Addicts build up a tolerance

Opiate addicts who have successfully completed detoxification treatment in hospital are more likely than other addicts to die within a year, research has found.

The researchers believe the reason may be that abstinence during treatment reduces a drug users' tolerance, so that if they later relapse their body is more sensitive to the effects.

They warn that if the results are confirmed by further studies, it will be necessary to urgently review the way treatment programmes are carried out.

A team from the National Addiction Centre at the Institute of Psychiatry in London identified 137 opiate addicts who were receiving detoxification as part of a 28-day inpatient treatment programme.

Integrated approach

Three of the patients died from a drug overdose within four months of being discharged.

To test whether loss of tolerance increased the risk of overdose, the team grouped the patients into three categories according to their opiate tolerance at the point of leaving treatment.

The three overdose deaths that occurred within four months after treatment were all from the group of patients who had lost their tolerance.

A detoxification programme alone does not constitute an effective treatment programme for drug abusers Professor Michael Gossop

In contrast, no patients who were rated as still tolerant to opiates died in the same period.

Two other patients also died within a year of discharge, but not from a drug overdose.

One of these was rated as having lost tolerance and the other as having a reduced tolerance.

The five patients who died were all men and had generally stayed longer in the inpatient unit.

Researcher Professor Michael Gossop, of the Maudsley Hospital in south London, told BBC News Online it was crucial that patients undergoing detoxification were told that loss of tolerance would make them vulnerable to overdose should they relapse.

He said: "A detoxification programme alone does not constitute an effective treatment programme for drug abusers.

"We need a treatment system in which detoxification and continuing rehabilitation are much more integrated.

Temptation

"However, the two have been deliberately and cynically broken up over the past couple of decades due to funding pressures, undoubtedly reducing the effectiveness of the treatment system as a whole."

Lesley King-Lewis, chief executive of Action on Addiction, agreed the research highlighted the importance of continuing rehabilitation.

"Many addicts return from treatment to the same social networks and situations that led them into substance misuse in the first place. The temptation to use again is huge.

"Long term psychiatric treatment is needed to address the problems which lead them to use in the first place.

"Ex-abusers should be encouraged to take part in schemes to develop new social networks away from the context in which they were using."

The research is published in the British Medical Journal.