Duration of treatment 1. While drug treatment has been shown to be effective in reducing illicit drug use patients may not cease illicit drug / alcohol use immediately, eliminating all drug / alcohol use may take months or years 2. Stability on substitute medication offers the opportunity to achieve and maintain health and social benefits while affecting wider lifestyle changes 3. If a patient is not benefiting from treatment clinicians should consider optimising treatment by increasing the intensity of programme rather than reducing it 4. Continued use of illicit drugs / alcohol may indicate patient requires discrete treatment for these substances, eg relapse prevention, triggers to use 5. Prescribers have a responsibility to make individuals aware of the criteria they apply when deciding whether it is safe or not to continue to prescribe or when it is necessary to make a change to the prescription 6. It may be necessary on occasions on the basis of careful assessment of risk to the patient and staff that a prescription must be suspended or withdrawn. Such decisions must involve the prescriber and other members of the multidisciplinary team 7. Detoxification is thought of as being a clearly defined process supporting safe and effective discontinuation of opioids whilst minimising withdrawals 8. The assessment and review process can establish whether a patient is suitable for detoxification. The detoxification process should be an active process carried out following joint and informed decision between prescriber, patient and multidisciplinary team 9. It should be remembered that detoxification is rarely successful especially at the first attempt. Patients who do not successfully detoxify should be offered seamless access back into maintenance or other treatment 10. There is clear evidence that detoxification against the patients expressed will is likely to lead to lapse and increased wider risks such as overdose 11. The following factors can guide the clinician / patient about suitability for detoxification – patient is committed and informed about the process, patient aware of risk of lapse, patient is in a stable and supportive social situation, plans for continued support and treatment are in place 12. NICE guidelines suggest that methadone and buprenorphine are as effective as each other in achieving good outcomes. They concluded that detoxification should be carried out with the medicine on which the patient has stabilised 13. Some patients and prescribers agree to reduce do...
