This guideline makes recommendations for the treatment of people who are undergoing detoxification for opioid dependence arising from the misuse of illicit drugs. It is concerned with opioid detoxification in community, residential, inpatient and prison settings, and will refer to the misuse of other drugs such as benzodiazepines, alcohol and stimulants only in so far as they impact on opioid detoxification. The guideline does not address the particular problems of detoxification of pregnant women and the related management of symptoms in neonates whose mothers misused opioids during pregnancy.
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. With opioids, this process 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.
Opioid misuse is often characterised as a chronic condition with periods of remission and relapse. Although abstinence may be one of the long-term goals of treatment, it is not always achieved. However, detoxification is a key stage in achieving abstinence for people who are opioid dependent.
Pharmacological approaches are the primary treatment option for opioid detoxification, with psychosocial interventions providing an important adjunct.
In order to ensure that all people to whom this guidance applies obtain full benefit from the recommendations, it is important that effective keyworking systems are in place. Keyworking is an important element of care and helps to deliver high-quality outcomes for people who misuse drugs. Keyworkers have a central role in coordinating a care plan and building a therapeutic alliance with the service user. The benefits of a number of the recommendations in this guideline will only be fully realised in the context of properly coordinated care.
NICE has also developed a clinical guideline on psychosocial interventions for drug misuse, public health intervention guidance on substance misuse in children and young people, and technology appraisals of methadone/buprenorphine and naltrexone for the management of opioid dependence (see section 6 below).
This guideline should be read in conjunction with the Department of Health's Drug misuse and dependence – guidelines on clinical management: update 2007, also known as the 'Orange Book', which provides advice to healthcare professionals on the delivery and implementation of a broad range of interventions for drug misuse, including those interventions covered in the present guideline. For more information see the National Treatment Agency for Substance Misuse.