Dear Editor,
Dr Moosajee Bhamjee (‘Ireland needs detox units’, IMT, 23.04.10, see www.imt.ie/opinion/2010/04/ireland_needs_detox_units.html) recommends inpatient treatment facilities for drug and alcohol users. (He wrote a similar letter a number of years ago, which seemed to recommend the hospitalisation of cannabis smokers.)
A few pages back in the same edition of your paper was an article that stated that the cost of a public hospital bed is €324,485 per year.
The last time I looked, research evidence indicated that outpatient treatment for those wishing to discontinue alcohol is equally as effective as inpatient treatment.
It is true that it is difficult to stop heroin use (this is why there are 10,000 patients on methadone treatment), but there is absolutely no evidence to indicate that inpatient detoxification produces any better medium- or long-term outcomes in terms of sustained abstinence than does outpatient treatment. The evidence on drug-free residential rehab facilities is ‘woolly’, to say the least.
Short inpatient detoxes also increase the risk of death by overdose on discharge due to loss of opioid tolerance.
The benefits of properly delivered methadone treatment (reduction of death, improved general health, decreased criminality, improved family/social relationships) are validated by large volumes of peer-reviewed research evidence.
Every euro spent on methadone treatment saves between €4 and €7 on other publicly funded healthcare and criminal justice services. Methadone treatment has been endorsed by three United Nations agencies: the United Nations Office on Drugs and Crime, the World Health Organization (WHO) and UNAIDS.
The WHO has also included methadone treatment in its ‘essential medicines’ list and 70 countries in the world now provide methadone or buprenorphine treatment to an estimated one million patients.
In most parts of the country, this treatment is either in very short supply or non-existent, as I believe is the case in Dr Bhamjee’s area. In these difficult times, I feel doctors must be seen to be using the limited resources allotted to us wisely.
In my opinion, any available resources that may be available to help those with drug or alcohol problems should be spent delivering proven and cost-effective treatments such as methadone programmes or structured alcohol-withdrawal programmes in a general practice setting.
Dr Cathal Ó Súilliobháin,
Blackrock,
Co Dublin.
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