Sarah Larney, Bradley Mathers and Kate Dolan Illicit drug treatment ...

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devoted to areas such as security. However, prisoners retain the right to adequatehealthcare, including access to effective treatments for drug dependence. Furthermore,according to the principle of equivalence of care, prisoners have the right to receivehealthcare equivalent to that available in the community (World Health Organization,1992). The issues of drug dependence and treatment in prison take on added importancein the context of the global HIV epidemic. Prisons are important sites of HIVtransmission due to sharing of drug injecting equipment and unprotected sexual activity(UNAIDS, 2006). Yet through the provision of effective drug treatment, prisons can alsobe sites for HIV education and prevention.This report summarises the published literature on illicit drug detoxification andtreatment interventions in prisons. Where relevant, literature on community-basedinterventions is also discussed. This report is not intended to be used as a guide forclinical practice; rather, its aim is to draw attention to various approaches for thetreatment of illicit drug dependence in prison settings.9
2. DETOXIFICATIONDetoxification is the management of withdrawal symptoms associated with the cessationof a drug of dependence. While not a treatment for drug dependence in itself, assisting adrug dependent person to detoxify safely and with a minimum of discomfort or dangerto their health may lead to further opportunities for clinicians to provide harm reductioninterventions or drug treatment services.There is a paucity of literature detailing or evaluating detoxification protocols in eithercommunity or prison settings. However, detoxification in prison need not differmarkedly from that provided in the community. Withdrawal can be managed in anumber of ways, depending on the drug or drugs of dependence. Medical interventionmay assist the detoxification process, particularly in the case of opiate dependence.Alternatively, detoxification can be managed non-medically, through the provision ofpsychological support and care.2.1 Opiate detoxificationOpiate detoxification is rarely life-threatening and clinical management is uncomplicated.Management of opiate withdrawal typically involves the use of alpha2-adrenergic agonists(e.g. clonidine, lofexidine), opioid agonists (e.g. methadone, buprenorphine) and/orsymptomatic treatment.2.1.1 Alpha2-adrenergic agonistsOne of the neurological mechanisms underlying opioid withdrawal is noradrenergichyperactivity. Alpha2-adrenergic agonists, such as clonidine and lofexidine, relieve opiatewithdrawal symptoms by moderating this activity (Gowing, Farrell, & White, 2004).Several community-based studies have examined the use of clonidine and lofexidine. Areview of studies found that withdrawal symptoms are similar whether adrenergicagonists or methadone is utilised. Treatment retention is worse compared to methadone-10
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Sarah Larney, Bradley Mathers and Kate Dolan Illicit drug treatment ...

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