Opioid antagonist detoxification under anaesthesia versus traditional clonidine detoxification combined with an additional week of psychosocial support: A randomised clinical trial

Favrat, B.; Zimmermann, G.; Zullino, D.; Krenz, S.; Dorogy, F.; Muller, J.; Zwahlen, A.; Broers, B.; Besson, J.

doi:10.1016/j.drugalcdep.2005.06.003

« Previous Next »Drug and Alcohol Dependence
Volume 81, Issue 2 , Pages 109-116, 1 February 2006

Opioid antagonist detoxification under anaesthesia versus traditional clonidine detoxification combined with an additional week of psychosocial support: A randomised clinical trial

B. Favrat
- Substance Abuse Division, Department of Psychiatry, University of Lausanne, Medical Outpatient Clinic, Bugnon 44, 1011 Lausanne, Vaud, Switzerland
- Corresponding author. Tel.: +41 21 314 4906; fax: +41 21 784 2555.
G. Zimmermann
- Substance Abuse Division, Department of Psychiatry, University of Lausanne, Medical Outpatient Clinic, Bugnon 44, 1011 Lausanne, Vaud, Switzerland
D. Zullino
- Substance Abuse Division, Department of Psychiatry, University of Lausanne, Medical Outpatient Clinic, Bugnon 44, 1011 Lausanne, Vaud, Switzerland
S. Krenz
- Substance Abuse Division, Department of Psychiatry, University of Lausanne, Medical Outpatient Clinic, Bugnon 44, 1011 Lausanne, Vaud, Switzerland
F. Dorogy
- Substance Abuse Division, Department of Psychiatry, University of Lausanne, Medical Outpatient Clinic, Bugnon 44, 1011 Lausanne, Vaud, Switzerland
J. Muller
- Department of Anaesthesiology and Intensive Care Medicine, Hospital ResHO of St-Loup, Switzerland
A. Zwahlen
- Department of Internal Medicine, Hospital ResHO of St-Loup, Switzerland
B. Broers
- Department of Community Medicine, University Hospital, Geneva
J. Besson
- Substance Abuse Division, Department of Psychiatry, University of Lausanne, Medical Outpatient Clinic, Bugnon 44, 1011 Lausanne, Vaud, Switzerland

Received 4 February 2005; received in revised form 7 June 2005; accepted 9 June 2005.

Abstract

Background

While detoxification under anaesthesia accelerates the detoxification procedure, there is a lack of randomised clinical trials evaluating its effectiveness compared to traditional detoxification procedures, and a lack of data on long-term abstinence.

Methods

Prospective randomised clinical trial. Analysis by intention to treat and per protocol. Setting: Specialised substance abuse unit in a psychiatric teaching hospital and an intensive care unit of a general hospital. Participants: Seventy patients with opiate mono-dependence requesting detoxification: 36 randomised to RODA (treatment as allocated received by 26) and 34 randomised to classical clonidine detoxification (treatment as allocated received by 21). Main outcome measures: Successful detoxification, safety and self-reported abstinence at 3, 6 and 12 months after detoxification.

Results

Socio-demographics were similar in both groups at baseline. No complications were reported during or after anaesthesia. According to the intention to treat analysis, 28/36 (78%) RODA patients and 21/34 (62%) of the clonidine group successfully completed the detoxification process (p=0.14). In the intention to treat analysis, 30% of RODA patients were abstinent after 3 months compared to 14% in the clonidine group (p=0.11). No difference was found at 6 and 12 months (both groups showed less than 5% abstinence after 12 months). The per-protocol analysis showed similar results with no statistical differences either for ASI mean scores or for the SF36 questionnaire.

Conclusion

Although the detoxification success rate and abstinence after 3 months were slightly better for the RODA procedure compared to clonidine treatment, these differences were not statistically significant and disappeared completely after 6 and 12 months.

Keywords: Ultra-rapid detoxification, Detoxification, Anaesthesia, Naltrexone, Clonidine, Opioid