Better support strategies are needed for people with opioid dependence who ‘aspire to live an opioid-free life’, says a new report from Imperial College London.
While substitution therapy can lead to long-term stability and improved wellbeing, drug services need to ‘urgently consider’ the way in which they support people who want to come off opioid substitutes altogether, says the report. Researchers looked at more than 40 studies from the UK, US, Canada, Scandinavia and elsewhere, covering methadone, buprenorphine and other treatments. Among the report’s recommendations are specialist training for staff to manage withdrawal during detox, and better provision of medication to alleviate withdrawal symptoms. Peer support should also be available during the detox process, it states, with people given more control over their own tapering.
Significant barriers to success were identified as both physical challenges – such as severe withdrawal symptoms during the dose taper – and psychological challenges like fear of withdrawal and relapse, and low confidence. Other factors included unstable housing and ‘negative social networks.’ Although complete detoxification is often not recommended, many people decide ‘they want to come off the substation therapies completely’ – however, a lack of recommended medicines to manage ‘notoriously challenging’ withdrawal symptoms meant that most people were treated with a ‘mixture of benzodiazepines, antidepressants, antihistamine, and anti-inflammatories’.
‘Detoxification from opioid substitutes is a difficult process to complete, but here we have found a clear roadmap to better treatment provision to support people who want to undertake it,’ said Dr Louise Paterson from Imperial College’s department of brain sciences. ‘In fact, many of these strategies are routine in alcohol detoxification pathways but less often present for opioid detoxification. Our recommendations should be urgently considered by addiction services to improve results for those who aspire to live an opioid-free life.’
‘In our experience as an addiction research team, many people with opioid dependence do want to come off opioids and their substitutes completely, at some stage,’ added lead author Amy Bagshaw. ‘But few people are managing to do this successfully every year. Having reviewed the evidence and the factors involved in successful withdrawal, we believe these steps could really help to improve the present situation. Staff at addiction services may not be aware of how to adequately support individuals through the detoxification process, or how to approach the initial conversations.’
Meanwhile, researchers at UWE Bristol have partnered with Via to develop a toolkit designed to improve access to community services such as activity and creative groups, employment, education and financial advice, recovery cafes and peer support. ‘Passive signposting’ to community assets is not effective, the researchers warn, with more assertive approaches needed instead. The toolkit is based on a ‘stages of engagement’ model, and includes conversational assessments, targeted enhancements, and a community connector role to ensure ‘warm’ handovers.
‘It was very clear from our co-production workshops that people in recovery – whatever stage they are at – do not want to be simply signposted to local assets and sent on their way,’ said senior lecturer in public health, Dr Amy Beardmore. ‘They want a friendly face (preferably someone with their own lived experience of dependency) who can tell them what to expect, build confidence and reduce fear and anxiety.’
Barriers and facilitators to detoxification from opioid substitution treatment: a mixed-methods systematic review is published in the journal Addiction at https://addictionjournal.org/