Inpatient versus other settings for detoxification for opioid dependence

Dependence on opioid drugs, such as heroin, morphine, and codeine, is a serious problem in many societies. Opioids are very difficult to quit using. The first step to quitting is detoxification, which can cause a number of painful symptoms as the drug withdraws from the body. Many people choose an inpatient detoxification program rather than trying to stop using opioids on their own. In an inpatient program, medications such as methadone can ease the symptoms of withdrawal and patients are in a secure, supportive environment with no access to opiates. However, inpatient programs are expensive and can disrupt patients' lives. An increasing number of outpatient programs are available, providing medication and some support while keeping the drug user in the community. In addition to drop-in programs, there are day centres and even residential facilities which are not staffed 24 hours, unlike inpatient programs. The authors of this review looked for research comparing inpatient and other types of opiate withdrawal programs to see which is more effective. They found only one study from 1975, which had 40 participants. The study suggested inpatient therapy might be more effective than outpatient therapy in the short-term, but all of the inpatients relapsed within three months after detoxification. Since they found only one outdated study which included very few patients, the Cochrane review authors could not conclude whether inpatient treatment is more effective than outpatient or other settings. More research must be done to measure the benefits and costs of inpatient detoxification, especially for more severely dependent users.