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At least 73 records · Page 4Linked to original sources

PubMed1998

Preliminary assessment of a 10-day rapid detoxification programme using high dosage buprenorphine.

The original French therapeutic strategy for the treatment of opioid addiction was a rapid detoxification occasionally accompanied by treatment for withdrawal symptoms. In 1995, substitution therapy using opioids was introduced with the aim of maintenance, utilising methadone and the partial agonist buprenorphine, introduced in 1996. As well as being a maintenance agent, buprenorphine has been prescribed for rapid detoxification due to its reduced tendency to cause any withdrawal effects and its ability to block the effects of other opioids. This trial was initiated to measure the efficacy of buprenorphine in rapid detoxification and to assess whether additional medication would be required. Participants in this open study had requested rapid detoxification and were referred to the addiction clinic as inpatients. Patients were assessed by the clinician and during counselling sessions, and an initial dose was agreed upon. This dose was then gradually decreased over ten days in a flexible dosing schedule, with concurrent toxicological urinalysis to ensure no illicit drug use. During the trial, 25% of patients transferred to a maintenance programme and 58% remained in the study. The large transfer of patients to maintenance programmes may indicate that many people requesting rapid detoxification are actually asking for a more generalised form of assistance. No opioid-positive urines were noted after the fourth day in any patients, and the study indicates that buprenorphine should prove to be a useful detoxification agent, particularly in less hardened addicts. Step-down buprenorphine detoxification minimises withdrawal symptoms and, therefore, reduces the need for concurrent medication.

Adolescent↗

PubMed1995

Medical services use by patients before and after detoxification from benzodiazepine dependence.

OBJECTIVE: The authors examined use of medical and mental health services before and after detoxification among a group of patients detoxified from benzodiazepines to see if the data suggested a reduction in service use and costs after detoxification, the so-called offset effect observed for treatment of alcohol and mental disorders. METHODS: Through a medical record review, information was collected about medical service use for patients aged 40 and older who were detoxified from benzodiazepines at Scott and White Clinic and Hospital between 1987 and 1991. RESULTS: Among the 76 patients, medical and mental health outpatient visits fell from an average rate of 25.4 visits per year before detoxification to 4.4 per year after detoxification. For the 44 patients with at least one inpatient stay besides the admission for detoxification, the mean number of inpatient days remained constant at three days per year before and after detoxification. CONCLUSIONS: Although a retrospective record review suffers from a range of limitations, the findings suggest that detoxification from benzodiazepines may be effective in reducing use of outpatient medical and mental health services and presumably in reducing costs of care.

Adult↗

PubMed1999

[The combined use of scopolamine, naltrexone and naloxone as a rapid, safe and effective detoxification treatment for heroin addicts].

OBJECTIVE: To evaluate the efficacy of a rapid detoxification schedule for heroin addicts by scopolamine combined with opiate receptor antagonists. METHODS: The life signs such as temperature, blood pressure, ECG, heart rate, respiratory rate and blood oxygen saturation were monitored during the process of rapid detoxification treatment. The naloxone challenge test, withdrawal symptoms scale and naltrexone maintenance were used to evaluate the efficacy of the rapid detoxification. RESULTS: The withdrawal symptoms of 84 heroin addicts induced by naltrexone and naloxone were controlled completely under scopolamine administration in the 6-8 hours treatment period, although the naloxone challenge test was able to induce slight and transient withdrawal symptoms in the second day, and all patients were transferred rapidly to naltrexone maintenance. During treatment, the temperature in 19 cases elevated, and all patients showed increased heart rate, blood pressure and respiratory rate. However, the blood oxygen saturation was still stable after oral-administration of naltrexone and continuous injection of naloxone during the detoxification. Blood test in gastric fluid was positive in 3 cases during the detoxification. The follow-up data showed that the average maintenance time of naltrexone was 2.6 months, and the percentage of drug free was 21% in 6 months after the detoxification in 84 cases. CONCLUSION: The combined use of scopolamine, naltrexone and naloxone is a rapid, safe and effective detoxification treatment protocol for heroin addicts.

Adult↗

PubMedDate not supplied

Ultra-rapid opioid detoxification: current status and controversies.

Opioid dependence is a major health problem and a cause of increasing concern to physicians and other health professionals worldwide. A crucial first step in intervention is detoxification. Recent trends in medical practice have seen the emergence of newer techniques that claim to accelerate the detoxification procedure and ensure prevention of relapse by rapid induction onto maintenance treatment with opioid antagonists such as naltrexone. This review delves into the theoretical and methodological aspects related to ultra-rapid opioid detoxification (opioid detoxification procedure using opioid antagonists, performed under general anaesthesia or heavy sedation) and discusses the status of the same in light of the available evidence regarding its applicability, safety and effectiveness. Although useful in some respects (especially in completion rates for detoxification and subsequent induction onto naltrexone maintenance), the justification of this procedure lies in (a) the resolution of the ethical conflicts surrounding the procedure and (b) conduction of methodologically sound long-term studies to demonstrate greater efficacy over routine/standard detoxification procedures beyond the short-term detoxification period.

Anesthesia, General↗

PubMedDate not supplied

Domiciliary detoxification: a cost effective alternative to inpatient treatment.

In this study, 20 subjects who had home detoxification with supervision and support from the Western Australian Alcohol and Drug Authority Community Nursing Service were matched with 20 subjects who had inpatient detoxification in the Authority's detoxification facility. Subjects were interviewed between nine and 22 months (mean 15.5 months) after detoxification to compare client outcomes and the costs of home and inpatient detoxification. The results indicate that, for suitable clients, home detoxification was at least as beneficial as inpatient detoxification and that it was achieved at a much lower cost than inpatient care.

Cost-Benefit Analysis↗

PubMed1995

Out-patient alcohol detoxification--outcome after 2 months.

We assessed the outcome after 2 months of 28 alcohol-dependent subjects following out-patient detoxification using an uncontrolled follow-up study with data collected at the time of detoxification (T1) and after 2 months (T2). We also determined the cost of out-patient versus in-patient detoxification. The setting was a psychiatric emergency clinic at a South West London University Hospital. Self-reported alcohol consumption in the week before T1 and T2, score on the 'Alcohol Problems Inventory' measuring alcohol-related relational, occupation, legal and medical problems in the 2 months prior to T1 and T2, mean corpuscular volume and gamma-glutamyl transferase at T1 and T2 were used as outcome measures. Eight subjects had a 'good' outcome (seven were abstinent and one only drank four units on one day). Nine subjects were 'improved' by either having their alcohol consumption, or halving their 'Alcohol Problems Inventory' score at T2. 'Good' and 'improved' outcome were confirmed by mean corpuscular volume and gamma-glutamyl transferase results. Eleven subjects were 'not improved'. Engagement following detoxification with voluntary alcohol agencies was associated with a better outcome. In-patient detoxification is calculated to be six times more expensive than out-patient detoxification. Out-patient detoxification is a cost-effective step in the treatment of alcohol-dependent patients.

Adult↗

PubMed1998

[The "Qualified Detoxification Treatment of Drug Dependent Patients" Federal Model Project in a general hospital: concept, investments and clinical results].

For 150,000 drug addicts 5,200 therapy slots are available in Germany. Until the late 80's detoxification treatment was only given a subordinate role in treating drug addicts. Due to the threat of the infectious disease AIDS and the increasing number of drug deaths new concepts were explored: In 1991 the first qualified detoxification ward for drug addicts was opened in a general hospital under the auspices of the Federal German model project "compact therapy for comprehensive drug treatment". Subsequently more than ten detoxification wards specifically for drug addicts were established in Bavaria alone, primarily in psychiatric county hospitals. Drug addicts are accepted into these qualified detoxification wards without preparation and precondition. Data of 1656 drug addicts were analysed who were treated between 1991 and 1996 at the ward described below: More than 70% come directly from the scene and 33% were accepted for the first time to inpatient detoxification treatment. Most of them are diagnosed with addictions to at least two substances (three substances 44%, two substances 24%). Many suffer from additional diseases: In 1079 out of 1656 a positive hepatitis-C serology was found, 22% had previously tried to commit suicide, 37% had to be treated in intensive-care because of life-threatening intoxication. Nevertheless, 58% of the drug addicts are transferred into continuing therapy after detoxification treatment or they continue to work in permanent employment. During detoxification treatment no patient died. Acceptance, additional diseases which can be diagnosed and treated best in a general hospital, and the high prevalence of addicted persons (at least 17-24%) in internal medical or surgical wards suggest that establishing qualified wards with special settings for addicts in general hospital is useful.

Adult↗

PubMed2003

[Outpatient alcohol detoxification].

Increasing significance is being attributed to outpatient detoxification treatment of alcohol-dependent patients. Many patients want to undergo outpatient detoxification or even carry it out without professional supervision. In some Scandinavian countries and in the USA, outpatient detoxification under medical supervision has increased substantially. In these countries,numerous studies describe outpatient alcohol detoxification as a safe and cost-reducing method. These studies vary in many aspects, especially regarding the nature and dose of the withdrawal medication, but also concerning the inclusion criteria of patients. Medications to treat or prevent alcohol withdrawal symptoms are rather heterogeneous. Besides well-known standard medication established in inpatient treatment (e.g.,benzodiazepines and carbamazepine), interesting studies report the application of rather uncommon substances such as physostigmine and psychotropic analgesic nitrous oxide (PAN) for alcohol detoxification. This article provides an overview on outpatient alcohol detoxification and discusses its transfer to practical application.

Alcohol Deterrents↗

PubMed1996

P300 assessment of opiate and cocaine users: effects of detoxification and buprenorphine treatment.

We assessed cognitive function following heroin and cocaine detoxification and investigated whether buprenorphine treatment improves the disruptive effects of detoxification. Three groups of male volunteers meeting DSM-III-R criteria for concurrent opiate and cocaine dependence were tested using an auditory oddball paradigm before and after detoxification, and again on the 15th day of either buprenorphine or placebo treatment. There were no significant differences in P300 amplitude, latency, or topographic distribution between drug-dependent subjects and controls on admission day. Following detoxification there was a significant decrease in P300 amplitude in the drug-dependent group at a time when self-reported signs of withdrawal were minimal. Buprenorphine treatment significantly reversed the P300 amplitude decrement following detoxification, whereas placebo-treated subjects continued to show depressed P300 amplitudes. These data demonstrate that buprenorphine treatment is effective in eliminating detoxification-induced impairments in one measure of cognitive ability.

Adult↗

PubMed1983

Efficacy of psychotherapeutic counselling during 21-day ambulatory heroin detoxification.

Structured, psychotherapeutic counselling during 21-day heroin detoxification was evaluated by randomly assigning a group of 25 heroin addicts to a detoxification treatment regimen with mandatory counselling by a therapist and 25 to a control group who received only standard detoxification without counselling. There was no significant difference between groups in the number who successfully detoxified as measured by conversion of morphine positive urine to morphine negative urine. The counselling intervention group did, however, improve the attendance of subjects while in detoxification treatment, and significantly more patients entered long-term treatment following detoxification. Maximal use of a counselor during 21-day heroin detoxification may best be realized by directing therapy toward engaging patients in long-term care.

Adolescent↗

PubMedDate not supplied

Preferential use of less toxic detoxification pathways by long-lived species.

This study was undertaken to determine whether the detoxification pathways producing the least oxidative stress appear to be favored in longer-lived mammalian species. Firstly, we focused on the cytochrome P-450 monooxygenase system. Although this system is an important component of the defenses that protect living organisms against toxic chemicals, some reactions catalyzed by the cytochrome P-450 system result in the formation of products that are highly reactive as well as active oxygen species. Our results suggest that the lower amount of hepatic cytochrome P-450 content found in longer-lived species may have evolved to reduce the toxic side-effect of this detoxification system. Support of the idea that the cytochrome P-450 system is an important source of oxidative stress is the positive correlation between cytochrome P-450 content and the amount of oxidized proteins found in liver of different human individuals. Secondly, we have measured the specific activity of other detoxification enzymes as a function of life span. Instead of a direct comparison of detoxification capabilities of the species, the approach used in this study was: (1) to select those detoxification enzymes which utilize the same substrate but differ in toxicity of the intermediate compounds formed in the reaction, and (2) to measure the levels of these enzymes in the two pathways to determine which pathway is dominant for each species. Our results suggest that the detoxification pathways producing the least oxidative stress do appear to be favored in longer-lived species.

Journal Article↗

PubMed2001

Changes in dopamine receptor responsivity during alcohol detoxification may predict relapse.

In the search for clinical and biological variables that may predict relapse of alcohol dependent patients after detoxification, we followed up for 1 year male patients that had undergone successful detoxification. The patients had been tested earlier during their usual alcohol consumption and immediately after detoxification for the responsivity of D2 dopamine receptors (as measured by the increases in prolactin plasma levels caused by intramuscular administration of 5 mg of the dopamine receptor blocker haloperidol). Of the 18 patients, eight had not consumed alcohol for more than 6 months, and ten had relapsed within 6 months. Comparison of the clinical and neuroendocrine data for the two subgroups revealed no significant differences in age, amount of alcohol consumed during alcohol abuse, score in the Beck Depression Inventory, score in the Brief Michigan Alcoholism Screening Test, or prolactin responses to haloperidol before detoxification. In patients who relapsed, the duration of alcoholism was marginally shorter (P=0.055). Patients who did not relapse had significantly higher (P=0.003) prolactin responses to haloperidol in the test performed after detoxification as compared with patients who did relapse, and their responses were similar to those of a group of healthy male subjects. The results show that the increase in dopamine receptor responsivity that occurs after detoxification is a favourable factor for non-relapse; it may reflect recovery from down-regulation of the dopaminergic reward system caused by alcohol consumption.

Adult↗

PubMed2002

Voucher-based reinforcement of opiate abstinence during methadone detoxification.

Methadone detoxification is often used in the treatment of opiate dependence. This procedure, however, is frequently associated with continued opiate use, and high rates of attrition and relapse. In this study, a 90-day methadone detoxification was enhanced by adding voucher-based reinforcement of opiate abstinence before, during and after the dose tapering schedule. After 4 weeks of standard methadone maintenance (baseline), subjects were randomized to either the abstinence (n=26), or attendance reinforcement (n=22) condition. During the remaining 22 weeks of the study, the abstinence reinforcement group could receive vouchers with monetary value three times per week for providing opiate-negative urine specimens, while subjects in the attendance reinforcement group received vouchers of equal value for attending the clinic, regardless of urinalysis results. Methadone maintenance continued during weeks 5-10, dose tapering was implemented during weeks 11-23, and during weeks 24-26 the voucher schedule remained in effect but no medication was provided. Fifty percent of clients in both groups completed dose tapering, and 40% completed the vouchers-only phase. Subjects in the abstinence as compared with the attendance reinforcement group had lower rates of opiate use during the maintenance and detoxification phases, and longer periods of opiate abstinence during the detoxification phase. Cocaine use was also lower in the abstinence than the attendance reinforcement group during the maintenance and detoxification phases. In addition, abstinence as compared with attendance reinforcement subjects reported significantly fewer intravenous injections during the detoxification phase. Voucher-based reinforcement procedures could be useful for successfully transitioning patients into opiate antagonist therapy, or drug-free treatments.

Adult↗

PubMed2000

Dopamine receptor responsivity in alcoholic patients before and after detoxification.

OBJECTIVE: To assess central dopamine receptor responsivity in alcoholic patients during their usual alcohol consumption and after detoxification. METHOD: Plasma prolactin levels were measured at 0, 30, 60, and 90 min after administration of 5 mg haloperidol i.m. in 21 hospitalized male alcoholic patients during usual alcohol consumption, and 13 days later (mean, range 7-17 days), after detoxification. The test was also performed in seven healthy male volunteers. The patterns of prolactin responses were compared using repeated measures analysis of variance. RESULTS: The prolactin responses to haloperidol increased significantly after detoxification compared to those during usual alcohol consumption (state x time interaction P < 0.01; planned comparisons for times 0 and 90 min between states P = 0.03). Compared to controls, the responses of the patients before detoxification were lower (group-time interaction P = 0.001), and the difference was not significant after detoxification (P = 0.19). The magnitude of plasma prolactin (PRL) responses were not related to duration of alcohol abuse, score in the Brief Michigan Alcoholism Screening Test (BMAST) scale, or family history of alcoholism. CONCLUSIONS: Alcohol detoxification is accompanied by a normalization of the low responsivity of central dopaminergic receptors during alcohol abuse. The data support the hypothesis of a participation of the central dopaminergic system in alcohol dependence.

Adult↗

PubMed2003

Slowing the revolving door: stabilization programs reduce homeless persons' substance use after detoxification.

This study examined whether homelessness predicted earlier resumption of substance use after detoxification, and sought evidence concerning the impact of post-detoxification stabilization programs among homeless and nonhomeless individuals. Kaplan-Meier plots and proportional hazards models were used to determine the association between homelessness, stabilization program use, and recurrent substance use in a prospective cohort of persons entering inpatient detoxification (n=470). Among 254 persons available at 6 months, 76% reported recurrent substance use. Homeless persons not using stabilization programs experienced the highest hazard of return to substance use after detoxification, Hazard Ratio (HR) 1.26, 95% CI (0.88, 1.80). Homeless persons using these programs had the lowest rate of return to substance use: HR 0.61, 95% CI (0.40, 0.94). A similar impact of stabilization programs was not seen among nonhomeless subjects. Post-detoxification stabilization programs were associated with improved outcomes for homeless addicted persons. This treatment modality may slow the "revolving door" phenomenon of relapse after detoxification among homeless persons.

Adult↗

PubMed2002

Effects of alcohol detoxification on dopamine D2 receptors in alcoholics: a preliminary study.

Imaging studies in patients with Type II alcohol dependence have revealed significant reductions in dopamine (DA) D2 receptor availability. Here we assessed the effects of alcohol detoxification in DA D2 receptors in alcoholic subjects. We evaluated 14 patients with Type II alcohol dependence tested within 6 weeks of detoxification and then re-tested 1-4 months later while alcohol free. The comparison group comprised 11 healthy controls. PET was used with [11C]raclopride to measure DA D2 receptors. Eight alcoholics and all control subjects were tested with a CTI 931 PET scanner and six alcoholics with a Siemens HR+ PET scanner. Data were analyzed separately for the studies done in the different scanners. Comparisons between early and late alcohol detoxification showed no significant changes in DA D2 receptor availability (B(max)/K(d)) for the studies done with the CTI and the HR+ scanners. Comparison with controls showed lower DA D2 receptor levels in caudate and putamen in alcoholics tested during early detoxification and in caudate during late detoxification. These studies replicate previous findings of lower striatal DA D2 receptors in alcoholics than in controls and absence of significant recovery during alcohol detoxification. These findings suggest that low DA D2 receptor availability in alcoholics is not due to alcohol withdrawal and may reflect a predisposing factor.

Adult↗

PubMed2002

Can methane suppression during digestion of woody and leafy browse compensate for energy costs of detoxification of plant secondary compounds? A test with muskoxen fed willows and birch.

Digestion and metabolism of woody and leafy browse requires detoxification of plant secondary compounds that can incur an energy cost. Browse, however, inhibits methane (CH(4)) production and therefore could offset some costs of detoxification. We measured an index of heat increment of feeding (HIFi) and CH(4) production in muskoxen (Ovibos moschatus) given a single test meal (at 10 g/kg BM(0.75)) composed of hay mixed with one of three browse species (Willow: Salix alaxensis, S. pulchra; Birch: Betula nana). Detoxification cost was estimated as HIFi of browse diet-HIFi of hay diet and CH(4) compensation as CH(4) production of hay diet-CH(4) production of browse diet. CH(4) compensation was noted in 47% of 15 trials in which a detoxification cost was evident; six trials were with woody browse and one with leafy browse. Separate controls were responsible for the difference in CH(4) compensation for leafy browse vs. woody browse. Detoxification costs for twigs and leaves of B. nana were underestimated because of their low digestibility. In only one of six treatments was CH(4) compensation documented for B. nana. We conclude that energy saved by CH(4) suppression was small (<6%) compared with detoxification costs.

Animal Feed↗

PubMed2000

Safety, efficacy, and long-term results of a modified version of rapid opiate detoxification under general anaesthesia: a prospective study in methadone, heroin, codeine and morphine addicts.

BACKGROUND: In the present study a method of rapid opiate detoxification under general anaesthesia has been evaluated regarding the safety, the efficacy in preventing withdrawal symptoms, and the long-term results. In addition, it was investigated whether the profile and severity of withdrawal symptoms depend on the type of opiate abused (methadone, heroin, codeine, morphine). METHODS: Seventy-two opiate addicts were detoxified in an intensive care unit (ICU). Anaesthesia was induced and maintained using propofol infusion. Patients were endotracheally intubated. The opiate receptor antagonist naltrexon was administered into the stomach via a nasogastric tube. Withdrawal symptoms before and after the detoxification treatment were assessed using an objective and a subjective opiate withdrawal scale (OOWS, SOWS). After detoxification patients entered a long-term naltrexone maintenance programme as well as a supportive psychotherapy programme. Vital organ function was monitored using haemodynamic and respiratory parameters as well as body temperature. RESULTS: Organ function parameters were stable during the whole treatment in all patients and no anaesthetic complications were registered. Minor side effects such as bradycardia or hypotension were observed in 20 patients. Compared to patients with pre-existing heroin, codeine, or morphine abuse respectively, patients from the methadone maintenance programme had significantly higher (P<0.01) OOWS as well as SOWS values after the treatment. Twelve months after the detoxification 49 patients (68%) were abstinent from opiates whereas 17 patients had relapsed during the period of follow-up. Six patients were lost during follow-up. CONCLUSIONS: Rapid opiate detoxification under general anaesthesia is a safe and efficient method to suppress withdrawal symptoms. This treatment may be of benefit in patients who particularly suffer from severe withdrawal symptoms during detoxification and who have failed repeatedly to complete conventional withdrawal. Methadone patients have more withdrawal symptoms than other opiate addicts.

Adult↗