Detoxing dependent drinkers in a methadone prescribing service

This paper examines a common presentation to primary care and specialist drug services. Often patients who are experiencing opioid dependencies when stabilising on methadone often increase their consumption of alcohol. Also, increasingly so, polydrug use is a growing presentation with heroin, crack and alcohol use used in dependent patterns when presenting for treatment.There is often a lack of alcohol detoxification treatment packages given to those who are on methadone, and often some prescribers in the area of substance use regard an alcohol detoxification programme when prescribing methadone as too risky. This has led to a reluctance in general to prescribe an alcohol detoxification programme for many patients who request it. This is the case in Islington, London.This paper looks at a new service set up in Islington, London and looks at the way it has treated the cohort of patients who have presented with polydrug use, including alcohol. It has seen that patients who were more stable on their methadone and had longer histories in treatment were more likely to complete an alcohol detoxification programme with some ‘dry’ time off alcohol. It proposes that while there is a risk of prescribing alcohol detoxification regimes with methadone, there is a cohort of patients were this can be prescribed with a favourable outcome.