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Abstract |
Within the Swiss Detoxification Coordination (SwiDeCo) framework, a number of randomised clinical trials on opiate detoxification took place, comparing different settings (in- and outpatient), medications (antagonists under anaesthesia, methadone, buprenorphine high/low dosage) and duration of treatment (fixed and flexible). A standard assessment with validated instruments and standard follow-up was used throughout all the studies. One study concerned neonatal opiate detoxification. The scientific framework offered by SwiDeCo provided an opportunity for links and exchange between different drug treatment centres (over 20 centres participated in the studies) and persons working in the field of substance abuse in Switzerland. Overall, 279 patients were included in the different trials, of whom three-quarters were male, on average 30 years old; multi substance abuse was frequent. All procedures to withdraw patients from opiates tested in the different trials resulted in an equally poor outcome regarding abstinence after 3 months (22%). There were no patient baseline characteristics predicting differences in outcome. However, in-patient detoxification resulted in higher short-term abstinence rates, but this advantage disappeared over time. Patients’ level of distress at baseline evaluation decreased independently of treatment outcome during the first three months. Therefore, there seems to be a beneficial, but outcome-independent, treatment initiation effect. Two patients died within 3 months of detoxification. Although we cannot formally conclude whether withdrawal treatment resulted in an excess mortality, this fact is disquieting. During the detoxification phase overdose prevention should be discussed. Finally, based on our study results and on similar results from other groups, we cannot recommend the UROD procedure for withdrawal. We would rather suggest engaging patients who insist on this treatment modality in outpatient treatment, where tapering of substitution opiates could be performed while monitoring resumption of heroin consumption or the consumption of other substances. Given the high relapse rates independent of the specific detoxification treatment offered, it is important to offer flexible treatment goals to patients undergoing withdrawal treatment, so that substitution treatment might be offered in case of failure. The technique is simple and can be applied by trained family doctors. |
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