Acute Blocking of Naloxone-Precipitated Opiate Withdrawal Symptoms by Methohexitone

Loimer, Norbert; Schmid, Rainer; Lenz, Kurt; Presslich, O; Grünberger, J

doi:10.1192/bjp.157.5.748

Cited by 65 publications

(26 citation statements)

References 10 publications

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“…* An early doubleblind study 42 described methohexitone anesthesia in 18 individuals randomly assigned to receive naloxone or placebo. But the study only compared withdrawal induced by naloxone vs placebo and included only a week of followup.…”

mentioning

confidence: 99%

Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction

Collins

Kleber²,

Whittington³

et al. 2005

JAMA

117

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mentioning

confidence: 99%

Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction

Collins

Kleber²,

Whittington³

et al. 2005

JAMA

117

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show abstract

“…19,32 Despite mixed results, the current research ¢ndings demonstrate that patients found naloxone-assisted detoxi¢cation acceptable and tolerable using a method that requires minimal diazepam sedation. This provides further support for the assertion by Buntwal et al 14 that there may be a ''middle way'' of increasing the rapidity of opiate detoxi¢cation without incurring the risks associated with general anaesthesia.…”

Section: Discussionmentioning

confidence: 82%

The Effectiveness of Combined Naloxone/Lofexidine in Opiate Detoxification: Results from a Double-blind Randomized and Placebo-controlled Trial

Beswick¹,

Best²,

Gossop³

et al. 2003

Am J Addict

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The efficacy of lofexidine/naloxone was compared with lofexidine/placebo in a double-blind, randomized, placebo-controlled trial in 89 opiate-dependent patients. There were no significant differences between the two groups in the proportion of patients completing detoxification or in the length of stay. Patients in the active naloxone group demonstrated gradual reductions in levels of withdrawal and craving over the detoxification period. At completion of detoxification, patients who received naloxone maintained a level of withdrawal consistently lower than that in the placebo group; however, naloxone did not substantially accelerate the resolution of the withdrawal syndrome. Implications for future research are discussed.

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“…Early studies demonstrated that this transition could be made rapidly by inducing the withdrawal under general anesthesia with high-dose antagonists. 7,8 Furthermore, data from early studies suggested that when high-dose opioid antagonists induced withdrawal, symptoms were greatest within the first few hours of treatment and declined to tolerable levels rapidly.…”

Section: Discussionmentioning

confidence: 99%

Complications of Ultrarapid Opioid Detoxification with Subcutaneous Naltrexone Pellets

et al. 2002

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Abstract. Rapid and ultrarapid opioid detoxification (ROD and UROD) centers promise quick, painless, same-day detoxification treatment for patients with opioid addiction. The goal of ROD and UROD is to provide a rapid transition from opioid dependency to oral naltrexone therapy. The patient is given general anesthesia and high-dose opioid antagonists. This induces a severe withdrawal but spares the patient the experience. In theory, the process is complete within four to five hours. The patient awakens without opioid dependency and is started on oral naltrexone. Any subsequent, persistent withdrawal symptoms are treated symptomatically. A novel, unapproved approach is to compound a pellet of naltrexone and implant it in the subcutaneous tissue. In theory, this should result in continuous therapeutic levels for this drug, and avoid issues with noncompliance. Case series: This article reports six cases of complications from the same detoxification center that performed UROD with naltrexone pellet implantation, including pulmonary edema, prolonged withdrawal, drug toxicity, withdrawal from cross-addiction to alcohol and benzodiazepines, variceal rupture, aspiration pneumonia, and death. Conclusions: The risks of this procedure are great and further studies should assess its safety and the novel use of naltrexone. Key words: opioids; heroin; addiction; detoxification; rapid detoxification; ultrarapid detoxification; naltrexone. ACADEMIC EMERGENCY MEDICINE 2002; 9:63-68 P ATIENTS with opioid addiction often struggle to achieve detoxification. Discontinuation of opioid use results in the severe discomfort of withdrawal. Many find methadone maintenance undesirable. For these patients, rapid and ultrarapid opioid detoxification (ROD and UROD) centers promise quick, painless, same-day detoxification treatment for patients with opioid addiction. This allows rapid transition from opioid dependency to oral naltrexone therapy. General anesthesia is given via endotracheal tube as well as highdose opioid antagonists. The induced withdrawal is complete within four to five hours and the patient awakens without opioid dependency. The patient is then started on oral naltrexone and any subsequent, persistent withdrawal symptoms are treated symptomatically. A novel, unapproved approach is to compound a pellet of naltrexone and

show abstract

Acute Blocking of Naloxone-Precipitated Opiate Withdrawal Symptoms by Methohexitone

Cited by 65 publications

References 10 publications

Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction

Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction

The Effectiveness of Combined Naloxone/Lofexidine in Opiate Detoxification: Results from a Double-blind Randomized and Placebo-controlled Trial

Complications of Ultrarapid Opioid Detoxification with Subcutaneous Naltrexone Pellets

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