Slow methadone reduction as a way towards recovery

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The latest national policy intends to move drug treatment from maintenance on substitution medication, such as methadone towards recovery. However, a primary care drug services in Islington, London, has used methadone reduction pathways as a way to recovery for several years. A negotiated and planned slow reduction off methadone introduces patients to the idea of recovery and detoxification. Maintaining patients on substitute medication benefits their overall wellbeing and helps them work towards recovery. This period of stability—where a patient is taking substitute medication and no illegal drugs—is the key to moving to reduction. The detoxification period can be flexible and slow but it results in abstinence. The final stages of reduction are usually completed as an inpatient in a detoxification centre; this appears to be effective for patients who have struggled on community detoxification. The reduction pathway has four planned stages: titration of substitute medication; stabilisation; planned reduction of substitute medication; and an aftercare plan. The evidence from an audit and a typical case study shows that a slow reduction plan can move a patient towards abstinence. Slow reduction is a useful concept to consider when planning drug service treatment.