Opiates detoxification

Substitution therapy with methadone or buprenorphine has been veiy successfiil in terms of harm reduction. Some opiate addicts might also benefit from naltrexone treatment. One idea is that patients should undergo rapid opiate detoxification with naltrexone under anaesthesia, which then allows fiuther naltrexone treatment to reduce the likelihood of relapse. However, the mode of action of rapid opiate detoxification is obscure. Moreover, it can be a dangerous procedure and some studies now indicate that this procedure can induce even more severe and long-lasting withdrawal symptoms as well as no improvement in relapse rates than a regular detoxification and psychosocial relapse prevention program. 

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Nimodipine A voltage-operated Ca2+ channel blocker with potential benefits in treating cognitive deficits and managing opiate and alcohol detoxification. 

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Methadone (Dolophine). For over 30 years, methadone has been the mainstay of treatment for opiate dependence. A replacement therapy, methadone has been used both for detoxification and for long-term maintenance. It has a slower onset of action and is longer acting than other narcotic analgesics. It causes little of the euphoria produced by drugs such as heroin. 

Naltrexone (ReVia). Naltrexone is a very potent antagonist of the actions of opiates. It has been used to reduce the rewarding effects of not only opiates but alcohol as well. Like buprenorphine, naltrexone appears to reduce craving for opiates by blocking their pleasurable effects. Naltrexone is not useful for detoxification and in fact worsens withdrawal. Naltrexone can be useful for maintenance treatment in those patients motivated to achieve total abstinence. It is taken at a constant dose of 50mg/day. A sustained-release depot formulation currently under development will likely help to overcome adherence issues that often undermine treatment for substance use disorders. 

Naloxone (Narcan). Naloxone, like naltrexone, is a potent opioid receptor blocker. Its primary use has been to reverse opiate toxicity after an overdose. However, some physicians have found it is also useful for a process known as rapid opiate detoxification. Although opiate withdrawal is not life threatening, it can be extremely unpleasant. Most opiate addicts are fearful of the withdrawal symptoms therefore, it usually requires a slow, deliberate detoxification to keep the withdrawal symptoms in check. Rapid opiate detoxification is an alternative approach that keeps the taper and detoxification as brief as possible. In this approach, naloxone is used in conjunction with general anesthesia or a nonopiate sedative such as the benzodiazepine mid-... 

When beginning treatment for opiate dependence, it is imperative to assess the patient s long-term goals for treatment. The key variable is whether the patient desires to control his/her opiate nse or whether the patient wants to achieve total abstinence. In both cases, the first stage of treatment is detoxification. The endpoint of detoxification differs, however. Detoxification is complete in a patient desiring abstinence when (s)he is entirely tapered from the opiate. Conversely, detoxification is complete in a patient desiring maintenance therapy when the withdrawal symptoms have abated. 

Clonidine Stimulates NE alpha-2 receptor None ADHD Agitation Opiate detoxification... 

Bradley, B.P., Phillips, G., Green, L., and Gossop, M. (1989) Circumstances surrounding the initial lapse to opiate use following detoxification. Br J Psychiatry 154 354-359. 

Some of the more interesting options in opiate withdrawal are those that achieve detoxification more quickly than a standard methadone reduction. These can include the precipitation of withdrawal by opiate antagonists and even detoxification under general... 

The strongest traditions of inpatient detoxification relate mainly to alcohol misuse, in which the withdrawal syndrome is inherently more dangerous than that from opiates, and the avoidance of withdrawal complications in standard treatment may be the prime consideration in selecting admission. (In drug misuse, as we shall see in subsequent chapters, indications for admission increasingly relate to new developments, such as rapid... 

Michael is a 30-year-old man who has been a patient in our methadone clinic for three years. He has a ten-year history of opiate use in all, but previous treatment had been elsewhere on a detoxification basis. At one time he had strongly wished to come off drugs completely and went into a residential rehabilitation centre, but although he completed the stay satisfactorily he relapsed into heroin use soon afterwards. It is now agreed between us that his methadone treatment will need to continue long-term. 

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