Ultra-rapid opioid detoxification increases spontaneous ventilation

Hoffman, William E.; Berkowitz, Richard; McDonald, Timothy; Hass, Frank J.

doi:10.1016/s0952-8180(98)00047-6

Cited by 13 publications

(5 citation statements)

References 17 publications

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“…However, these treatments are expensive (up to $7500 in 1997, 12 and as much as $15 000 in 2005), are not covered by insurance, and lack good evidence to support efficacy. 13 There are also significant concerns about risk, including marked increases in plasma corticotropin, 14 cortisol, 14 respiration, 15,16 sympathetic activity, 16 and catecholamines 17,18 ; suppression of thyroid hormones 19 ; pulmonary distress 14,20 ; pulmonary edema 19 ; acute renal failure 19 ; ventricular bigeminy 21 ; psychosis 21,22 ; delirium 23,24 ; suicide attempts 21,25 ; and deaths associated with the procedure. [26][27][28][29] In addition, several reports describe persistent, marked withdrawal symptoms following the procedure.…”

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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“…The depth of anesthesia is reduced to a BIS reading of approximately 60%, and the patient is observed for signs of withdrawal. Signs of withdrawal include: hypertension (systolic pressure >140 mm Hg), tachycardia (>90/min), tachypnea (respiratory rate >20), mydriasis, lacrimation, rhinorrhea, diaphoresis, piloerection, yawning, myoclonus, hyperthermia, minute ventilation, Q–Q variability, and median EEG frequency 38–40 …”

Section: Initiation Of Opioid Withdrawalmentioning

confidence: 99%

“…Severe diarrhea is treated with octeotride. Full‐blown withdrawal symptoms with high blood pressures, excessive myoclonus or seizure‐like behavior are not seen with appropriate titration of the described medications and the use of propofol or a barbiturate in an infusion 38 . Because fluid loss via the gastrointestinal tract can be considerable, adequate fluid replacement may be necessary 41 .…”

Section: Initiation Of Opioid Withdrawalmentioning

confidence: 99%

Chronic Pain and Ultrarapid Opioid Detoxification

et al. 2005

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Availability of opiate substances through physicians and on the street has led to a rise in dependence and in addiction resulting in countless numbers of people hooked on these drugs. Long-term use of these agents results in reduction of endogenous supply of opiate replaced by these exogenous compounds. A technique known as Ultrarapid Detoxification (UROD) has been developed and appears more promising than conventional modalities. UROD has been modified over 3 decades resulting in a safe and an effective general anesthetic that results in hemodynamically stable withdrawal without manifestation of central nervous system hyperarousal. A cornerstone of this technique involves clonidine, which stimulates reuptake of catecholamines and allows for large doses of opioid antagonist to be delivered without significant changes in heart rate or blood pressure, displacing the opiate. Though techniques vary from center to center, safety should be paramount with the technique performed in an intensive care unit with trained professional anesthesiologists. Psychosocial issues should be evaluated by a trained addictionalist and most people will succeed from the UROD procedure without experiencing the horrible withdrawal syndrome. Patients must have realistic goals and be prepared to deal with psychosocial issues post-procedure.

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“…Signs of withdrawal include: hypertension (systolic pressure > 140 mmHg), tachycardia (> 90 min -1 ), tachypnea (respiratory rate > 20), mydriasis, lacrimation, rhinorrhea, diaphoresis, piloerection, yawning, myoclonus, hyperthermia, minute ventilation, Q-Q variability, and median EEG frequency. [52][53][54] Excessive withdrawal responses can be controlled with appropriate drugs. If clonidine is not effective in the control of hemodynamics, beta-blockers, such as labetalol or esmolol may be indicated.…”

Section: Initiation Of Opioid Withdrawalmentioning

confidence: 99%

Ultrarapid opiate detoxification: a review

Kaye

Gevirtz

Bosscher

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : This review on ultrarapid detoxification examines the pharmacology, techniques, and efficacy of this potentially promising technique and contrasts it with conventional treatment modalities.S So ou ur rc ce e: : The information found here is derived from experiences at the Texas Tech University, government reports, and peer reviewed journals. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Incidence and prevalence of heroin use is on the rise. Social and treatment costs suggest that this problem is staggering. Approximately 400,000 patients are enrolled in or are actively seeking methadone therapy. While many of these individuals want to undergo detoxification, traditional techniques, including methadone tapering are usually unsuccessful. The withdrawal syndrome is extremely unpleasant, may be fatal, and deters patients from completing the detoxification process. Ultrarapid detoxification entails general anesthesia in conjunction with large boluses of narcotic antagonists. This combination allows the individual to completely withdraw from the opiate without suffering the discomfort of the withdrawal syndrome. Unless performed properly, this procedure can be dangerous due to the sympathetic outflow. However, with proper support, this danger can be mitigated.C Co on nc cl lu us si io on n: : Ultrarapid opiate detoxification, performed under the proper circumstances, is associated with few adverse events and is relatively comfortable for patients who seek treatment for their addition. Objectif : La présente étude portant sur la désintoxication ultrarapide revoit la pharmacologie, les techniques et l'efficacité de cette technique potentiellement prometteuse et la compare avec les modalités thérapeutiques traditionnelles. Source : Nos informations sont tirées des expériences à la Texas Tech University, des rapports officiels et des journaux scientifiques.

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Ultra-rapid opioid detoxification increases spontaneous ventilation

Cited by 13 publications

References 17 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

Chronic Pain and Ultrarapid Opioid Detoxification

Ultrarapid opiate detoxification: a review

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