[When and how to detoxify clients from methadone maintenance treatment?]

Abstract

Background: Methadone is prescribed in France as a maintenance treatment for heroin dependence since 1969. Nevertheless, the optimal duration of methadone maintenance treatment and how detoxification from methadone at the end of the treatment should be performed is still discussed.

Objective: To conduct a literature review on when and how detoxify clients from methadone maintenance treatment and to collect the opinion of experts in the field. DOCUMENTARY SOURCES: We searched the PubMed, Embase, Cochrane Library and PsycINFO databases on the 1966-2011 period using the keywords "methadone", "maintenance", "detoxification", "tapering", "cessation", "withdrawal". We also searched data in other addictive journals in French that are not available in those databases. We also collected the opinion of the physician in charge of the oldest methadone program in France (1969). STUDIES SELECTION: We excluded studies that used methadone as short time treatment of heroin withdrawal and thus selected 23 articles.

Results: There is a consensus on when methadone maintenance treatment should be stopped, defined by the client's will to stop, the judgement from the physician that the client has been stable for a period of time that is long enough, but also the client's motivation to live his life without maintenance treatment. There is also a majority, among articles on how methadone treatment should be stopped, recommending ambulatory, practical approaches using slow tapering of the dose, with the ability to go back to the previous dose if needed, namely in case of relapse to heroin use, heavy withdrawal or psychiatric symptoms.

Limits: There are few articles addressing the subject, especially comparing prospectively different cessation strategies.

Conclusion: Methadone maintenance treatment should not necessarily be maintained all life long and can be stopped within its prescription setting, including medical, psychological and social evaluation.