Efficacy and safety of two new methods of rapid intravenous detoxification in heroin addicts previously treated without success

Seoane, Albert; Carrasco, Genís; Cabré, Lluís; Puiggrós, Ana; Hernández, Eustaqui; Álvarez, Manuel; Costa, Josep; Molina, Ricard; Sobrepere, G

doi:10.1192/bjp.171.4.340

Cited by 69 publications

(39 citation statements)

References 17 publications

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“…Para las adicciones existen soluciones equivalentes a las técnicas de PF asequibles a los usuarios, como varias preparaciones de naltrexona en depot de larga duración o en implantes; algunas ya se han autorizado; hay también vacunas de larga duración o anticuerpos monoclonales (a punto de ser comercializados) para el tratamiento del consumo de nicotina, cocaína, fenciclidina y otras drogas. Las técnicas humanas de abandono de los opiáceos que utilizan diferentes niveles de sedación en varias etapas evitan el malestar y la fobia específica al abandono de la sustancia que disuaden a muchos pacientes de la desintoxicación, sobre todo después de malas experiencias previas 22 . Sin embargo, en Grecia se considera delito utilizar la sedación durante un abandono precipitado de la adicción.…”

Section: Political Considerationsunclassified

“…Los servicios de PF de todo el mundo, sean públicos o privados, to user-friendly FP techniques are various long-acting depot or implanted naltrexone preparations, some of which are now licensed, and long-acting vaccines or monoclonal antibodies (some of them very near commercial availability) aimed at nicotine, cocaine, phencyclidine and other drugs of abuse. Humane techniques of opiate withdrawal, using various levels of sedation for various periods, can largely remove the distress and specific withdrawal phobia that deters many patients from considering detoxification, especially after previous bad experiences 22 . However, in Greece, it can apparently be a criminal offence to use sedation during precipitated withdrawal.…”

Section: Conclusiónmentioning

confidence: 99%

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Reducción de daños en embarazos no deseados y de adicciones no deseadas: una instructiva analogía

Brewer¹

2008

Adicciones

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El tratamiento de las adicciones busca reducir el daño que la adicción causa a los individuos y a la sociedad. Sin embargo, muchos servicios, sobre todo en el sector privado, tienen objeciones ideológicas a la hora de utilizar tratamientos médico-farmacológicos y se muestran críticos con otros servicios que sí ofrecen tratamientos farmacológicos. Esta situación contrasta profundamente con la actitud de las clínicas de planificación familiar (PF), que también buscan reducir daños. Irónicamente, las clínicas más antifarmacológicas suelen ser las que proclaman a toda voz que la adicción es una «enfermedad», mientras que el evitar un embarazo no deseado, que no se considera enfermedad, se aborda y soluciona de forma muy efectiva con técnicas médicas. Las clínicas de PF tienen en cuenta los diferentes modelos de conducta sexual, los contextos sociales y las actitudes de las pacientes cuando diseñan planes de tratamiento individuales, mientras que las clínicas que tratan adicciones parten de un enfoque de talla única o de «lo tomas o lo dejas». Los servicios de adicción pueden aprender lecciones clínicas e ideológicas muy útiles de las clínicas de PF.Palabras clave : adicción, alcohol, contracepción, reducción del daño, heroína, embarazo, naltrexona. Reducción de daños en embarazos no deseados y de adicciones no deseadas: una instructiva analogía ABSTRACTAddiction treatment aims to reduce the harm that addiction causes to individuals and society. However, many clinics, especially in the private sector, have ideological objections to using medico-pharmacological treatments and are often critical of other services that do offer pharmacological treatments. This situation contrasts sharply with the attitude of family planning (FP) clinics, even though they too aim to reduce harm. Ironically, the most anti-pharmacological clinics are often those which proclaim most loudly that addiction is a 'disease', while avoiding unwanted pregnancy, which is not usually seen as a disease, is widely and effectively achieved with medical techniques. FP clinics typically consider widely varying patterns of sexual behaviour, social contexts and patient attitudes in devising individual treatment plans, while addiction clinics commonly have a one-size-fits-all, take-it-orleave-it approach. Addiction services could learn some useful clinical and ideological lessons from FP clinics.

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Section: Political Considerationsunclassified

Section: Conclusiónmentioning

confidence: 99%

Reducción de daños en embarazos no deseados y de adicciones no deseadas: una instructiva analogía

Brewer¹

2008

Adicciones

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“…While all studies suggest that the detoxification procedure is physiologically successful as measured by the response to antagonist challenge, recidivism ranges from 10% to 50%. 10,16 In addition, the outpatient nature of UROD may lead to diminishment of the importance of continued medical and psychosocial support to ensure success. 17 These patients are sent home with a large number and variety of potent medications to counter the continued withdrawal symptoms, including clonidine, baclofen, octreotide, ondansetron, benzodiazepines, and trazodone-with little ongoing therapy provided by the center.…”

Section: 10mentioning

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

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“…Die ersten viel versprechenden Erfahrungen mit dieser Entzugsform [4,5] [19] 11 100 % ± ± ± ± ± Seoane et al [15] 300 93 % ± ± ± ± ± Rabinowitz et al [20] 83 ± ± ± ± 57 % ± Tretter et al [21] 108 52 % ± 31 % ± ± ± Brewer [22] 150 ± ± 60 % ± ± ± Cucchia et al [23] ± In der Zukunft sollte das Verfahren in randomisierten Studien mit anderen Alternativen verglichen werden. Dies wären vor allem Entzugsformen mit Clonidin/Naltrexon mit und ohne Sedierung [15,29] oder mit Buprenorphin und Naltrexon [30].…”

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“…Dies wären vor allem Entzugsformen mit Clonidin/Naltrexon mit und ohne Sedierung [15,29] oder mit Buprenorphin und Naltrexon [30].…”

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Katamnestische Entwicklung Opiatabhängiger nach Naltrexoninduziertem Entzug unter Narkose, naltrexongestützter Rückfallprophylaxe und ambulanter psychosozialer Nachsorge

Gölz¹,

Partecke²

2000

Suchttherapie

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Zusammenfassung: 108 Opiatabhängige, denen mit konventionellen Methoden mehrfach kein Entzug gelang, wurden mit Naltrexon-induziertem Entzug unter Narkose, Naltrexon-gestützter Rückfallprophylaxe und psychosozialer Nachsorge behandelt. 67 % waren männlich, 33 % weiblich. Das Durchschnittsalter bei Behandlungsbeginn war 33 (18±50) Jahre, die durchschnittliche Dauer der Heroinabhän-gigkeit betrug 10 (1±30) Jahre, die durchschnittliche Substitutionsdauer betrug 2 (0±9) Jahre. Alle Patienten lebten in stabilen sozialen Bedingungen, 57 % waren berufstätig oder in Ausbildung.Die durchschnittliche Katamnesendauer beträgt 18 (1±45) Monate. Insgesamt werden katamnestisch 160 Patientenjahre erfasst. Bei Entlassung aus der stationären Behandlung waren 100 % abstinent.Die Abstinenzraten entwickelten sich folgendermaûen: nach 1 Monat 81 % (n 108), nach 3 Monaten 70 % (n 99), nach 6 Monaten 61 % (n 93), nach einem Jahr 53 % (n 90), nach 2 Jahren 50 % (n 54).Die monatliche subkutane Implantation von NaltrexonPellets führte zu einer deutlich höheren Adhärenz als die direkt überwachte orale Naltrexonvergabe. Die orale Einnahme wurde im Durchschnitt 43 (7±150) Tage durchgehalten, bei den Implantaten ergab sich eine durchschnittliche Exposition von 75 (30±570) Tagen. In der Implantat-Gruppe (n 69) wurden 60 % der katamnestischen Patientenjahre abstinent verbracht, in der Gruppe mit oraler Einnahme (n 39) waren es nur 40 %.Das dargestellte Therapiekonzept führt zu einer langfristigen Abstinenzrate um 50 %, bei einer Problemgruppe, die durch ihre Erfolglosigkeit bei konventionellen Entzugsformen kaum therapeutisch zu beeinflussen ist.Schlüsselworter: Opiatabhängigkeit ± Katamnesen ± Opiatentzug unter Narkose ± Naltrexon

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Efficacy and safety of two new methods of rapid intravenous detoxification in heroin addicts previously treated without success

Abstract: Successful rapid intravenous detoxification can be achieved using relatively light levels of sedation.

Cited by 69 publications

References 17 publications

Reducción de daños en embarazos no deseados y de adicciones no deseadas: una instructiva analogía

Reducción de daños en embarazos no deseados y de adicciones no deseadas: una instructiva analogía

Complications of Ultrarapid Opioid Detoxification with Subcutaneous Naltrexone Pellets

Katamnestische Entwicklung Opiatabhängiger nach Naltrexoninduziertem Entzug unter Narkose, naltrexongestützter Rückfallprophylaxe und ambulanter psychosozialer Nachsorge

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