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The role of detoxification in the medical response to opioid dependence is a matter of some controversy. Most authorities in the field have dismissed this form of treatment as ineffective. The reason is clear: they view both the achievement and maintenance of abstinence as universal goals of treatment, and there is no question that detoxification rarely leads to the latter. Recidivism is the rule regardless of how detoxification is achieved, and in what setting: on an in-patient or out-patient basis; with diminishing doses of methadone or clonidine or other opiates, or with strictly symptomatic, non-narcotic medications; whether over a gradual period of weeks or months, or in the course of only a few hours through the administration of a narcotic antagonist (e.g., Naltrexone) under general anesthesia. There are no subgroups of opioid dependent individuals whose prognosis is appreciably better than the norm.
Evidence suggests strongly that addiction is a chronic, notoriously relapsing
disease, whose etiology remains unclear, and which - today - defies attempts
at "cure" (note that the same statement applies to another form
of dependence - alcoholism). That is the bad news. The good news is that
while the addict can not be cured, s/he can be treated, and treated with
very great effectiveness. It all depends, of course, on one's concept of "success." It
is good to bear in mind the observation made some 30 years ago in a report
prepared for the Ford Foundation: "The most straightforward way to help
a heroin addict is to detoxify him....Detoxification has several clear
benefits for both the addict and society. Even if the addict does not intend
to stay off drugs, it reduces his habit and decreases its cost."
Reference: DeLong JV: Treatment and Rehabilitation.
In "Dealing with
Drug Abuse ƒ A Report to the Ford Foundation," Praeger, N.Y., 1972,
p 181
In the early '70's the New York City Health Department established a network
of ambulatory detoxification centers, which had a maximum duration of treatment
of 14 days and provided decreasing doses of methadone (with no "take-home" medication
permitted). In the first full year of operation, that program admitted over
22,000 (!) patients. One-third of these patients accepted referral to (and
were admitted by) long-term methadone maintenance or drug-free care after
completing detoxification. Given a daily average cost of heroin of $100-150,
one can readily calculate the enormous reduction of expenditures for illicit
drugs (and the crimes that generate those funds) associated with the detoxification
of this many individuals.
Reference: Newman RG: Methadone Treatment in Narcotic Addiction, Academic
Press, N.Y., 1977, pp 75-78
To the extent one can not give up "cure" (i.e., permanent abstinence) as a therapeutic objective, one must be wary of detoxification treatment. There are no credible data to support advocacy of any particular detoxification method by suggesting (or implying) that it promises significant reduction in the likelihood of recidivism. The corollary is also true: if one believes that there is benefit to assisting the addict in forgoing even a single self-administration of illicit narcotics, and thereby avoiding the many potentially fatal dangers with which such use is associated, then detoxification is a treatment modality of unparalleled effectiveness, and is attractive to a large proportion of those dependent on illicit opiates.
See also Naltrexone In The Treatment Of Opioid Dependence