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HOT TOPIC 2016 HTM file
Harm reduction: what’s it for?

‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Opposing agendas have led to a shifting balance between seeing harm-reduction as acceptable only in the service of the greater good of reducing or eliminating drug use, versus seeing it as the overriding objective, one which should never be sacrificed to an anti-drugs agenda.

STUDY 2001 PDF file 98Kb
Opiate detoxification: spending more may save long term

British study suggests that inadequately supervised outpatient programmes may be a waste of money and that costly specialist inpatient programmes are not necessarily more costly per abstinent outcome, but methodological flaws cloud the picture.

STUDY 2002 PDF file 105Kb
Rapid opiate detox guarantees completion, but abstinence depends on what follows

Compared to a conventional inpatient programme, the worlds largest private provider of ultra-rapid opiate detoxification improved completion rates, but after leaving fewer patients remained abstinent. Extended text offers comprehensive review.

REVIEW 2003 PDF file 178Kb
Lofexidine safe and effective in opiate detoxification

Cochrane review concludes that lofexidine almost matches methadone for opiate detoxification and has fewer side effects than clonidine, making it preferable when opiate-type drugs are contra-indicated. Extended text includes details of relevant studies.

STUDY 2004 PDF file 109Kb
Rapid detoxification facilitates transfer to naltrexone but gains fade

Relative to usual procedures, in the Netherlands, Australia and the USA, rapid withdrawal under anaesthesia enabled more opiate dependent patients to transfer to naltrexone and remain opiate free in the short-term, but within a year gains had diminished.

STUDY 2008 HTM file
High risk of overdose death for opiate detoxification completers

Findings from Italy and Australia warn that detoxification without throughgoing stabilisation, preparation and aftercare is too often a band-aid measure which risks more harm then good.

STUDY 2006 PDF file 279Kb
British study makes a case for buprenorphine as first line heroin detox option

Compared to a standard lofexidine regime, buprenorphine was preferred by opiate dependent patients and enabled more to complete outpatient detoxification.

STUDY 2011 HTM file
Outpatient versus inpatient opioid detoxification: a randomized controlled trial

Methadone maintained heroin-dependent patients in Birmingham (UK) randomised to inpatient v. outpatient lofexidine-based detoxification rarely sustained long-term opioid abstinence; return to maintenance was the typical outcome.

IN PRACTICE 2004 PDF file 418Kb
Giving the silent majority a voice

Constrained by guidelines and standards, a UK prescribing service could do little to respond to user survey feedback.

STUDY 1999 PDF file 178Kb
Some counselling maximises methadone cost-effectiveness

Suggests that increasing availability of counselling modestly (to three times a week, uptake in practice under one a week) buys more abstinence per dollar than offering daily access plus other services.

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