Resources must target proven treatments.

Letter to the 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