A 24-h inpatient detoxification treatment for heroin addicts: a preliminary investigation

doi:10.1016/0376-8716(94)90115-5

Drug and Alcohol Dependence

Volume 35, Issue 2, April 1994, Pages 91-93

https://doi.org/10.1016/0376-8716(94)90115-5 Get rights and content

Abstract

The present study describes a detoxification method which takes only 4 h to complete. Eleven polydrug users addicted to opiates were detoxified 12 h after their last dose of heroin, in an intensive care unit. The detoxification was carried out using naltrexone, after sedation with midazolan. After detoxification (12 h) patients were discharged without withdrawal symptoms. This procedure offers a rapid detoxification procedure which seems to be widely accepted by the addicts themselves.

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2008, Massachusetts General Hospital Comprehensive Clinical Psychiatry
Presence of 14 Hz spindle oscillations in the human EEG during deep anesthesia
2006, Clinical Neurophysiology
To report on presence of human EEG spindle oscillations on the cortical level within flat periods of the burst–suppression pattern during propofol-induced anesthesia; to search for corresponding oscillations and possible functional connections.
Artefact-free epochs of spindle activation were selected from the electroencephalograms of opiate-dependent patients undergoing rapid opiate detoxification. Power spectral analysis and source localization using low-resolution-brain-electromagnetic-tomography (LORETA^Key) were performed.
Sinusoidal rhythms with waxing and waning amplitudes appeared after propofol-induced narcosis but no direct correlations could be determined between individual dosage and characteristic spindle attributes. The power maximum stood midline over the cortical areas, especially around C_z. We calculated a peak frequency of 14(±1.2) Hz. Motor fields, particularly in the frontal, parietal, and various cingulate areas, were found to be the primary sources of spindle oscillations in the cortex.
The frequent occurrence of these localized spindle sources demonstrates the preference for motor fields. Spindle oscillations observed during propofol-induced narcosis were similar in frequency and shape to those observed in natural sleep.
The results lend support to models that postulate a close link between the motor system and the organization of behavior. In addition, spindle rhythms under propofol bore some resemblance to spindle types which occur during sleep.
Drug-Addicted Patients
2004, Massachusetts General Hospital Handbook of General Hospital Psychiatry
Ultra-rapid opiate detoxification using deep sedation and prior oral buprenorphine preparation: Long-term results
2003, Drug and Alcohol Dependence
Background: New methods of ultra-rapid opiate detoxification (URD) under intravenous sedation have been criticized because of limited data on safety and long-term follow-up. Premedication with buprenorphine has been advocated to improve safety by decreasing vomiting. Prior research has not explored URD in socially impaired patients. Method: Sixteen patients were detoxified with URD and prospectively evaluated over at least 30 months. Data of this procedure were compared with those of our previous study without buprenorphine preparation (Drug Alcohol Depend. 52(3) (1998) 243). The 16 patients were followed up by a general practitioner (GP) before and after URD. The GPs also supervised the 7-day course of buprenorphine treatment prescribed for the 16 patients prior to URD. Results: During the procedure, only one episode of vomiting occurred instead of 13 out of 20 in our previous study. Post-procedure, only two patients experienced moderate withdrawal symptoms, such as persistent nausea, abdominal cramps and vomiting lasting from 24 to 48 h, in comparison with most patients in the previous study without buprenorphine. After a period of at least 30 months (36.0±6.38), the 16 patients were still alive and were regularly monitored by their GP. Only two of the 16 never relapsed after URD and reported total opiate abstinence. Fourteen patients relapsed; 12 of these were prescribed a licensed methadone substitution program and two were still using heroin. Conclusion: In this small sample, the data indicated that URD with buprenorphine preparation was safe and that it markedly decreased post-procedure morbidity. No patient died over a minimum 30-month follow-up period. Furthermore, the procedure was employed with socially impaired patients. In the long term, a few patients were still free of opiates, while the majority opted for a methadone maintenance program, showing that URD can serve as one possible step in a long-term treatment program.
Lofexidine versus clonidine in rapid opiate detoxification
2001, Journal of Substance Abuse Treatment
The aim of the present study is to evaluate lofexidine and clonidine, in an accelerated opiate detoxification procedure (3 days), without anaesthesia. Forty heroin-dependent individuals were detoxified, evaluating withdrawal symptoms, craving levels, mood changes, urine toxicologic screens, and dropout during therapy with either (1) clonidine, oxazepam, baclofen, and ketoprofene, with naloxone and naltrexone for 3 days (20 subjects) or (2) lofexidine, oxazepam, baclofen, and ketoprofene with naloxone and naltrexone for 3 days (20 subjects).
Both clonidine and lofexidine rapid detoxifications were found effective. The subjects treated with lofexidine showed significantly lower levels of withdrawal symptoms, fewer mood problems, less sedation and hypotension. No significant differences in craving levels, morphine metabolites in urine, or dropout rate were evidenced between the two groups. The early use of naltrexone during detoxification in combination with either alpha-2-agonist facilitated the acceptance for long-term naltrexone treatment. Lofexidine appeared to be more useful than clonidine in a 3-day accelerated opiate detoxification, not only to counteract withdrawal symptoms, but also in the treatment of dysphoria and mood changes. Because lofexidine does not produce hypotension, safe outpatient treatment, without hospital support, could be possible.
Ultrarapid opioid detoxification: Effects on cardiopulmonary physiology, stress hormones and clinical outcomes
2001, Drug and Alcohol Dependence
This study explored the acute and long-term consequences of ultrarapid opioid detoxification (URD) in individuals with opioid dependence. In an open case series, seven patients underwent URD and subsequent treatment with daily naltrexone. Structured interviews, integrated rehabilitation and hair sampling were employed in the 12-week course of longitudinal follow-up. Cardiac and pulmonary physiology did not change significantly during the anesthesia phase of URD, but plasma ACTH and cortisol levels increased 15- and 13-fold, respectively. Marked withdrawal and tachypnea in all patients and respiratory distress in one patient occurred during the acute post-anesthesia phase. Withdrawal scores were significantly elevated for 3 weeks compared with baseline in the face of minimal self-reported craving for opioids. Anxiety, depression and vegetative symptoms improved gradually. Four patients remained abstinent of opioid use, two reported a brief period of opioid intake and one relapsed into daily opioid consumption. Given its effect on breathing and stress hormones, this procedure should be conducted by experienced anesthesiologists. The fact that URD and subsequent naltrexone treatment appears to cause a dissociation effect in the usual relationship between withdrawal and craving has implications for behavioral pharmacology. Further research is needed on the efficacy, safety, mechanisms and neurobiological sequelae of the procedure.

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A 24-h inpatient detoxification treatment for heroin addicts: a preliminary investigation

Abstract

Lancet

Lancet

Clin. Psychol. Rev.

The development of an opiate withdrawal scale (OWS)

Br. J. Addict.

Opioid withdrawal and naltrexone induction in 48–72 h with minimal dropout using a modification of the naltrexone-clonidine technique

Br. J. Psychiatry

The combined use of clonidine and naltrexone as a safe, rapid and effective treatment of abrupt withdrawal from methadone

Am. J. Psychiatry

Opiate withdrawal: inpatient versus outpatient programmes and preferred versus random assignment to treatment

Br. Med. J.

Opiate withdrawal responses to 10-day and 21-day methadone withdrawal programmes

Br. J. Psychiatry

Substance abuse disorders: A psychiatric priority

Am. J. Psychiatry