Ultra‐rapid, antagonist‐precipitated opiate detoxification under general anaesthesia or sedation

Abstract

Ultra‐rapid opiate withdrawal precipitated by naloxone or naltrexone during general anaesthesia or varying degrees of sedation, usually with the addition of α‐2 adrenergic agonists, is an increasingly popular technique. As with anaesthesia or effective analgesia for dentistry or obstetrics, it can be justified on general humane principles. It also simplifies and speeds the transition to treatment programmes involving naltrexone. This paper reviews its development and the current range of techniques, including the use of octreotide to prevent diarrhoea. The prospect of avoiding or shortening the worst discomforts of withdrawal may encourage more opiate addicts to attempt detoxification and opiate‐free management, including patients who have been successfully rehabilitated on long‐term methadone maintenance treatment (MMT). Despite good motivation and preparation, a significant minority of MMT patients consistently fail to complete conventional withdrawal programmes because of increasing physical discomfort. It is emphasized that there is usually more to the treatment of opiate dependence than withdrawal.

Últimos desarrollos en los implantes y las inyecciones depot de naltrexona; el jovencito de la escalera se está haciendo mayor

“…30 Both methods shortened detoxification and the use of anaesthesia gave a smoother transition to oral NTX maintenance than previous rapid methods using only oral sedation. 31 Their approach was indisputably original and helped to confirm the present acceptance that Rapid Antagonist Induction (RAI), with or without anesthesia, is the most effective (and generally cost-effective) method of withdrawal and of starting NTX treatment. 32 Interestingly, it was a decade later before researchers developed an animal model of RAI in order to better understand its biological mechanisms.…”

The novel depot of buprenorphine propionate has a long‐acting effect on physical dependence on morphine

“…Buprenorphine is a promising new pharmacotherapy for treating opioid dependence, especially in rapid detoxification [Brewer 1997;Kosten 2003;Assadi et al, 2004]. However, the typical detoxification regimen with sublingual buprenorphine for a continuous 4-8 days treatment is inconvenient for patients and an alternative of high take-home doses may increase the risk of illicit diversion [Bickel and Amass 1995;Sobel et al, 2004;Umbricht et al, 1999].…”

“…While buprenorphine is a promising drug for rapid detoxification of opioid dependence [Brewer, 1997;Kosten 2003;Assadi et al, 2004], there is considerable variation in proposed detoxification regimens. For example, dosage forms and routes of administration vary from tablets for sublingual uses to solutions for intravenous and intramuscular uses [Janiri et al, 1994;Umbricht et al, 1999;Assadi et al, 2004].…”

Commissioning pharmacological treatments for drug users: a brief review of the evidence base

“…There are a number of newer approaches to detoxification such as rapid detoxification under sedation or anaesthetic (Merrill & Marshall, 1997;Brewer, 1997;Fontaine et al, 2001;Beaini et al, 2000) and, while these are not yet generally available or widely researched and for this reason remain controversial (Scherbaum et al, 1998;Lawrental, 2000;Boehle et al, 2000;Rumball & Williams, 1997), the evidence for their effectiveness should be kept under review.…”