Successful discharges from opiate substitution therapy: dose reduction to zero


Dr Robert Cohen

Consultant Addiction Psychiatrist

Robert Cohen is a Consultant Addiction Psychiatrist in Luton, currently working for Change, Grow, Live Ltd, a third sector organisation.  Having trained as a doctor and completed a specialist training in General Psychiatry and Addiction Psychiatry, he first became a Consultant in 1995. He has worked in NHS Services in West, East, North-East and South-West London, Winchester and Luton. He focuses on clinical research, with previous work on motivation in addiction, including whether referral source affects engagement with treatment; opiate substitution therapy dosing; clinical alcohol pharmacokinetics; hair testing for drugs; respiratory complications of opiate use; he has edited a book on the Pharmacodynamics of Addiction.  He is a regular contributor to the Society’s Annual Symposium, both as a speaker and presenting posters.  He is currently researching patterns of progress that patients with a diagnosis of the opiate dependence syndrome make when treated with opiate substitution therapy with methadone or buprenorphine.

The Recovery Model at the heart of the current UK drug strategy aims to help opiate dependent people become abstinent from illicit and prescribed opiates. There is little data about how many people receiving opiate substitution therapy become drug-free and how they do it.  This study addresses this gap. Data of patients receiving opiate substitution therapy from the Luton Drug Service (at that time provided by Cambridgeshire Community Services NHS Trust) were collected from the electronic medical record.  They included the doses of sequential prescriptions throughout treatment and the date that treatment started.  From this, it could be calculated for how many patients the dose was reduced to zero and how long this process took. In 2015-16, 82 patients were successfully discharged drug-free from the service. Of them, 26 completed reduction of dose to zero.  The length of time in treatment showed a bimodal distribution, with 19 patients completing detoxification in 0-3 years, and 7 patients in 6-12 years. The highest daily dose of methadone prescribed in the former group was 65mg (mean 46mg), for the latter group it was 100mg (mean 79mg). These results, concordant with other studies, suggest that reduction to zero is not common, occurs in 2 patterns of distribution, and does not necessarily require the high doses of methadone advised in conventional guidelines.