The remaining role and feasibility of detoxification in opioid addiction after 30 years of medication for opioid use disorder: A systematic review

Abstract

IntroductionIn last thirty years, substitution therapy for opiate-dependant patients has been widespread in general practice with a corresponding decrease in detoxification strategies. ObjectivesEvaluate the remaining role of detoxification and its feasibility in the management of opioid addiction over the last decade. MethodsA systematic review (PRISMA criteria) was conducted using 14 databases. Both English and French keywords (opioid, withdrawal, addiction, detoxification) were used to find research papers published between January 2010 and January 2020. The data were exploited by applying the Synthesis Without Meta-analysis protocol. ResultsOf the 282,865 screened publications identified through the database search, and following a bias assessment, 11 quantitative studies were selected on detoxification, modalities and post-detoxification support. There is general consensus regarding the alpha2-adrenergic drug protocol and symptomatic treatment. Transcutaneous electrical acupoint stimulation alleviates withdrawal symptoms. Involvement in the Twelve Step program recommended by Alcoholics Anonymous and Narcotics Anonymous with adapted aftercare accommodation has proved effective. The results gained from inpatient and outpatient detoxification with regular and prolonged support are similar. The main factors facilitating detoxification are rapid access to support structures, training of nursing staff to support patients during detoxification and post-detoxification, and age (30-40 y.o.). The societal cost of detoxification is lower than that of substitution therapy. ConclusionA combination of primary care, psycho-social intervention during detoxification, followed by care support facilitates the detoxification process and long-term abstinence. The promotion of opiate detoxification among eligible patients must be encouraged in dedicated medico-psychosocial organisations via ambulatory primary care.