Detoxification long-term

The extent of cleanup that is necessary to protect human health and welfare aries with different use ctitegories. Residential development is probably the most sensiti e type of land use because of the long-term and multiple e.xposure routes and because of potential e.xposure to the most sensitive population segments (e.g., children and elderly persons). E.xcavation and removal appears to be the remedial tiction alternative selected at most sites where there is redevelopment. This is because no one can guaratitee tliat a site is stife (i.e., offers zero risk) unless all contaminants are removed. Neitlier a developer nor a municipality can accept responsibility for site safety as long as haznrdous materials remain there. In situ treatment approtiches are seldom iewed is the best option because they are unproven and because 100% detoxification or stabilization caimot be achieved. 

Methadone (Dolophine). For over 30 years, methadone has been the mainstay of treatment for opiate dependence. A replacement therapy, methadone has been used both for detoxification and for long-term maintenance. It has a slower onset of action and is longer acting than other narcotic analgesics. It causes little of the euphoria produced by drugs such as heroin. 

When beginning treatment for opiate dependence, it is imperative to assess the patient s long-term goals for treatment. The key variable is whether the patient desires to control his/her opiate nse or whether the patient wants to achieve total abstinence. In both cases, the first stage of treatment is detoxification. The endpoint of detoxification differs, however. Detoxification is complete in a patient desiring abstinence when (s)he is entirely tapered from the opiate. Conversely, detoxification is complete in a patient desiring maintenance therapy when the withdrawal symptoms have abated. 

Michael is a 30-year-old man who has been a patient in our methadone clinic for three years. He has a ten-year history of opiate use in all, but previous treatment had been elsewhere on a detoxification basis. At one time he had strongly wished to come off drugs completely and went into a residential rehabilitation centre, but although he completed the stay satisfactorily he relapsed into heroin use soon afterwards. It is now agreed between us that his methadone treatment will need to continue long-term. 

Finally, it should be stressed again that certainly not all benzodiazepine prescribing to opioid maintenance patients need be long term. McDuff et al. (1993) reported on detoxification from alprazolam, the benzodiazepine most commonly used by their methadone subjects. With methadone dosage usually remaining the same, patients were offered a set reducing course of alprazolam over 11 weeks. Of 22 patients, four refused the treatment and 12 out of 18 subsequently completed detoxification, although timescales in practice proved variable. In a comparative study by Weizman et al. (2003) just over a quarter of benzodiazepine-dependent methadone maintenance patients remained free of benzodiazepines... 

Eklund C, Melin L, Hiltunen A Borg S (1994). Detoxification from methadone maintenance treatment in Sweden long-term outcome and effects on quality of life and life situation. The International Journal of the Addictions, 29, 627-45... 

Once detoxification is complete, the drug abuser can start the rehabilitation and long-term recovery process with a clear head. Research shows that detoxifi-... 

For short-term detoxification, a person would decrease and stop methadone in less then a month. It should be noted that people in short-term detoxification programs have a higher likelihood of returning to heroin abuse than do people in a long-term methadone detoxification program. 

In a long-term detoxification program, people on methadone may spend up to six months gradually cut-... 

Once detoxification is complete, the drug abuser can start the rehabilitation and long-term recovery process with a clear head. Research shows that detoxification alone is not an effective treatment, and addicts who leave rehab immediately after detox with no further counseling or interventions soon abuse methaqualone or another mind-altering substance again. 

Treatment of acute overdoses of opioids can be lifesaving and is described in Chapters 31 and 59. In long-term treatment of opioid-dependent persons, pharmacologic and psychosocial approaches are often combined. Chronic users tend to prefer pharmacologic approaches those with shorter histories of drug abuse are more amenable to detoxification and psychosocial interventions. 

If medical detoxification is needed, it is only the first stage of treatment and does little to change long-term... 

---