Turned away from treatment: Maintenance-seeking opiate addicts at two-year follow-up

Follow-up of the un-treated condition is generally considered not feasible due to ethical considerations and the ability of the un-treated addict to obtain treatment elsewhere. The absence of any organised drug services in the North West of England in the early 80s provided an opportunity to study the course and outcome of help-seeking addicts who were turned away from treatment. Two-year follow-up data are presented in this paper on 32 opiate addicts who had been seeking maintenance. Whilst 29 received some form of treatment, only 2 were seen by the specialist drug treatment unit, with the remainder receiving medical care from either GPs or local general psychiatric services. 13 were opiate-free at follow-up, with a mean duration of abstinence of 11 months. 19 were still using opiates at follow-up, with continued drug use positively associated with poly-drug use and with a pending court case at the time of original referral. Levels of treatment contact were similar for those still using drugs and those who were abstinent at follow-up. Improved functioning of several of these 19 continuing drug users was evident, with improvements including reductions in frequency of injecting, reductions in amount of drug used and reductions in number of other drugs also being used. The considerable proportion of maintenance seeking opiate addicts who were opiate-free at two-year follow-up despite the non-provision of specialist treatment should stimulate more rigorous study of other pathways to abstinence (which may be similar to previous reports of "spontaneous remission" and "maturing out"). The habit-moderation changes amongst those who continued to use drugs also demonstrate the feasibility of intermediate therapeutic goals short of abstinence. The substantial health gains in these opiate addicts turned away from treatment indicate the importance of inclusion of non-treatment conditions in future controlled studies.