Ultrarapid opiate detoxification: a review

Abstract

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.

Anesthetic management of the illicit-substance-using patient

“…Often these prove to be unsuccessful. Newer methods are being studied for detoxification [42]. Ultrarapid detoxification allows the individual to withdraw from the opioid without suffering from withdrawal syndrome and, if done properly, with few adverse events.…”

Evidence-Based Treatment of Opioid-Dependent Patients

“…They concluded that the data do not support the use of anesthesia for detoxification. Similarly, a review of the literature found anesthesia-assisted detoxification to be dangerous, owing to the sympathetic outflow if the procedure is not performed properly (49). Two recent Cochrane reviews clearly state that naltrexone withdrawal under heavy sedation or full anesthesia should not be pursued because it does not confer additional benefits in terms of less severe withdrawal or increased rates of commencement on naltrexone maintenance, whereas at the same time, it does lead to an increase in potentially life-threatening adverse events (44,50).…”

Ultra-Rapid Opiate Detoxification Followed by Nine Months of Naltrexone Maintenance Therapy in Iran

“…McGregor et al [34] recommended an UROD procedure including the application of 10 − 12 mg naloxone. Excessive withdrawal responses can be controlled with appropriate drugs [25] . Indeed, Propofol provides an excellent means of controlling symptoms of arousal and sympathetic activity caused by the administration of opiate receptor antagonists.…”

“…Treatment was performed by experienced anesthetists and qualifi ed nursing care was present continuously throughout the procedure for at least 24 h. Monitored cardiopulmonal parameters were stable during the whole treatment in all patients. In review articles, authors suggested that clonidine treatment should be continued for about 16 -40 h to reduce post UROD sympathetic hyperactivity [25,41] . In our procedure, clonidine infusion was provided only for hypertensive urgency but not on routine base.…”