Future research activity should also analyse prescribing data for buprenorphine as this is increasingly being used for both maintenance and detoxification in prison settings.
It seems that, in some cases and with our settings, the detoxification properties of MARS may be insufficient.
Dihydrocodeine has a shorter half life than methadone and has been widely used in both primary care and prison drug treatment settings for opiate detoxification.
The treatment of choice for those patients is the withdrawal of the overused drug either performed at home, using some advice and patient coaching, or in hospital settings exclusively for patients who failed ambulatory detoxification or seem to have a real addictive behavior [8 11].
The marked heterogeneity in recruitment settings, with some samples coming mainly from detoxification centres and others from the drug user community makes any comparison between sites questionable.
Afghan law allows an addict, as diagnosed by a medical professional, to enter a detoxification facility, which may reduce the number and exposure of IDUs to prison settings.
About half of the respondents originated from detoxification centres, one third from the community, and the remainder from other recruitment settings (Table 1).
These programs include detoxification programs, needle exchange and methadone programs, 12-step meetings, residential rehabilitation programs and intensive outpatient treatment settings.
Similar settings have already been used in an in vitro comparison of MARS and SPAD that resulted in equivalent detoxification [ 8].
However, treatment in acute settings would seem to be woefully inadequate, as in most cases alcohol dependent hospitalised patients are given pharmacological detoxification and, when stable, discharged into primary care without further treatment or support.
