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The Royal College of Psychiatrists Improving the lives of people with mental illness

Drug Misuse: Opioid Detoxification - The NICE Guideline

National Collaborating Centre for Mental Health (NCCMH)

Price: £35.00

College members' price: £31.50

Published: Feb 2008

Format: Paperback + free CD-ROM

Number of pages: 272

ISBN: 9781854334695

Drug Misuse: Opioid Detoxification - The NICE Guideline

This evidence-based clinical guideline endorsed by the National Institute for Health and Clinical Excellence (NICE) presents guidance on physical, psychological and service-level interventions for healthcare staff on how to work with people who misuse opioids to significantly improve their treatment and care, and to deliver detoxification safely and effectively. Of the estimated 4 million people in the UK who use illicit drugs each year, approximately 50,000 misuse opioids (such as heroin, opium, morphine, codeine, and methadone). Opioid misuse presents a considerable health risk and can lead to significant social problems. The NICE guideline is an important tool in helping people to overcome their drug problem.


It provides an overview of drug misuse and opioid detoxification and covers assessment and testing, pharmacological and physical interventions used in detoxification, psychosocial interventions to support detoxification, and the settings in which the treatment can take place. The book contains experiences by people who have been dependent on opioids, and there is also advice for family members and carers of people with a drug problem.


This book has a ‘sister title’: Drug Misuse: Psychosocial Interventions

NICE Mental Health Guidelines

These guidelines from NICE set out clear recommendations, based on the best available evidence, for health care professionals on how to work with and implement physical, psychological and service-level interventions for people with various mental health conditions.

The book contains the full guidelines that cannot be obtained in print anywhere else. It brings together all of the evidence that led to the recommendations made, detailed explanations of the methodology behind their preparation, plus an overview of the condition covering detection, diagnosis and assessment, and the full range of treatment and care approaches.

The accompanying free CD-ROM contains all the data used as evidence, including:

  • Included and excluded studies.
  • Profile tables that summarise both the quality of the evidence and the results of the evidence synthesis.
  • All meta-analytical data, presented as forest plots.
  • Detailed information about how to use and interpret forest plots.

Full Contents

1. Executive summary

  • General considerations
  • Assessment
  • Pharmacological interventions in opioid detoxification
  • Opioid detoxification in community, residential, inpatient and prison settings
  • Specific psychosocial interventions
  • Research recommendations

2. Introduction

  • National guidelines
  • The national opioid detoxification for drug misuse guideline

3. Introduction to drug misuse

  • Drug misuse and opioid dependence
  • Epidemiology of drug misuse
  • Aetiology and maintenance of drug misuse
  • The course of drug misuse
  • The pharmacology of opioids
  • The public health impact of drug misuse
  • Identification and assessment of drug misuse
  • The aims of the treatment and management of drug misuse
  • The development of detoxification services
  • Current care and treatment in the NHS
  • The experience of drug misuse – personal perspectives
  • Impact of drug misuse on families and carers
  • Economic impact of drug misuse

4. Methods used to develop this guideline

  • Overview
  • The scope
  • The Guideline Development Group
  • Clinical questions
  • Systematic clinical literature review
  • Systematic economic literature review
  • Stakeholder contributions
  • Validation of this guideline

5. Assessment and testing

  • Introduction
  • Clinical assessment in the management of detoxification
  • Drug testing
  • Psychometric assessment tools

6. Pharmacological and physical interventions in opioid detoxification

  • Introduction
  • Pharmacological interventions in detoxification
  • Overall clinical summary of pharmacological interventions in detoxification
  • Clinical practice recommendations
  • Ultra-rapid, rapid and accelerated detoxification using opioid antagonists
  • Clinical practice recommendations
  • Physical and complementary interventions during detoxification

7. Psychosocial interventions in opioid detoxification

  • Introduction
  • Current practice
  • Definitions
  • Outcomes
  • Databases searched and inclusion/exclusion criteria
  • Studies considered
  • Psychosocial interventions in combination with detoxification
  • Clinical summary
  • Literature review of health economics evidence
  • Economic modelling
  • Clinical practice recommendations

8. Settings for opioid detoxification

  • Introduction
  • Inpatient and community-based settings
  • Unassisted/self-detoxification
  • Prison-based detoxification

9. Appendices
10. Glossary
11. References
12. Abbreviations

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