Practice NICE guidelines

Psychosocial interventions and opioid detoxification for drug misuse: summary of NICE guidance

BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39265.639641.AD (Published 26 July 2007) Cite this as: BMJ 2007;335:203
  1. Stephen Pilling, joint director of National Collaborating Centre for Mental Health, director of Centre for Outcomes, Research and Effectiveness1,
  2. John Strang, professor in addiction research2,
  3. Clare Gerada, general practitioner3
  1. 1Centre for Outcomes, Research and Effectiveness, Department of Psychology, University College London, London WC1E 8XA
  2. 2National Addiction Centre, Institute of Psychiatry, King's College London, London SE5 8AF
  3. 3Hurley Clinic, Ebenezer House, London SE11 4HJ
  1. Correspondence to: S Pilling s.pilling{at}ucl.ac.uk

    Why read this summary?

    Drug misuse is an increasing problem that not only impairs the physical and mental health of people who misuse drugs but also negatively affects their families and wider society (for example, in its association with crime). Recently expanded drug services in the United Kingdom involve general practitioners to a considerable degree, who care for at least a third of opioid misusers in treatment. Many clinicians remain pessimistic, however, about the possible benefits of any treatment and how to engage drug users in treatment.1 This article summarises two new NICE guidelines that identify the most effective, safe detoxification regimens for primary and secondary care, the most cost effective psychosocial interventions, and effective ways to promote patient engagement.2 3

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, a range of consensus techniques is used to develop recommendations. In this summary, recommendations derived primarily from consensus techniques are indicated with an asterisk (*).

    Opioid detoxification

    General principles

    For all patients who are opioid dependent and have expressed an informed choice to become abstinent, services should:

    • Offer detoxification as a readily available and effective treatment option;

    • Provide detailed information about detoxification and the associated risks, including:

      • - The physical and psychological aspects of opioid withdrawal, including the duration and intensity of symptoms

      • - How such symptoms may be managed, including non-pharmacological approaches

      • - The loss of opioid tolerance after detoxification, and the ensuing increased risk of overdose and death from illicit drug use (this risk may be potentiated by alcohol or benzodiazepine use)

      • - The importance of continued support, and psychosocial and appropriate pharmacological interventions, to maintain abstinence, treat comorbid mental health problems, and reduce the risks of serious adverse events (including death) that may arise as a result of reduced opioid tolerance;

    • *Offer a community based detoxification …

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