Home > Effectiveness Bank Bulletin [Ultra-rapid opiate detoxification followed by nine months of naltrexone maintenance].

Drug and Alcohol Findings. (2013) Effectiveness Bank Bulletin [Ultra-rapid opiate detoxification followed by nine months of naltrexone maintenance]. Effectiveness Bank Bulletin, 28 Jan,

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Ultra-rapid opiate detoxification followed by nine months of naltrexone maintenance therapy in Iran.
Naderi-Heiden A., Naderi A., Naderi M.M. et al. Pharmacopsychiatry:2010, 43(4), p. 130–137.

Further evidence from Iran that rapid withdrawal from opioids under anaesthesia followed by the opioid-blocking drug naltrexone can work for highly motivated caseloads with copious 'recovery capital'. For others this expensive and when not adequately controlled, potentially risky procedure generally ends in overdose-threatening relapse.

Ultra-rapid opiate detoxification typically involves a day or two of hospitalisation during which patients dependent on opiate-type ('opioid') drugs like heroin are anaesthetised or deeply sedated while the opiate-blocking drug naloxone is administered by infusion in to the blood stream to precipitate sudden withdrawal. Then patients are started on prescriptions of naltrexone tablets which (as long as they are taken) continue to block the effects of opiate-type drugs, an attempt to prevent the relapse to regular opioid use which commonly follows withdrawal.

For the featured study records were analysed of 45 male patients admitted for such procedures between 2003 and 2005 to a surgical centre's department of anaesthesiology in Iran's capital Tehran. They were selected to be free of dependence on other drugs or alcohol except for cannabis, and free of severe physical or mental illness which might contraindicate general anaesthesia. For this and for other reasons they were relatively well placed to overcome their dependence via an abstinence-oriented route. Forty of the 45 were addicted to opium and just five injected. On average in their early 30s, they were committed to abstinence and had good family support. Over half were married and nearly 80% employed. They were attending an expensive private hospital so came predominantly from wealthy families, who (in the absence of a public welfare support system) can exert considerable pressure on opiate-dependent relatives, as can wives for whom such dependence is grounds for divorce. Also, in Iran familial solidarity is highly developed and can provide a high level of support and motivation for abstinence-oriented patients.

On admission patients were detoxified by means of a six-hour infusion of naloxone under general anaesthesia; medications used were midazolam, propofol, clonidine and the muscle relaxant atracurium. For 24 hours after patients woke staff documented severity of withdrawal on a standard checklist of physical signs such as runny noses, sweating, cramps and dilated pupils.

Usually discharge was scheduled for the day after detoxification. Then naltrexone (50mg/day) was prescribed for nine months with assessments every four weeks by a clinician with extensive experience in the treatment of dependence. At these consultations, naltrexone was re-prescribed and the patient's progress monitored, verified with the patients' agreement by talking to their families. For the purposes of the study, patients who missed these visits were considered relapsed.

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