Medication-assisted treatment for opioid use disorders 2: detoxification

This chapter is the second of two parts describing the advantages, standards, and goals of medication-assisted treatment (MAT) for opioid use disorders. MAT is a complex biopsychosocial intervention with the provision of opioid substitution treatment (OST) at its core. These chapters aim to provide the clinician with charts, tables, and clinical guidance around the prescribing of OST within MAT. This second part (this chapter) covers the process of detoxification from OST as well as aftercare including the use of naltrexone. This chapter also looks at the care of special patient groups requiring MAT, such as those who are pregnant or who have multiple substance dependencies and gives brief guidance around the management of comorbid mental health problems. These chapters focus on the prescribing issues within MAT and are not able to cover the full scope of the social and psychological aspects of this complex intervention; clinicians are recommended to read broadly to ensure they understand the full scope of MAT, which is far more than just the prescribing of OST. Data presented here is based on clinical guidelines and the experience in treating persons with OUDs in Scotland, United Kingdom (UK), and reflects evolution in practice in response to the high levels of drug deaths and Scottish national MAT standards published in May 2021. Within the UK, the National Health Service (NHS) exists as a single-payer healthcare system, providing universal care to all residents. This of course is not the case worldwide, and there is substantial variation in availability of services between countries. Clinicians should always ensure that they are familiar with what services are available locally as well as local licensing and legal requirements around prescribing OST, as substitute medications are usually controlled drugs.