A 24-h inpatient detoxification treatment for heroin addicts: a preliminary investigation
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Detoxification
The use of antagonist drugs to reduce the duration of opiate detoxification severely enhances withdrawal symptoms. To investigate the feasibility of administering antagonists with opiates without intense withdrawal during detoxification, 5 methadone maintained patients were evaluated while tapering methadone and receiving at the same time very low (0.125 mg), then increasing daily doses of naltrexone in the course of a 6-day, day hospital treatment. Reduced quantities of adjunctive medications were administered, as compared to the standard protocols, the treatment was completed without incidents or particular discomfort and all patients were easily induced to naltrexone maintenance by the day of discharge. Controlled studies will clarify whether very low-dose naltrexone provides a safe and comfortable detoxification technique to reduce withdrawal intensity and duration without the problems of heavy sedation, as suggested by the description of these clinical cases.
Detoxification
Opiate
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Opiate
Narcotic antagonists
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The ability of naltrexone to increase hypothalamo-pituitary-adrenocortical (HPA)-axis activity was recently reported to be associated with its effects on the reduction of craving for alcohol. We now present data showing naltrexone to be more efficacious in female alcoholics. Since HPA-axis might be interpreted as a key mechanism of action that could explain the observed gender differences in the abstinence maintenance treatment of alcohol addiction.
Alcohol Dependence
Relapse prevention
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Detoxification
Opiate
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Relapse rates of 30 opiate-addicted social service clients who were given a 9-month course of naltrexone after being rapidly detoxified using naltrexone + clonidine under anesthesia were compared to 33 similar clients detoxified in a 30-day intensive inpatient detoxification but not given naltrexone. Both groups had the same counseling aftercare. Telephone follow-up of 26 of the intensive inpatient detoxification clients and 24 of the rapidly detoxified clients found no significant differences (p = .62) in relapse rates, with 34% of respondents returning to regular opiate use 13.4 (+/- 3.8) months after detoxification. Naltrexone maintenance and counseling following rapid detoxification may be as effective as intensive inpatient detoxification and counseling.
Detoxification
Opiate
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During a period of one year naltrexone was given to twenty-nine subjects. Fifteen of these subjects concurrently participated in a comprehensive behavior therapy program. The subjects in this naltrexone/behavior therapy group were maintanine on naltrexone for nearly twice as long as naltrexone group clients who received no therapy. If the chances for readdiction are reduced by increased time on naltrexone, then the data states the naltrexone should be dispensed as part of a broader therapeutic strategy. Follow-up data, which will be collected during the next year will test the validity of this hypothesis.
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To evaluate the clinical efficacy of buprenorphine (Bup) in treatment of acute heroin withdrawal.Bup was given sublingually daily to 60 cases of heroin addicts in 3 groups: low, medium, and high doses. Withdrawal signs and symptoms of heroin were rated by Clinical Institute Narcotic Assessment. Craving for heroin during detoxification was assessed by Visual Analogue Scale. The side effects of Bup was assessed by Treatment Emergent Symptom Scale.The mean daily consumption of Bup in low, medium, and high group was 2.0, 2.9, and 3.6 mg, respectively. Bup not only suppressed objective signs and withdrawal symptoms for heroin withdrawal, but also reduced the duration for heroin detoxification over 7-8 d.Bup is an effective and rapid detoxification agent with fewer side effects for treatment of acute heroin withdrawal.
Detoxification
Narcotic
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Interviews were conducted with 101 heroin dependent persons entering a residential drug-free detoxification unit in 1989. These self-report data were compared with those previously collected in 1985-6 from 457 methadone maintenance patients. The detoxification patients injected less frequently, used less heroin, had been physically dependent for a shorter period and were more likely to be single, unemployed and to have been charged with a criminal offence in the last 12 months. It is suggested that these findings may indicate that addicts who use more heroin are less likely to seek drug-free detoxification. The wider implication of the finding is that future surveys of injecting drug users should assume that there are significant differences between heroin users entering different modalities of treatment.
Detoxification
Methadone maintenance
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