Sunday February 28, 2016

Detox is not the answer for opiate addiction

First responders in Surrey, B.C., work to revive a man who has suffered an overdose and collapsed on the floor of a McDonald's in October, 2015.

First responders in Surrey, B.C., work to revive a man who has suffered an overdose and collapsed on the floor of a McDonald's in October, 2015. (Rafferty Baker/CBC)

Listen 11:39

Across Canada, cities and provinces are struggling to deal with a fentanyl crisis. This week in Alberta, new detox beds were announced as part of a plan to deal with mental health and drug addiction.

But Dr. Hakique Virani says detox is an ineffective — and dangerous —  way to treat opiate addicts. 

The full interview is available in the audio player above. The following portions have been edited for clarity and length. 

What is wrong with detox for opiate addicts?

For decades we've used detox as one of the initial interventions we use when we're trying to treat an addiction. After all those years, I know it sounds cliche, but when the tool that you have is a hammer, everything starts to look like a nail. And unfortunately, all substances don't behave the same. When it comes to opiates, and particularly when we're dealing with some highly-toxic opiates like fentanyl that we're seeing on the street in most Canadian cities and even small towns —  when somebody goes to detox and is abstinent from opiates for a number of days, then their tolerance to opiates decreases dramatically and rapidly... Upon release from detox, and we see this in incarcerated individuals as well, the likelihood of relapse to opiates is extremely high. Particularly when we're dealing with those toxic opiates on the street, one hit can be the fatal hit — whereas that same dose when they were actively using may not have caused a fatal overdose. 

So it sounds like what you're saying is that if we require that opiate addicts go through some kind of detoxification before they're admitted into a follow-up program, and then if there's any kind of a wait involved...they're probably worse off than if we didn't require them to go through detox first? 

I think that's about as fair a characterization as I could give myself. 

So then why do we do this? 

Well, unfortunately, the availability and accessibility of methadone and Suboxone programs in Alberta and many other places in Canada is extremely poor. And to me, that's a head-scratcher, because really, detox beds are quite expensive, and we cannot begin to touch the demand for treatment that exists in the population. On the other hand, maintenance medication therapy with methadone and Suboxone is remarkably cheap. So not only are we talking about more effective treatment with pharmacotherapy, we're also talking about safer treatment. Detox is, unfortunately, ineffective and very likely to be unsafe. 

Click on the button above to hear the full interview.