SEARCH · PubMed Health

Results for “Detoxification”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources

PubMed2002

Nimodipine in opiate detoxification: a controlled trial.

OBJECTIVE: To evaluate the use of L-type calcium channel blockers (CaCB) in out-patient opiate detoxification. DESIGN: Controlled trial with sequential allocation of patients to groups. METHODS: Three groups of individuals subject to opiate detoxification were involved: (1) the experimental group (n=30) received a course of nimodipine and dextropropoxiphen; (2) one control group (n=20) was detoxified with a course of dextropropoxiphen and benzodiazepine; and (3) a second control group (n=30) was treated with a standard course of alpha-2-adrenergic agents and naltrexone. In all cases, the detoxification course was scheduled to last 7 days. RESULTS: All the groups showed a significant opiate withdrawal syndrome (OWS) during detoxification (follow-up effect: Lambda=0.04; F6.52=201.89; P < 0.001), but from the first day the group treated with CaCB manifested fewer symptoms than the control groups (treatment effect: F2.57=97.99; P < 0.001). From the start, the intensity of the OWS was reduced by half in the CaCB group (M=6.67) compared with that manifested by the two other groups (M approximately 13). The clinical impression of the evolution of the detoxification was that it was comfortable and free of complications (significant side-effects were not observed). CONCLUSIONS: The results of the study suggest that the use of calcium channel blockers (CaCB) may be an effective method in opiate detoxification. Full randomized trials are warranted.

Adult↗

PubMed2003

Short-term outcomes after brief ambulatory opioid detoxification with buprenorphine in young heroin users.

AIMS: This study examines the outcomes at 1, 3 and 6 months after a very brief outpatient detoxification with buprenorphine in 18-25-year-old heroin users. DESIGN: Prospective follow-up study. SETTING: Outpatient drug treatment clinic, providing brief detoxification in downtown Baltimore, Maryland, USA. PARTICIPANTS: One hundred and twenty-three subjects between 18 and 25 years old; 56% male; 95% Caucasian; seeking detoxification; living in Baltimore City and five surrounding counties. INTERVENTION: Detoxification with buprenorphine over 3 days. Follow-up at 1, 3 and 6 months. MEASUREMENTS: Drug use history, the Addiction Severity Index at baseline and follow-up, urine drug screens, evaluation of the detoxification experience. FINDINGS: By self-report, 37% of the total sample were not currently using heroin at 1 month, 32% at 3 months and 29% at 6 months, and 6.7%, 10.1% and 11.8% had an opioid negative urine test at 1, 3 and 6 months, respectively. There was a significant reduction from the baseline in mean Addiction Severity Index drug use composite score, as well as the mean number of days of heroin and cocaine use during past 30 days, that was sustained over the three follow-up points. Engagement in aftercare was generally poor. CONCLUSIONS: The findings show a reduced frequency and intensity of drug use, suggesting a possible role for brief outpatient detoxification in reducing the severity of dependence for some younger heroin users who may not yet be ready to engage in long-term abstinence-oriented or opioid substitution treatments.

Adolescent↗

PubMed2001

[Frequency and causes of premature termination (drop-out) during in-patient opiate detoxification].

A typical problem concerning in-patient detoxification is the high drop-out rate. This phenomenon represents a significant problem for both the patient and the therapeutic team, as it is a factor which reduces motivation. While several studies confirm a positive shift of early drop-out behavior with the aid of methadone-supported detoxification, the overall drop-out rate still saw no improvement. Unexpectedly the latter rate was found to be around 50 %. The aim of the present study was to determine the sociodemographic, dispositional and addiction-related factors, as well as subjective ratings of the present state, which have predictive value, i. e. which could discriminate drop-outs from those patients who bring their detoxification to a regular end. 176 patients from two different clinical detoxification wards of the Hannover Clinic of Psychiatry and Psychotherapy participated in the study. The overall drop-out rate was 49.4 %, the rate of female patients failing to conclude detoxification was significantly higher than that of males (68.4 % vs. 44.2 %). On average drop-out patients were 2.2 years younger and their former (i. e. uninterrupted) periods without drug consumption were shorter, while criminal circumstances (e. g. therapy as probation vs. voluntary participation) did not play a major role in influencing staying power. As expected, patients terminating their treatment against medical advice evaluated the therapeutic program more critically than the others. Interestingly drop outs rated their own mental and somatic condition very pessimistic. We concluded from these results two essentials being necessary to improve staying power of drug patients during clinical detoxification: systematic induction of (1) a positive self concept and (2) an optimistic view of chances to reach social adjustment and health.

Adult↗

PubMed2001

One-, three-, and six-month outcomes after brief inpatient opioid detoxification.

The purpose of this study was to investigate short-term outcomes of a 3-day inpatient medical detoxification. Heroin abusers (n = 116; 66% male, 77% African-American, X = 38 years old), completed the Addiction Severity Index during detoxification, and at 1, 3, and 6 months after detoxification; 94.5% of the postdetoxification interviews were completed. During the 30 days before detoxification, mean days of self-reported use for heroin was 28, for cocaine 19, and for alcohol 14; a mean of $1,975 was spent on drugs. Across the postdetoxification interviews, mean days of reported heroin use ranged from 11 to 14; 21-30% of patients reported no heroin use, whereas 25-36% reported almost daily use. Reported use of cocaine and alcohol showed similar reductions from pre- to postdetoxification. Reports of heroin and cocaine abstinence were generally verified through urine tests. Other psychosocial factors improved as well from pre- to postdetoxification (e.g., employment increased and needle use decreased). During the 6-month evaluation, at least 41% reported engaging in formal inpatient or outpatient treatment; another 25-33% reported attending self-help groups. Engaging in formal treatment (at least 7 days duration) was associated with significantly better outcome. Nevertheless, pre- to postdetoxification changes were significant and robust for the entire study sample. These findings demonstrate that brief inpatient detoxification is followed by reduced drug use over several months and is accompanied by substantial treatment-seeking behavior. Thus brief detoxification may serve as an effective harm-reduction intervention.

Adult↗

PubMedDate not supplied

Alcohol home detoxification: a literature review.

There are various definitions, aims and objectives of, and settings for, detoxification. Careful assessment is essential before any client can be detoxified at home. Scales and biological markers exist to aid this process. Close supervision (i.e. two or three home visits a day) is then required for at least 3 days. Supervision of clients can be done by the client's general practitioner (GP) or any member of a primary health care team as long as there is adequate specialist support. Clients can usually complete home detoxification within 9 days. It is safe and clinically effective for the vast majority of problem drinkers. Despite increasing the demand for detoxification, it is also cost-effective because it allows better utilization of in-patient facilities in the short term and should prevent more resources being required further along the treatment continuum. Home detoxification has wide support from both clients and their GPs. Indeed, there are many advantages for the client in detoxifying at home. However in-patient detoxification can never be replaced entirely. There will always be some problem drinkers for whom home detoxification is not a viable alternative (such as those with severe withdrawal symptoms and those lacking a suitable home environment).

Alcoholism↗

PubMed2002

Fdb1 and Fdb2, Fusarium verticillioides loci necessary for detoxification of preformed antimicrobials from corn.

Fusarium verticillioides is a fungus of significant economic importance because of its deleterious effects on plant and animal health and on the quality of their products. Corn (Zea mays) is the primary host for F. verticillioides, and we have investigated the impact of the plant's antimicrobial compounds (DIMBOA, DIBOA, MBOA, and BOA) on fungal virulence and systemic colonization. F. verticillioides is able to metabolize these antimicrobials, and genetic analyses indicated two loci, Fdb1 and Fdb2, were involved in detoxification. Mutation at either locus caused sensitivity and no detoxification. In vitro physiological complementation assays resulted in detoxification of BOA and suggested that an unknown intermediate compound was produced. Production of the intermediate compound involved Fdbl, and a lesion in fdb2 preventing complete metabolism of BOA resulted in transformation of the intermediate into an unidentified metabolite. Based on genetic and physiological data, a branched detoxification pathway is proposed. Use of genetically characterized detoxifying and nondetoxifying strains indicated that detoxification of the corn antimicrobials was not a major virulence factor, since detoxification was not necessary for development of severe seedling blight or for infection and endophytic colonization of seedlings. Production of the antimicrobials does not appear to be a highly effective resistance mechanism against F. verticillioides.

Anti-Infective Agents↗

PubMed2003

Impairment in cognitive functions after multiple detoxifications in alcoholic inpatients.

BACKGROUND: Repeated experience of withdrawal from alcohol results in a kindling-like process leading to increased likelihood and severity of convulsions during detoxification. The aim of this study was to determine whether repeated withdrawals affect cognitive function. METHODS: We investigated alcoholic patients undergoing detoxification in an inpatient setting, using tasks sensitive to dysfunction of prefrontal areas. The tasks applied were two maze tasks from the Wechsler Intelligence Scale for Children, the color Stroop task, and the vigilance task for adults and the delay task from the Gordon Diagnostic System. Forty-two abstinent alcoholic patients who were no longer receiving pharmacotherapy for detoxification participated. RESULTS: Compared to a group of forty-three social drinkers matched for age, sex, and verbal IQ, the alcoholic patients took more time to complete maze 1 and made more errors in both mazes. Alcoholics made more commission errors and gave fewer correct answers in the vigilance task. No differences were found in the color Stroop task between alcoholic patients and social drinkers. Patients with 2 or more detoxifications were more impaired in the maze 1, in the vigilance task and in the delay task than patients with a single, or no previous detoxification. When patients were reclassified on the basis of the total number of attempts at withdrawing from alcohol (including the medically supervised) only the deficit in the vigilance task was associated with the number of withdrawal attempts. The effects of medically supervised detoxifications on maze 1 and vigilance task were confounded with other factors related to the history of alcoholism, alcohol use, age of starting heavy drinking and years of problem drinking. CONCLUSIONS: Repeated experience of withdrawal from alcohol is thus associated with impaired cognitive function although it appears that for some of these effects, other factors associated with the history of alcoholism might also be involved.

Adult↗

PubMedDate not supplied

Effects of opioid prescription medication dependence and detoxification on pain perceptions and self-reports.

The purpose of this work is to document whether prescription opioid medications used for pain enhanced or worsened pain syndromes from medical conditions in patients who received a diagnosis of prescription opioid dependence as determined by a diagnosis by Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria. Further, whether detoxification improved or worsened pain perceptions and self-reports in patients who chronically administered prescription opioid medications. Our study consisted of a retrospective sample of patients taken from the Addiction Treatment Unit at St Lawrence Hospital in Lansing, MI. Patients were selected from those who voluntarily sought detoxification from opioid medications in an inpatient setting. Selection criteria for the study consisted of a DSM-IV diagnosis of opioid prescription medication dependence, willingness to undergo medical detoxification, cooperation with self-report scales, and abstinence from opioid medications. Study patients were randomly selected from discharges in patient census for the years 2001 to 2003. The significant findings were that self-reported pain scores improved during the detoxification from admission to discharge, from a mean of 5.5 at admission to mean of 3.4 at discharge (0 is no pain and 10 is the most pain). The detoxification period extended to an average of 5 days. Whereas oxycodone CR (OxyContin) produced higher levels of self-reported pain at admission than at discharge, and these patients experienced significant levels of pain reduction with decremental opioid doses as with other opioid medications. Patients with a DSM-IV diagnosis of prescription opioid dependence reported (self) less pain with detoxification and abstinence from the opioid medications.

Adult↗

PubMed1991

Should opiate addicts be involved in controlling their own detoxification? A comparison of fixed versus negotiable schedules.

This study compares the responses of opiate addicts at a London drug treatment centre to two outpatient methadone-based detoxification programmes. These involved either a fixed (non-negotiable) dose reduction schedule or a flexible, negotiable withdrawal schedule. In the negotiable condition, subjects were less likely to complete the detoxification programme and the mean reduction in dose achieved by the subjects in the negotiable condition was less than that in the fixed group. There was no difference between groups in programme retention at 6 weeks though subjects who remained in treatment in the negotiable group tended to extend their detoxification period beyond this point. The overall response of subjects in both groups was unsatisfactory. Only 13% of the subjects initially allocated to detoxification or 28% of those who actually started detoxification completed treatment; urine screening showed that heroin abuse was a continuing problem during treatment. The implications of these results for detoxification and drug treatment services are discussed.

Adult↗

PubMed2005

General anaesthesia does not improve outcome in opioid antagonist detoxification treatment: a randomized controlled trial.

AIM: Opioid detoxification by administering opioid-antagonists under general anaesthesia has caused considerable controversy. This study is conducted to determine whether rapid detoxification under general anaesthesia results in higher levels of opioid abstinence than rapid detoxification without anaesthesia. DESIGN: Randomized controlled open clinical trial from September 1999 to August 2001. SETTING: Four addiction centres in collaboration with three general hospitals in the Netherlands. PARTICIPANTS: A total of 272 opioid-dependent patients whose previous attempts to abstain were unsuccessful. INTERVENTION: Patients received rapid detoxification with general anaesthesia (RD-GA) or without general anaesthesia (RD). MEASUREMENTS: Urine screens and an interview (EuropASI) to assess opioid abstinence; two questionnaires (SOOS, OOWS) to measure withdrawal symptoms and one to measure craving (VAS). FINDINGS: One month after the intervention 62.8% of the patients in the RD-GA group and 60.0% in the RD group were abstinent for opioids (P = 0.71). No adverse events or complications occurred during RD; however, in the RD-GA group, five adverse events necessitated admission to a general hospital. The average 1-month cost for RD was Euros 2517 versus Euros 4439 for RD-GA. CONCLUSIONS: Rapid detoxification under general anaesthesia did not result in higher levels of opioid abstinence than rapid detoxification without anaesthesia. The cost of the former intervention was much higher.

Adult↗

PubMed1975

Outpatient alcohol detoxification: initial findings on 564 patients.

The authors report on a large-scale outpatient alcohol detoxification program, presenting a clinical rationale for outpatient detoxification, describing the program method, and giving initial evaluation data on the first 564 patients. Only 47 percent of the patients required detoxification, and only 19 percent of these required inpatient care. The majority of the patients successfully completed outpatient detoxification; half of these continued in the related rehabilitation program. There were no fatalities. The authors believe the results support the utility of outpatient detoxification as a cost-effective alternative to inpatient detoxification for the majority of acute alcoholics.

Acute Disease↗

PubMed2005

Fear during alcohol detoxification: views from the clients' perspective.

Little is known about fears experienced during alcohol detoxification. Using qualitative research this preliminary study analysed descriptions of fears during one-to-one interviews about the experience of undertaking alcohol detoxification. Fears about detoxification centred around four main areas: the setting in which the process takes place, the physical consequences of withdrawal, the medication given to manage detoxification and the experience of future daily living without alcohol. The findings suggest that particular attention needs to be paid to the environmental setting of detoxification and the personal meaning of receiving medical care for withdrawal. In addition, more integration of relapse prevention work into the earliest stages of alcohol-related treatment and the provision of accurate information about detoxification may prove effective in reducing fears about the process.

Adult↗

PubMed1991

Similar efficacy of abrupt and gradual opiate detoxification.

A study comparing abrupt and gradual opiate detoxification which identified the efficacy by means of computer-assisted pupilometry and rating of withdrawal distress is presented. This paper concentrates on the efficacies of these two detoxification modes with regard to the identical results after successful opiate detoxification treatment. The findings of the present investigation support the hypothesis that withdrawal distress returns to a normal level after rapid naloxone withdrawal treatment within 6 days. Similar results can be seen for inpatient methadone withdrawal after 3 weeks of treatment. These results indicate that by rapid detoxification therapy, the time of withdrawal can be effectively shortened. Considering the low dropout rate and the high degree of acceptance during rapid detoxification, the rapid detoxification regimen is an effective and economic alternative to gradual withdrawal treatments.

Adult↗

PubMedDate not supplied

The significance of drinking context for home detoxification.

AIM: A research study was conducted to examine the concordance between the severity of alcohol dependence and the nursing activity found in an episode of care for home detoxification. This article is based on an audit of clients' records which formed part of the research project. The aim was establish the degree of dependence through the application of a severity assessment instrument and to relate this to the level of nursing activity from the recorded client contacts. METHOD: Quantitative and qualitative data were obtained from a clinical audit of each client's nursing and medical notes. Examination of the data provided an insight into the client's drinking context. RESULTS: The findings demonstrated substantial levels of drinking at home, drinking alone, and all-day drinking. This could have significant implications for traditional methods of assessment and the routine practice of home detoxification. CONCLUSION: Evidence from the audit suggests that criteria such as environmental and psychosocial issues should be considered alongside physical and psychological aspects as part of the assessment criteria for home detoxification. Some clients might benefit from alternative strategies such as outpatient detoxification, day-patient attendance detoxification, or specialist inpatient treatment rather than home detoxification.

Adult↗

PubMedDate not supplied

[Ultra-rapid detoxification of opiate dependent patients: review of the literature, critiques and proposition for an experimental protocol].

UNLABELLED: Ultra-rapid opioid detoxification (UROD) is an increasingly popular technique for detoxifying patients addicted to opiates. This technique aims at reducing not only the duration but also the intensity of withdrawal by using general anesthesia coupled with a naloxone or naltrexone medication. In this paper the authors attempt to review the history of UROD and the logic of its procedure and results whilst also demonstrating its advantages and limits. METHOD: The MEDLINE database was searched from 1966 to 2000 using the terms "ultra-rapid opioid detoxification, rapid opioid detoxification under anesthesia, naloxone, naltrexone, opioid-related disorders". Additional data sources included bibliographies in textbooks on substance abuse. RESULTS: Nine studies identified in our search were analysed. The technique is based on a three-phases procedure. It consists of a medical and psychiatric selection of patients addicted to opiates, followed by the detoxification itself and finally a medical and psychosocial follow-up. A brief presentation is made of the theoretical aspects based on the use of a specific opioid receptor antagonist (naloxone and naltrexone). Only inpatients were included in the studies. The detoxification and anesthesia protocols varied. In every study all the subjects were completely detoxified. Only three studies included a control group and two used a randomized design. Three studies reported a follow-up beyond 30 days. DISCUSSION: Although this technique constitutes a safe and effective solution for opiate addicted patients, there are criticisms to be made. The absence of an animal model prior to the study of a human model, the lack of comparison with other procedures, the limitation of available literature, the cost and the risks of this technique and the lack of long-term treatment outcomes obtained from rigorous clinical trials, all call for further assessments. A more rigorous protocol based on the main areas of criticism is proposed (presentation of the inclusion and exclusion criterias, description of the three preliminary interviews, presentation of the UROD technique itself and finally a detailled nine month follow-up). CONCLUSION: Ultra-rapid opiate detoxification represents a potentially safe and effective treatment for opiate addicted patients but more rigorous research methods are needed to render this procedure entirely valid.

Anesthesia, General↗

PubMed2002

Injury among detoxification patients: alcohol users' greater risk.

BACKGROUND: Little information exists about serious injury in alcohol or drug abusers who seek detoxification. This study examined injury prevalence, and the impact of alcohol use on injury, among alcohol- and drug-dependent persons. METHOD: We enrolled patients at a detoxification unit into a prospective cohort study and performed follow-up interviews to determine the prevalence of injury. Baseline and follow-up (6, 12, 18, and 24 month) data were examined separately by using multivariate logistic regression to determine factors associated with self-reported episodes of serious injury. The main independent variable was self-reported first and second substances of choice at admission: alcohol only, drug only, or both. RESULTS: Overall, 24% of the 470 subjects reported at least one instance of serious injury over the 6-month period before detoxification. Similarly, approximately 20% of subjects had serious injury during each 6-month follow-up period. Injury in the past 6 months was highest among the 63% of subjects who reported alcohol as a drug of choice (28-29% vs. 16% for drug only), even after we controlled for potential confounders. Analysis of 2-year follow-up data revealed a similar association, after we controlled for baseline injury and alcohol consumption. CONCLUSIONS: Injury is a serious problem for a substantial proportion of patients who undergo detoxification, particularly those with alcohol dependence. This marked risk for serious injury persisted for 24 months after detoxification. Patients at detoxification, particularly those with alcohol problems, represent a high-risk population for injury that may benefit from interventions to reduce these preventable complications.

Adult↗

PubMed1997

[Clinial study of "qingjunyin" detoxification for the treatment of heroin addicts].

To evaluate the efficacy of treatment of heroin addicts (n = 100) by "Qingjunyin" (QJY) detoxification (10 days program). Methadone detoxification (10 days program) group (n = 50) and colonidine treated group (n = 50) serve as controls. QJY group is given 180 ml P. O daily. The dosage of the two comparatine groups is given according to Documentation, the method of abserving the treatment protocols and detoxification standard is according to current regulation. The scores of abstinence syndrome in QJY detoxification group are lower than those in colonidine treated group in the first three days of potocol, but this difference disappear in the late stage of treatment. While QJY detoxification is effective as methadone detoxification in the control of abstinece syndrome during the first five days of treatment but the difference in the scores of abstinence syndrome between QJY and methadone group is observed during the late five days of protocol. QJY does not result in potential dependence and has definite curative effect in the treatment of heroin addiction.

Adolescent↗

PubMed2005

Measurement of symptom withdrawal severity in a 24-hour period after the anesthesia-assisted rapid opiate detoxification procedure.

This study examined the Anesthesia-Assisted Rapid Detoxification (AAROD) procedure and the measurement of withdrawal symptom severity within a 24-hour period. The Clinical Opiate Withdrawal Scale (COWS) was utilized at various time intervals, post detoxification. This study demonstrated that all of the patients who underwent the AAROD procedure had withdrawal symptoms post detoxification in the mild range of severity, unlike like traditional detoxification procedures. Further studies are needed to measure withdrawal symptoms longer than one-day post detoxification and to compare the differences between various detoxification protocols.

Adult↗