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PubMed1994

Clonidine is not a useful adjunct to methadone gradual detoxification in opioid addiction.

BACKGROUND: The role of clonidine in the management of opioid-dependent individuals undergoing gradual detoxification. METHOD: A double-blind placebo-controlled trial was conducted on 86 voluntary in-patients (59 male, 27 female) aged 18-47 years, at a specialist drug-dependence treatment unit. Patients entered the trial when on 40 mg of methadone daily or less, and were randomised to receive incremental doses of clonidine (increasing from 0.2 mg daily to 1.2 mg daily) during a 14-day period of gradual methadone detoxification and for four weeks thereafter. Blood pressure was monitored and severity of opioid abstinence was assessed by questionnaire and by clinical examination. RESULT: Half the subjects were withdrawn or defaulted from the trial by the end of two weeks, those receiving clonidine earlier than those receiving dummy medication (9 of the former and only one of the latter because of systemic hypotension). Similar proportions of subjects completed detoxification in the two groups. In those who completed detoxification, clonidine did not significantly reduce either the symptoms or objective signs of opioid withdrawal. CONCLUSIONS: These findings suggest that clonidine has no place as an adjunct to a programme of gradual opioid detoxification.

Adolescent↗

PubMed2006

S(+)-ketamine attenuates increase in electroencephalograph activity and amplitude height of sensory-evoked potentials during rapid opioid detoxification.

Anesthesia-assisted opioid detoxification offers an opportunity for patients who have undergone unsuccessful conventional detoxifications. Little is known of excitatory effects taking place in the central nervous system during this procedure. Because acute withdrawal is accompanied by N-methyl-d-aspartic acid (NMDA)-receptor activation we tested whether the administration of the nonspecific N-methyl-d-aspartic acid antagonist S(+)-ketamine results in a reduction of hyperactivity in the central nervous system. Thirty-one patients with a long history of opioid abuse were acutely withdrawn with naltrexone during propofol/clonidine anesthesia and mechanical ventilation. Electroencephalogram (EEG) power spectra as well as median nerve-evoked somatosensory potentials (SSEP) were determined at the following times: evening before detoxification (control), steady-state propofol/clonidine-anesthesia, 30 min after naltrexone administration, and 5 min and 60 min after additional S(+)-ketamine (1.5 mg/kg). Compared to steady-state anesthesia, naltrexone induced a decrease by 270% in the low delta (0.5-3 Hz) and an increase by 110% in the fast beta (13-30 Hz) domain of the EEG with only minor changes in the theta-(3-7 Hz) and alpha-(7-13 Hz) band. Simultaneously, mean amplitude of the late N(100) peak of the SSEP increased from 3.3 muV to 10.5 muV. The changes could be attenuated by the additional administration of S(+)-ketamine, 5 min and 60 min after injection. Cardiovascular changes were not a reliable index for monitoring acute withdrawal symptoms and determining termination of rapid opioid detoxification. In this regard, EEG power spectra and SSEP were more consistent and clinically useful variables. S(+)-ketamine is a valuable adjunct in the anesthetic regimen, since it attenuates hyperactivity of the central nervous system during rapid opioid detoxification.

Adult↗

PubMed1994

A preliminary investigation of outcome following gradual or rapid buprenorphine detoxification.

Eight opioid-dependent individuals were maintained on daily sublingual buprenorphine (8 mg) for 28 days and assigned randomly to one of two outpatient detoxification schedules under double-blind, double-dummy conditions. The two detoxification schedules were buprenorphine gradual (36 days; N = 3) or buprenorphine rapid (12 days; N = 5). Outcome variables were subject- and observer-ratings of opioid withdrawal, treatment retention and illicit-opioid use. Outcome measures were similar for the two groups during buprenorphine maintenance. Increases in subject-rated opioid withdrawal and illicit-opioid use, and a drop in treatment retention occurred during rapid detoxification. Stable subject-rated opioid withdrawal and treatment retention, and less illicit-opioid use occurred during gradual detoxification. These data suggest that gradual reduction in buprenorphine dose is likely to produce superior treatment outcomes than more rapid buprenorphine detoxification.

Administration, Sublingual↗

PubMed2005

Management of opiate detoxification in jails.

Little is known about how jails manage opiate withdrawal among arrestees and inmates. We conducted a national survey of 500 jails in the United States. We specifically asked about assessment and management opiate dependency among arrestees and use of standardized protocols. Among the 245 jails that responded, more than half (56%) reported they routinely assessed arrestees for opiate dependency and most (59%) reported using standardized detoxification protocols. Fifty percent of jails used clonidine for detoxification. Very few jails (1%) used methadone or other opiates (2%) for detoxification. Half of all jails (49%) failed to use clonidine, methadone or other opiates for detoxification. These results show that many jails fail use recommended opiate detoxification procedures and highlight the need for uniform national standards for jail management of opiate dependence.

Acute Disease↗

PubMedDate not supplied

An analysis of federal narcotic detoxification policy: implications for rehabilitation.

The current federal narcotic detoxification policy, limiting such treatment to 21 d, is analyzed with respect to its impact on the success rate for complete withdrawal. Data are drawn from an historical review of American Medical Association statements on narcotic addiction and a review of empirical data on short- and long-term detoxification. The 3-week limit is shown to interfere with achieving successful detoxification rates, although it continues to guide federal detoxification policy. Empirical evidence supports long-term detoxification that recognizes other factors as also having a therapeutic effect. It is time to revise the current federal policy to more accurately reflect the progress made in long-term care.

Drug and Narcotic Control↗

PubMed1985

Comparison of clinician ratings to self reports of withdrawal during clonidine detoxification of opiate addicts.

Opiate withdrawal symptom ratings by trained clinicians were compared to self-reports of withdrawal discomfort during an outpatient, blinded, randomized clinical trial of clonidine detoxification for methadone maintained subjects. The randomized comparison group of subjects were detoxified using a slow tapering of methadone over 1 month. For all 39 subjects in this study the observer and self-ratings were substantially correlated (r = .75), but moderate levels of disagreement also occurred and the observer ratings were often lower. The difference in actual withdrawal scores and amount of shared variance between the observer and self-ratings were used as indices of disagreement for each individual subject. We found that detoxification failures had significantly less interrater agreement than the successes and that subjects who reported more distress than the observers noted were more likely to fail at detoxification. Subjects being detoxified using clonidine were more likely to fail at detoxification. Subjects being detoxified using clonidine were more likely to demonstrate this association between failure and disagreement on self versus observed withdrawal than were the methadone group. We concluded that self-reports are as important as observer ratings in assessing treatment efficacy and in the clinical use of clonidine for outpatient detoxification.

Adult↗

PubMed1996

Rapid opiate detoxification.

We report on clinical and practical aspects of treatment of opiate addiction with a relatively new approach, rapid opiate detoxification (ROD). The goal is to induce rapid narcotic withdrawal in a controlled environment using narcotic antagonists while suppressing withdrawal symptoms with sedative drugs, thus effecting a dramatic abbreviation of the traditional withdrawal schedule. Twenty-five consecutive heroin-addicted patients presenting for detoxification were treated at a university hospital. There were 14 women and 11 men, with a mean age 32.6 years (range, 24-48). They underwent 29 separate detoxifications over a 4-month period. All but 3 of the detoxifications were effected with ROD. Several different techniques were used over the 4-month period, ranging from intramuscular and oral sedation to intravenous sedation, paralysis, and intubation. Efficacy of detoxification was demonstrated for all patients undergoing ROD; all were given 50 mg of naltrexone PO prior to discharge, and none had withdrawal symptoms. (The three patients treated with abstinence were not so tested.) We derive three conclusions from this early clinical experience: First, ROD appears to be a valuable tool in the treatment of heroin addiction. ROD is an efficient, effective technique that can play an important role in an integrated rehabilitation program. Second, the optimal method of ROD is yet to be determined; a continuum of approaches is available. Third, ROD is probably most suited to designated outpatient centers.

Adult↗

PubMed1981

Retention in ambulatory detoxification.

The background characteristics and mean levels of neuroticism were compared for three groups of 20 male addicts, each, who (1) completed 21 d of ambulatory detoxification, (2) transferred to methadone maintenance before completing detoxification, and (3) dropped out of detoxification. The patients who completed treatment or dropped out were more likely to be Black and less neurotic than those who transferred to methadone maintenance. In addition, it was found that patients dropped out near the time of the first methadone dose reduction, whereas those who transferred to methadone maintenance did so near the final dose reduction in the 21-d detoxification schedule. The clinical implications for retaining patients until completion of ambulatory detoxification treatment are discussed.

Black or African American↗

PubMed1997

Three methods of opioid detoxification in a primary care setting. A randomized trial.

BACKGROUND: Opioid detoxification in a primary care setting followed by ongoing substance abuse treatment may be appropriate for selected opioid-dependent patients. OBJECTIVE: To compare three pharmacologic protocols for opioid detoxification in a primary care setting. DESIGN: Randomized, double-blind clinical trial with random assignment to treatment protocols. SETTING: A free-standing primary care clinic affiliated with drug treatment programs. PATIENTS: 162 heroin-dependent patients. INTERVENTIONS: Three detoxification protocols: donidine, combined donidine and naltrexone, and buprenorphine. MEASUREMENTS: Successful detoxification (that is, when study participants received a full opioid-blocking dose [50 mg] of naltrexone), treatment retention (8 days), and withdrawal symptoms. RESULTS: Overall, 65% of participants (36 of 55) who received clonidine, 81% (44 of 54) who received combined clonidine and naltrexone, and 81% (43 of 53) who received buprenorphine were successfully detoxified. Retention did not differ significantly across the groups: 65% of participants (36 of 55) who received clonidine, 54% (29 of 54) who received combined clonidine and naltrexone, and 60% (32 of 53) who received buprenorphine. Participants who received buprenorphine had a significantly lower mean withdrawal symptom score than those who received clonidine or combined clonidine and naltrexone. CONCLUSIONS: Participants in the combined clonidine and naltrexone group and those in the buprenorphine group were more likely to complete detoxification, although retention at 8 days did not differ among the groups. Participants who were assigned to the buprenorphine group experienced less severe withdrawal symptoms than those assigned to the other two groups.

Adolescent↗

PubMed2003

Risk factors associated with dropout and readmission among First Nations individuals admitted to an inpatient alcohol and drug detoxification program.

BACKGROUND: There is a need for clinically relevant research into treatment for substance abuse among Aboriginal people. In this study, I aimed to provide a predictive model of dropout from and readmission to an inpatient detoxification program in a large treatment sample of Aboriginal patients. METHODS: I reviewed the medical charts of all self-reported First Nations people (n = 877) admitted to an inpatient detoxification centre in British Columbia, between Jan. 4, 1999, and Jan. 30, 2002, and used binary logistic regression models to identify predictors of dropout from and readmission to the program. Each of these models was validated using an independent subset of the treatment sample. RESULTS: Overall, 254 (29.0%) people dropped out of the program, and 219 were readmitted. Statistically significant predictors of treatment dropout were a preferred drug other than alcohol (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.12-2.50) and self-referral (OR 1.89, 95% CI 1.28-2.80). Statistically significant predictors of readmission to inpatient detoxification within a 1-year period were a previous history of detoxification treatment (OR 3.52, 95% CI 2.16-5.75) and residential instability (OR 1.82, 95% CI 1.11-2.99). INTERPRETATION: Although factors were identified that are associated with each of treatment dropout or readmission for detoxification, only the latter can be reliably predicted by them.

Adult↗

PubMedDate not supplied

[Complications of accelerated opioid detoxification].

All accelerated opioid detoxifications under anesthesia, which were performed at our district hospital during 3 years (1999 to 2002), have been retrospectively analyzed. A total of 48 detoxifications were made in 43 patients. Three serious complications were recorded. In the first case, there was incomplete detoxification using naltrexone. The naloxone test was negative. After recovery from anesthesia, the patient developed a severe withdrawal syndrome that required repeated detoxification. In the second case, the patient developed bedsores at the site of the sacrum and scapulae after 7-hour detoxification. Reddening and edema disappeared on day 3 without treatment. In the third case, there was insufficient artificial ventilation due to inspiratory valvular defect. Capnography was not applied. The symptoms of hypercapnia, such hypertension, hyperemia, sweating, were regarded as the symptoms of abstinence so anesthesia was intensified. Valvular defect was detected when the patient developed hypoxia. All the patients were discharged from hospital in a satisfactory condition.

Adult↗

PubMedDate not supplied

Effect of alcohol detoxification on serum S-100B levels of alcohol-dependent individuals.

BACKGROUND: Chronic alcohol consumption has been associated with both liver dysregulation and neurotoxic effects in the central nervous system of human beings and experimental animals. Serum levels of S100B protein have been extensively studied in several conditions of neural tissue injury but not in alcohol abuse. The aim of this study was to evaluate the serum levels of S100B in alcohol-dependent individuals and to further investigate the effect of alcohol detoxification on the levels of S100B. PATIENTS AND METHODS: Our study included 20 alcohol dependent/abusing subjects, diagnosed based on the DSM-IV criteria and treated on an inpatient basis according to a standard detoxification protocol. The serum concentration of hepatic enzymes (ASAT, ALAT, gammaGT), as well as measurements of anxiety, depression and global functioning were obtained at baseline and at weekly intervals over the period of 4-5 weeks, while S100B levels were measured on admission and discharge. RESULTS: Upon admission, hepatic enzyme levels were found increased compared to normal levels and correlated positively with the degree of alcohol consumption of the last year. Interestingly, the ALAT levels correlated positively with S100B levels upon admission. After completion of alcohol detoxification, the hepatic enzyme levels returned to normal. The S100 B levels decreased in 10 patients with a moderate alcohol-consumption over the last year, but increased in 10 patients with high alcohol consumption over the last year. Additionally, a significant correlation was found between the levels of S100B and the global functioning scale at the end of detoxification treatment. CONCLUSION: S100B protein levels are affected differently in alcohol-dependent individuals with either mild or high alcohol consumption during the period of up to one year before assessment. A good correlation between the release pattern of S100B and global functioning scale was found. Although this is a preliminary study, the present data suggest a possible use of S100B protein measurements in detecting alcohol-dependent individuals with high alcohol consumption and in further monitoring the alcohol detoxification treatment.

Adult↗

PubMed1995

[Results of integrated inpatient detoxification and motivation treatment of alcohol dependent patients].

During the course of the disease many alcoholic patients are detoxified on an inpatient basis. Detoxification lasts for some days to 2 or 3 weeks. The treatment goal of abstinence usually cannot be achieved by detoxification alone. Therefore a qualified detoxification should consist of a medical treatment, a careful (psychiatric) diagnostic process and a psychotherapeutic treatment aiming at motivation for further treatment. The described program integrates these components. The psychotherapeutic approach is emphatic and directive, trying to convince all patients to apply for further alcoholism treatment. Follow-up data of 120 of the initial 130 patients eight months after detoxification showed, that 68 patients (57%) started further treatment, most of them as inpatients. In the group of prognostic unfavourable patients, who had not received any disease related counseling before detoxification (77% of the sample), 47% started further alcoholism treatment.

Adult↗

PubMed1996

[Clinical study of scopolamine detoxification for the treatment of heroin addicts].

OBJECTIVE: To evaluate the efficacy of treatment of heroin addicts (n = 100) by scopolamine detoxification (10 days program). METHODS: Methadone detoxification (10 days program) group (n = 50) and clonidine treated group (n = 50) served as controls. RESULTS: The scores of abstinence syndrome in scopolamine detoxification group were lower that those in clonidine treated group in the first three days of protocol, but this difference disappeared in the late stage of treatment. While scopolamine detoxification was effective as methadone detoxification in the control of abstinence syndrome during the first five days of treatment but the difference in the scores of abstinence syndrome between scopolamine and methadone group was observed during the late five days of protocol. The side-effects produced by scopolamine in general were dry mouth, somnolence, tachycardia, blurred vision and so on, which relieved gradually or disappeared with decreasing of its doses. CONCLUSION: Scopolamine does not result in potential dependence and has definite curative effect in the treatment of heroin addiction.

Adult↗

PubMed2003

Detoxification on top of enhanced, diamine-extended glutaraldehyde fixation significantly reduces bioprosthetic root calcification in the sheep model.

BACKGROUND AND AIM OF THE STUDY: Increased concentrations of glutaraldehyde (GA), diamine-extension (DA) of crosslinks and subsequent extraction of excess GA all reduce bioprosthetic calcification in the subdermal rat model. The study aim was to demonstrate the combined effect of all three treatments in a circulatory sheep model. METHODS: Two fixation treatments were used for GA detoxification (urazole in acetate buffer, 0.1 M; pH 4.5; 37 degrees C; 7 days): (i) conventional 0.2% GA fixation (4 degrees C; 7 days); and (ii) enhanced 3.0% GA fixation (4 degrees C; 2 days, followed by a DA interim step; 100 mM L-lysine; 37 degrees C; 2 days, followed by GA; 3.0%; 37 degrees C; 5 days). Entire porcine root prostheses were implanted in the distal aortic arch of young sheep for 12 weeks (n = 5 per group). Non-detoxified 0.2% GA-treated roots served as controls (n = 5). Calcium analysis was based on atomic absorption spectrophotometry; morphology was assessed using light and transmission electron microscopy. RESULTS: Detoxification alone resulted in an 83% reduction of leaflet calcification (p = 0.086), but achieved only 23% (p = 0.145) and 12% (p = 0.362) mitigation of calcification in aortic wall and sinus tissue, respectively. When combined with DA-enhanced 3% GA fixation, detoxification led to a 95% reduction in leaflet calcification (p = 0.057), followed by 79% in sinus (p = 0.003) and 79% in aortic wall tissue (p = 0.0003). Morphologically, detoxification primarily affected leaflets and the subadventitial layer of aortic wall tissue, whereas enhanced fixation seemed to affect all structures. CONCLUSION: It was shown in a circulatory sheep model that a combination of DA-enhanced fixation with an extraction process of excess GA leads to a distinct mitigation of leaflet and aortic wall calcification.

Animals↗

PubMed1999

Biological detoxification of fungal toxins and its use in plant breeding, feed and food production.

Enzymatic inactivation of fungal toxins is an attractive strategy for the decontamination of agricultural commodities and for the protection of crops from phytotoxic effects of fungal metabolites. This review summarizes research on the biological detoxification of fungal toxins by microorganisms and plants and its practical applications. Some mycotoxins are detoxified during ensiling and other fermentation processes (aflatoxins, alternariol, mycophenolic acid, patulin, PR toxin) while others are transformed into toxic products or survive fermentation unchanged. Plants can detoxify fomannoxin, fusaric acid, HC-toxin, ochratoxin A and oxalate but the degradation of deoxynivalenol has yet to be proven. Microflora of the digestive tract of vertebrates and invertebrates exhibit detoxification activities towards aflatoxins, ochratoxin A, oxalate and trichothecenes. Some toxin-producing fungi are able to degrade or transform their own products under suitable conditions. Pure cultures of bacteria and fungi which detoxify mycotoxins have been isolated from complex microbial populations by screening and enrichment culture techniques. Genes responsible for some of the detoxification activities have been cloned and expressed in heterologous hosts. The detoxification of aflatoxins, cercosporin, fumonisins, fusaric acid, ochratoxin A, oxalic acid, patulin, trichothecenes and zearalenone by pure cultures is reviewed. Finally, current application of these results in food and feed production and plant breeding is summarized and expected future developments are outlined.

Agriculture↗

PubMed1992

Methadone maintenance detoxification fear: a study of its components.

These studies added three hypothesized fear components to the Detoxification Fear Survey Schedule (DFSS-14) and compared its psychometric properties to the original. Two disparate methadone maintenance populations (N = 226) were used in scale development. Thirty-one items and three factors emerged. A validation sample (N = 159) from two diverse methadone maintenance populations yielded a 27-item scale that discriminated between interview-diagnosed detoxification fear and non-fear (91.8% and 85.4% correctly classified). Finally, in methadone maintenance patients from three disparate programs in which the prevalence of detoxification fear was known, the DFSS-27 and DFSS-14 were compared. The DFSS-27 showed substantially improved sensitivity. The DFSS-27 seems a useful screen for detoxification fear in methadone maintenance, may aid intervention planning, and may prove a useful interventions outcome measure.

Acquired Immunodeficiency Syndrome↗

PubMed2002

Transcript profiling of enzymes involved in detoxification of xenobiotics and reactive oxygen in human normal and simian virus 40 T antigen-immortalized oral keratinocytes.

The metabolic detoxification capacity may critically regulate the susceptibility of human tissues to cancer development. We used standardized and quantitative, reverse transcription-polymerase chain reaction (StaRT-PCR) and microarray chip techniques to analyze transcript levels of multiple detoxification enzymes in cultured normal human oral keratinocytes (NOK) and the Siman virus 40 T antigen-immortalized oral keratinocyte line SVpgC2a, viewing the latter as a model of a benign tumor state. With good agreement between the 2 methodologies, NOK and SVpgC2a were found to express transcripts for cytochrome P450 enzymes (CYPs), factors related to CYP induction and enzymes involved in conjugation reactions or detoxification of reactive oxygen. The cell types expressed similar levels of CYP 2B6/7, CYP 2E1, P450 oxidoreductase, the aryl hydrocarbon receptor nuclear translocator, sulfotransferase 1A1, sulfotransferase 1A3, epoxide hydrolase, glutathione S-transferase M3, glutathione S-transferase pi and catalase, superoxide dismutase 1, glutathione peroxidase 1 and glutathione peroxidase 3. In contrast, SVpgC2a exhibited comparatively higher levels of CYP1A1, 1B1, aryl hydrocarbon receptor, glutathione S-transferase M1, 2, 4, 5, glutathione S-transferase theta 1 and superoxide dismutase 2 and comparatively lower levels of UDP glycosyltransferase 2 and microsomal glutathione S-transferase 1. Some transcripts, e.g., CYP 2A6/7, were not detected by either standard, non quantitative RT-PCR or the above methods, whereas others were barely quantifiable by StaRT-PCR, i.e., were present at 1-10 molecules/10(6) molecules of actin. Overall, the expression analysis demonstrated presence of mRNA for multiple enzymes involved in foreign compound metabolism and detoxification pathways, including several enzymes not previously reported for oral epithelium. Generally, the comparison of NOK from 2 individuals indicated relatively similar transcript levels of these enzymes. In contrast, differences between NOK and SVpgC2a, e.g., for CYP1B1, may reflect alteration caused by immortalization and aid identification of early stage tumor markers in oral epithelium.

Antigens, Polyomavirus Transforming↗