Sir: There are a number of options available for detoxification from heroin, including methadone tapering regimes, dihydrocodeine reduction, lofexidine, and ultra-rapid naltrexone assisted detoxification under general anaesthetic (Reference SievewrightSievewright, 2000). Buprenorphine has recently been licenced in the UK for the treatment of opiate dependence and offers an alternative method of withdrawal from heroin; it has proven efficacy for out-patient detoxification (Reference O'Connor, Carrol and ShiO'Connor et al, 1997) but has been little used in the UK. Here we present the results of a pilot study of 30 consecutive out-patient detoxifications with patients who were using low-dose heroin (£20 approximately 0.2 g daily) using buprenorphine with a standard treatment protocol lasting 7 days.
Of the 30 patients who participated in the study, 15 (50%) successfully completed the detoxification programme and 15 (50%) defaulted. Symptom control appears to have been good, with subject showing mild to moderate withdrawal symptoms throughout the detoxification. The consumption of the medication was easily supervised by clinic staff, ensuring good compliance.
This suggests that, for some opiate dependent patients, a standard prescription protocol of buprenorphine can be used effectively for out-patient heroin detoxification with good compliance and good symptom control. However, as of yet there is no evidence to suggest which type of detoxification is the most effective in terms of matching to patient variables, cost, completion rate or symptom control. Leeds Addiction Unit is currently undertaking a randomised control trial of lofexidine v. buprenorphine to look at these issues in detail.
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