Detoxification dihydrocodeine

In another example of switching to a different drug to conclude a detoxification, dihydrocodeine itself has been found useful at the tail-end of methadone treatment (Banbery et al. 2000). 

Whatever the length of detoxification, the issue of some symptomatic medication such as hypnotics at the very end can arise just as with methadone or dihydrocodeine, but there has been no informative investigation of this aspect. 

It is known, however, that drugs are readily available in many prisons, and the rate of adverse incidents and the time and effort spent in detecting smuggling of drugs in has been enough to persuade some authorities that at least the basics of treatment should be available. The most routine option has become to provide a detoxification for opiate misusers, with for instance lofexidine or dihydrocodeine, and also benzodiazepines will often be issued if there is a history of abuse of these and it is intended to avoid the possibility of fits with a short withdrawal course. The adverse incidents in custody and prisons have included some deaths in users of crack cocaine, with physical explanations postulated but no very satisfactory treatment for cocaine withdrawal indicated. Prison services have typically been wary of methadone, and in favouring lofexidine use it was encouraging that a randomized double-blind trial carried out by prison specialists found lofexidine to be as effective as methadone in relief of withdrawal symptoms (Howells et al. 2002). 

Not all patients require the relatively high dihydrocodeine doses suggested at the start of the course. If this method is used to detoxify from low levels of heroin, a shorter course may be used, as indicated. Some adjustments may be necessary to have the maximum dihydrocodeine dose about 3 days into the detoxification. 

Banbery J, Wolff K Raistrick D (2000). Dihydrocodeine a useful tool in the detoxification of methadone-maintained patients. Journal of Substance Abuse Treatment, 19, 301-5... 

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