Patients who use private residential detox clinics are being put at risk of harm because a large number of these services are not providing safe care, health inspectors have said.
An analysis of inspection reports from 68 independent sector services for people withdrawing from alcohol or drugs found that a "substantial proportion" did not provide good care and treatment.
The Care Quality Commission (CQC) said that common concerns raised with the residential facilities included: doctors and nurses not following best practice, poor assessment of patient risks, poor medicine management and staff not having appropriate checks in place.
The watchdog warned that there could be "potentially fatal outcomes" if medics failed to follow best practice for detoxification.
A review into these services found that inspectors had to tell almost three quarters (72%) of providers to improve.
Almost two thirds 63% were found to not be providing safe care and treatment.
Inspectors said that "too often" services lacked good clinical leadership and clinical governance
They added: "Failure to follow best practice could reduce the likelihood of successful withdrawal and increase the likelihood of complications and avoidable harm with potentially fatal outcomes."
The analysis of the inspection reports, which have been published in the last two years, also found that some staff were administering medication - including controlled drugs like methadone - without the appropriate training or being assessed as competent to do so.
At one unit, inspectors even found basic blunders such as staff giving patients paracetamol more frequently than the recommended four hour interval.
In 2015/16, 2,622 people received medical detoxification from a residential rehabilitation service in England.
"We are deeply concerned about how people undergoing residential-based medical detoxification from alcohol or drugs are being cared for in many independent clinics across the country," said Dr Paul Lelliott, deputy chief inspector of hospitals and lead for mental health at the Care Quality Commission.
"Detoxification under clinical supervision is often the first stage of a person's addiction treatment. It can be a difficult, unpleasant and sometimes, risky experience.
"It is vital that providers get this right to support people's onward rehabilitation and recovery."
Rosanna O'Connor, director of drugs, alcohol and tobacco at Public Health England, said: "While residential detox makes up a small part of the overall treatment system, seeing about 1% of all in treatment, they do have a vital role.
"It's crucial these services are in line with best practice. This helps ensure not only safety, but gives some of the most vulnerable and disadvantaged people the best chance of getting their recovery on track."
Commenting on the report, Professor Colin Drummond, chairman of the Addictions Faculty at the Royal College of Psychiatrists, said: "It shows systemic failings in the way these services are provided and that people undergoing detoxification are being exposed to unnecessary risks.
"It is essential that staff looking after these patients are properly trained, follow national clinical guidelines, and have appropriate 24-hour medical cover. The CQC report shows that in many cases this is not happening."
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