Loss of tolerance and overdose mortality with detoxification: Abstinence is a valid choice

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7411.393-c (Published 14 August 2003) Cite this as: BMJ 2003;327:393
  1. Gordon Ridding Morse (gordonmorse{at}yahoo.com), RCGP regional lead clinician
  1. Bechers Brook Surgery, Salisbury SP3 5JL

    EDITOR—Strang et al's study is noteworthy for putting some statistical evidence to what has long been a widely held belief in the medical profession—namely, that opiate “detoxification” and the subsequent period of loss of tolerance to opiate dosing leaves people open to accidental overdose should they relapse to their former dosage.1

    But I and many of my colleagues are concerned that this study should be taken by some as an argument in favour of indefinite “maintenance” treatment with opioids, such as methadone, to the exclusion of abstinence based programmes. Instead, this study should be seen as a strong warning against precipitous or enforced abstinence without adequate preparation or education. There is no reason why relapse should be any more (or less) dangerous than using heroin the first time if the patient is adequately prepared.

    Dealing with drug addiction is all about choices, and clearly the choice for wanting to be free of addiction is at least as valid as choosing to take methadone. It is our responsibility as professionals who seek to help addicts to use every worthwhile strategy at our disposal wisely and appropriately.


    • Competing interests GRM is medical consultant to Clouds House, an abstinence based residential treatment centre.


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