in the management of opioid abuse - this is because it has a long duration of action which allows the daily oral dose to maintain blood opiate levels within the desired range. Note that methadone syrup is unsuitable for injection

• methadone or buprenorphine should be offered as the first-line treatment in opioid detoxification. When deciding between these medications, healthcare professionals should take into account:
  • whether the service user is receiving maintenance treatment with methadone or buprenorphine; if so, opioid detoxification should normally be started with the same medication
  • the preference of the service user
• lofexidine may be considered for people:
  • who have made an informed and clinically appropriate decision not to use methadone or buprenorphine for detoxification
  • who have made an informed and clinically appropriate decision to detoxify within a short time period
  • with mild or uncertain dependence (including young people)
• clonidine should not be used routinely in opioid detoxification
• dihydrocodeine should not be used routinely in opioid detoxification
• duration of opioid detoxification should normally be up to 4 weeks in an inpatient/residential setting and up to 12 weeks in a community setting

Notes (2):

• for women who are opioid dependent during pregnancy, detoxification should only be undertaken with caution
• alcohol abuse and opioid detoxification
  • if a person presenting for opioid detoxification also misuses alcohol, healthcare professionals should consider the following
    • if the person is not alcohol dependent, attempts should be made to address their alcohol misuse
      • this is because they may increase this as a response to opioid withdrawal symptoms, or substitute alcohol for their previous opioid misuse
    • if the person is alcohol dependent, alcohol detoxification should be offered
      • should be carried out before starting opioid detoxification in a community or prison setting, but may be carried out concurrently with opioid detoxification in an inpatient setting or with stabilisation in a community setting
• benzodiazepine abuse and opioid detoxification
  • if a person presenting for opioid detoxification is also benzodiazepine dependent, healthcare professionals should consider benzodiazepine detoxification. When deciding whether this should be carried out concurrently with, or separately from, opioid detoxification, healthcare professionals should take into account the person's preference and the severity of dependence for both substances

Reference:

1. Prescribers' Journal (2000); 40 (2): 67-76.
2. NICE (July 2007).Drug misuse - Opioid detoxification.