Binge Inking parses a study on post-detox outcomes and discovers something very interesting under those “poor” outcomes:
Alarmingly, at follow up only 11 patients were opiate free at one month (16%) and only 8 (12%) were opiate free at 6 months. The reviewer points out that:
“Buried in the results section are the comments on post-detoxification care which showed that only two (out of a total of 30) detoxification completers had access to a residential rehabilitation programme (this was in 2001-3). Only one participant attended a local abstinence based day programme, but this service was closed six months after the start of the trial. So overall, the access to post-detoxification care was pitifully low”
And I hope that it is in this area of “what happens next” where we are hopefully making progress. The paper makes the point:
“Opioid detoxification is not an effective stand-alone treatment for heroin dependence but is nevertheless an essential step in the path to recovery”
Detox could be properly thought of as an emergency department for the addiction treatment system. Emergency departments are not held responsible for long term outcomes–that would be silly. Rather, they are responsible for stabilizing the patient, patching them up and passing them along to long term care. Emergency departments are the front door for the system, not the system.
This is too often lost and scarce resources leave us with difficult questions, if the front door isn’t big enough to meet the demand and the back door does not lead to proper long term care, where do we invest our resources?
Personally, I believe we need to invest in long term care. It means that we can’t serve everyone, but it also means that we can produce good outcomes and make the case for greater investment in addiction treatment.