Key priorities for implementation

Providing information, advice and support

Detoxification should be a readily available treatment option for people who are opioid dependent and have expressed an informed choice to become abstinent.

In order to obtain informed consent, staff should give detailed information to service users about detoxification and the associated risks, including:

  • the physical and psychological aspects of opioid withdrawal, including the duration and intensity of symptoms, and how these may be managed

  • the use of non-pharmacological approaches to manage or cope with opioid withdrawal symptoms

  • the loss of opioid tolerance following detoxification, and the ensuing increased risk of overdose and death from illicit drug use that may be potentiated by the use of alcohol or benzodiazepines

  • the importance of continued support, as well as psychosocial and appropriate pharmacological interventions, to maintain abstinence, treat comorbid mental health problems and reduce the risk of adverse outcomes (including death).

The choice of medication for detoxification

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.

Ultra-rapid detoxification

  • Ultra-rapid detoxification under general anaesthesia or heavy sedation (where the airway needs to be supported) must not be offered. This is because of the risk of serious adverse events, including death.

The choice of setting for detoxification

Staff should routinely offer a community-based programme to all service users considering opioid detoxification. Exceptions to this may include service users who:

  • have not benefited from previous formal community-based detoxification

  • need medical and/or nursing care because of significant comorbid physical or mental health problems

  • require complex polydrug detoxification, for example concurrent detoxification from alcohol or benzodiazepines

  • are experiencing significant social problems that will limit the benefit of community-based detoxification