Drug Misuse: Opioid Detoxification - The NICE Guideline
National Collaborating Centre for Mental Health (NCCMH)
This evidence-based clinical guideline
endorsed by the National Institute for Health and Clinical
Excellence (NICE) presents guidance on physical, psychological and
service-level interventions for healthcare staff on how to
work with people who misuse opioids to significantly improve their
treatment and care, and to deliver detoxification safely and
effectively. Of the estimated 4 million people in the UK who use
illicit drugs each year, approximately 50,000 misuse opioids (such
as heroin, opium, morphine, codeine, and methadone). Opioid misuse
presents a considerable health risk and can lead to significant
social problems. The NICE guideline is an important tool in helping
people to overcome their drug problem.
It provides an overview of drug misuse and
opioid detoxification and covers assessment and testing,
pharmacological and physical interventions used in detoxification,
psychosocial interventions to support detoxification, and the
settings in which the treatment can take place. The book contains
experiences by people who have been dependent on opioids, and
there is also advice for family members and carers of people with a
drug problem.
This book has a ‘sister title’: Drug Misuse: Psychosocial Interventions
NICE Mental Health Guidelines
These guidelines from NICE set out clear
recommendations, based on the best available evidence, for health
care professionals on how to work with and implement physical,
psychological and service-level interventions for people with
various mental health conditions.
The book contains the full guidelines
that cannot be obtained in print anywhere else. It brings together
all of the evidence that led to the recommendations made, detailed
explanations of the methodology behind their preparation, plus an
overview of the condition covering detection, diagnosis and
assessment, and the full range of treatment and care
approaches.
The accompanying CD-ROM contains all the data used as evidence,
including:
- Included and excluded studies.
- Profile tables that summarise both the quality of the evidence
and the results of the evidence synthesis.
- All meta-analytical data, presented as forest plots.
- Detailed information about how to use and interpret forest
plots.
Full Contents
1. Executive summary
- General considerations
- Assessment
- Pharmacological interventions in opioid detoxification
- Opioid detoxification in community, residential, inpatient and
prison settings
- Specific psychosocial interventions
- Research recommendations
2. Introduction
- National guidelines
- The national opioid detoxification for drug misuse
guideline
3. Introduction to drug misuse
- Drug misuse and opioid dependence
- Epidemiology of drug misuse
- Aetiology and maintenance of drug misuse
- The course of drug misuse
- The pharmacology of opioids
- The public health impact of drug misuse
- Identification and assessment of drug misuse
- The aims of the treatment and management of drug misuse
- The development of detoxification services
- Current care and treatment in the NHS
- The experience of drug misuse – personal perspectives
- Impact of drug misuse on families and carers
- Economic impact of drug misuse
4. Methods used to develop this guideline
- Overview
- The scope
- The Guideline Development Group
- Clinical questions
- Systematic clinical literature review
- Systematic economic literature review
- Stakeholder contributions
- Validation of this guideline
5. Assessment and testing
- Introduction
- Clinical assessment in the management of detoxification
- Drug testing
- Psychometric assessment tools
6. Pharmacological and physical interventions in opioid
detoxification
- Introduction
- Pharmacological interventions in detoxification
- Overall clinical summary of pharmacological interventions in
detoxification
- Clinical practice recommendations
- Ultra-rapid, rapid and accelerated detoxification using opioid
antagonists
- Clinical practice recommendations
- Physical and complementary interventions during
detoxification
7. Psychosocial interventions in opioid
detoxification
- Introduction
- Current practice
- Definitions
- Outcomes
- Databases searched and inclusion/exclusion criteria
- Studies considered
- Psychosocial interventions in combination with
detoxification
- Clinical summary
- Literature review of health economics evidence
- Economic modelling
- Clinical practice recommendations
8. Settings for opioid detoxification
- Introduction
- Inpatient and community-based settings
- Unassisted/self-detoxification
- Prison-based detoxification
9. Appendices
10. Glossary
11. References
12. Abbreviations