Opiates rapid opiate 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. 

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-... 

Rumball D Williams J (1997). Rapid opiate detoxification. British Medical Journal, 315, 682... 

Some experts recommend a newer option for withdrawal known as rapid opiate detoxification (ROD). This method is typically carried out in a hospital or private treatment facility, and as its name implies, it is faster than some of the more conventional methods. In some cases, withdrawal treatment with ROD can be completed in just a few days. Compared with conventional withdrawal treatment, ROD also has been found to cause less physical discomfort. Even more recently, some researchers have investigated an even faster method called ultra-rapid opiate detoxification (UROD), in which the patient goes through withdrawal while asleep under anesthesia. The entire process takes four to seven hours. 

E. For rapid opiate detoxification, patients are given 2-4 mg/kg (or 6 mg/kg/h with intermittent boius doses of 0.3-0,5 mg/kg) foiiowed by maintenance of 3.5-6 mg/kg/h (usuaiiy for 5-8 hours). This is coupied with a neuromuscuiar biocker, and an opiate antagonist (naioxone or naitrexone) is administered after anesthesia is achieved. 

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... 

Clonidine (Catapres) is another drug used to treat opiate addiction. It can relieve the anxiety, runny nose, salivation, sweating, abdominal cramps, and muscle aches of opiate withdrawal. Side effects are dry mouth, dizziness, and drowsiness. Clonidine is initially taken at 0.8-1.2 mg a day, maintained for a few days, and then gradually decreased. Combined with the opiate blocker naltrexone, clonidine can allow a more rapid detoxification (the removal of morphine from the body). Detox in a single day can be accomplished by heavy sedation or anesthesia while giving naltrexone to an unconscious addict. This controversial method has not been studied in controlled trials. 

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