Methadone versus other drugs in heroin detoxification

Abstract

Overview of Topic: This study dealt with the introduction of evidence based practice in various clinical settings, particularly that of a detoxification setting. Methadone is often the drug of choice in scenario's of detoxification from illegal drug use. This treatment however, carries substantial faults and this fact inspires further research in other alternatives. This can potentially advance detoxification advancement rates, which is usually considered to be an arduous phase of treatment often yielding un-satisfactory results (in terms of treatment completion and maintenance). The Research Question: In heroin addicts (Population), what is the effect of methadone (Intervention) in comparison to other therapies (Comparison) for effective detoxification (Outcome). Inclusion/Exclusion Criteria: Studies that involved the comparison of methadone with other renowned detoxification agents were accepted but excluded if the studies were not, did not have clear ethical considerations or if they had less than 200 patients participating in the study. Systematic reviews were included by default as they had been crucial in the determination of suitable implications for practice. The aim of this criteria was to keep literature that had been more efficacious, feasible and reliable through the hierarchy of evidence done by Evans (2002). The Search: This yielded seven systematic reviews and 7 RCTs, four of which met the inclusion criteria. They were then appraised using the Critical Appraisal Skills Programme (CASP) tools. Results of the Study: Methadone was proven to be very reliable form of treatment in detoxification. Even though there were numerous studies that showed results that closely resembled those of the former intervention, they were often criticized for safety, expense or convenience reasons. Recommendations for Practice: Standard evidence based protocol needs to be employed and nurses should be aware of these guidelines and become more active in their delivery of care. This constitutes thorough assessments (using withdrawal scores) and additional, non pharmacological solutions such as counselling.