The detoxification of high dose heroin addicts in Pakistan

Treatment services in Pakistan have been swamped by the recent appearance and rapid growth of heroin abuse, and there is an urgent need to initiate and strengthen effective responses. This paper presents the results of an exercise in national monitoring of heroin detoxification services in Pakistan. The study also offers the first systematic description of the withdrawal response of heroin addicts dependent upon doses greatly in excess of those reported in developed countries. The trial was conducted at four major treatment centres and looks at three of the most widely used detoxification procedures in Pakistan (symptomatic treatment only, opium reduction plus symptomatic treatment and clonidine). Data are presented on 118 addicts receiving inpatient detoxification from heroin. The results indicate that all three detoxification methods reduced peak levels of withdrawal symptoms to acceptable levels, and that all produced a return to baseline levels of symptomatology within 10 days or less. The three most persistent symptoms were aches and pains, restlessness and insomnia. Several differences were found between treatments, notably with regard to the number of drugs required to modify the withdrawal response. The implications of these and other results are discussed.