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

To date, there have been no published studies examining the use of buprenorphine forwithdrawal management in prison and only two studies of methadone. One, a descriptivestudy of 49 newly received inmates, noted that while withdrawal severity was reducedthrough the use of methadone, symptom relief was not complete (Jeanmonod, Harding,& Staub, 1991). The other was the randomised controlled trial comparing methadone tolofexidine, as described above in section 2.1.1. To reiterate, methadone treated patientswere more likely than lofexidine treated patients to be retained in treatment, but thisdifference was not statistically significant (Howells et al., 2002).2.1.3 Symptomatic treatmentWithdrawal symptoms such as nausea, vomiting, cramps and diarrhoea can be treatedsymptomatically as they arise. Symptomatic treatment can be provided in conjunctionwith the pharmacotherapies described above.The only study on the use of symptomatic treatment for opioid withdrawal wasconducted in a community setting and referred to the use of ‘clonidine plus symptomaticmedications’. This combination was found to be inferior to buprenorphine-assistedwithdrawal in terms of treatment completion and entry into post-withdrawal treatment(Mattick et al., 2001).2.2 Psychostimulant detoxificationPsychostimulants include cocaine and methamphetamine. Treatment for withdrawaltypically consists of psychological support (see section 2.6 below), symptomatictreatment and observation for psychiatric complications.2.2.1 Symptomatic treatmentWithdrawal symptoms such as cramps, anxiety and insomnia can be treatedsymptomatically as they arise.12