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Heroin Addiction and Related Clinical Problems: 2017, 19, N4 (pages: 5 - 12)

Substantial Improvement in Outpatient Opiate-Free Exits Using a Novel Resource-Efficient Lofexidine and Buprenorphine-Based Protocol (‘Detox-in-a-Box') – a Service Evaluation Study

Iosub R., Seeger I., Law F., Wallbank N., and Melichar J.

Summary: Background: Due to relatively poor outpatient opiate detox success rates locally and limited access to inpatient opiate detoxification beds, we introduced a novel two week long structured opiate detoxification regime using five key principles: 1) Four outpatient visits over the two week regime. 2) Buprenorphine frontloading: long-acting partial agonist with less severe withdrawal symptoms. 3) Lofexidine: an α2-adrenoceptor agonist for opiate withdrawal symptoms, with significantly less sedation and hypotension than clonidine. 4) “Well-being medication”: symptomatic relief for insomnia, abdominal symptoms, etc. 5) Naltrexone: offered for relapse prevention. Aims: We assessed the efficacy of this regime in our outpatients setting (annual numbers coming into treatment 120-150/year) compared to previous years when client-led opiate replacement dose reduction regimes were used solely. Methods: Electronic patient management software was used by data analysts to filter our caseload and calculate the number of ‘opiate-free' discharges yearly 2010 – 2014. Results: In the first year after its introduction the number of patients achieving abstinence quadrupled. ‘Detox-in-a-Box' was rapidly embraced by both key-workers and patients, and continued to prove highly successful over the subsequent four years leading to a dramatic improvement in the number of patients exiting drug-free from our services. This dramatic improvement cleared the backlog of highly motivated clients awaiting a detox. Conclusions: Compared to other community opiate detox strategies used, ‘Detox-in-a-Box' proved to be a highly efficient, successful, structured and resource efficient protocol. It continues to be used by services and is gradually being rolled out elsewhere.