In-patient detoxification procedures, treatment retention, and post-treatment opiate use : comparison of lofexidine+naloxone, lofexidine+placebo, and methadone

Objective: In-treatment and post-treatment outcomes were compared for three detoxification procedures (lofexidine + naloxone, lofexidine + placebo naloxone, and methadone).

Sample and design: The sample was 137 opiate dependent in-patients. Detoxification treatments were 6-day lofexidine + naloxone (n = 45), lofexidine + placebo naloxone (n = 46), or 10-day methadone reduction (n = 46). A cohort study design was used with double-blind random allocation to lofexidine + naloxone versus lofexidine + placebo. Patients who did not consent to, or who were excluded from randomisation received methadone.

Results: Outcome differences between treatment groups at follow-up were generally associated with length of stay post-detoxification rather than detoxification procedure. Among patients who were not opiate abstinent throughout follow-up (n = 85), those who received lofexidine + naloxone detoxification reported a longer interval to first heroin use, with an interaction between detoxification medication and subsequent retention in treatment also identified.

Conclusions: Detoxification medication may influence medium-term opiate use outcomes via its effect upon retention in treatment.