Residential inpatient support

 

Residential treatment aims to be similar to a community based setting with pharmacological and psychosocial interventions, but with 24 hour medical support for those with comorbidities, such as polydrug abuse or mental ill- health and restricted access to illicit substances.

 

Use via the NHS tends to be reserved for those who have suffered frequent relapse within the community and may not have the home support required for recovery, however, there are numerous private institutions offering support.

 

Treatment within the prison service

In the UK the aim is for those in prisons to have the same access to treatment programs as those in the community. This includes continuing or initiating methadone treatment. But difficulties in this remain, including assessment of dependence, the likelihood of early release affecting their treatment program and the risk of self-harm or post release over dose due to the loss of opioid tolerance.

 

The situation in America though is different. In the states of Massachusetts and Rhode Island, all inmates are forced to withdraw from methadone- despite the World Health Organisation classifying it as an essential medicine. In Rhode Island, inmates are given a maintenance dose for 7 days before beginning a 30 day tapering course; however, in Massachusetts the inmates are forced to go “cold turkey”. 

 

A study found that participants believed that forced methadone withdrawal is a deterrent for community methadone maintenance therapy. 50% stated concern for forced methadone withdrawal if incarcerated and would therefore rather not start methadone maintenance in a community setting. 70% of the participants claimed that they would rather withdraw from heroin than methadone.