Long-Term Relapse of Ultra-Rapid Opioid Detoxification

Ultra-rapid opioid detoxification (UROD) and subsequently induction of naltrexone maintenance therapy can be regarded as a safe and effective detoxification method for use in patients with opiate addiction. Long-term efficacy, relapse time, and relapse rate of this method is not clear. The aim of this article was to assess UROD efficacy and estimate the relapse rate in the 2-year follow-up period. Opioid-addicted, self-reporting patients referred to our hospital center were enrolled. All demographic data were collected by direct interview and based on patients’ official documents. Addiction information were obtained from the patients’ own admission and the interviews. Patients then began the UROD process. Thereafter, patients were scheduled for follow-up visits every 3 months for a 2-year period. A total of 424 patients were enrolled in the study and entered the UROD program, of which 400 patients completed. Of the total patients, 303 (75.75%) were successful (successful group) and 97 (24.25%) relapsed (relapse group). The unemployment rate was significantly higher in the relapse group (76%) compared with those in the successful group (21%) (P = .02). No patients in the relapse group continued naltrexone maintenance at 6-month follow-up, which was significantly lower than successful group (75.8%) (P < .05). The relapse rate was 14% at the first month visit and 24% at the 6 month and thereafter. All patients who had a relapse incident discontinued use of naltrexone before relapse happened. UROD could be an effective method of detoxification in addicted patients, but case selection, sticking to the guidelines, and maintenance therapy accompanied with social support is necessary to minimize relapse and withdrawal symptoms.     

Effects of ondansetron administration on opioid withdrawal syndrome observed in rats

This study tested whether a 5-HT₃ receptor antagonist could reverse the signs of precipitated opioid withdrawal. Rats were treated with either saline or morphine for 4 days. After the four days, half of the rats in each group received naloxone and half received saline. Each animal also received one of four doses of ondansetron (0, 1, 2 and 4 mg/kg i.p.). Administration of ondansetron to rats receiving naloxone after chronic morphine decreased the intensity of withdrawal signs such as increased defecation, jumping and wet-dog shakes, elevated the nociceptive threshold values which were decreased by precipitated withdrawal, but produced no change in urination, rectal temperature or salivation. The effects exhibited by ondansetron administration may be explained through interference of its 5-HT₃ receptor antagonist activity with serotoninergic mechanisms involved in the regulation of these withdrawal symptoms. The use of this drug is thus suggested as a possible treatment of opioid withdrawal signs in heroin addicts.     

A Comparison of Clonidine and Buprenorphine in the Outpatient Treatment of Opiate Withdrawal

The opiate withdrawal syndrome, although not life threatening, is a major obstacle in the treatment of opiate dependence. Over a 12 week period, 124 patients (63% female, 66% African American and mean age 32.6 years) underwent 5 day treatment for opiate withdrawal. Patients treated in the first 6 weeks (n = 69) received clonidine based treatment (0.1 mg every 6 h with one dose received on-site each day and the others taken home), while patients treated in the latter 6 weeks (n = 65) received buprenorphine 0.3 mg IM daily. Both groups received supportive medications for diarrhea, cramps, aches, and nausea, had clonidine patches placed on day 4, and were offered naltrexone upon completion. Based on age, gender, and race the two treatment groups were similar. The completion rate was 75.4% for buprenorphine group and 47.5% for the clonidine group, (p = .001). In conclusion, buprenorphine was superior to clonidine in enabling opiate dependent patients to successfully complete an outpatient detoxification program.     

Ultrarapid Opioid Detoxification of Two Children with Congenital Heart Disease

Abstract

The cases of two children with congenital heart disease and severe opioid dependency who underwent ultrarapid opioid detoxification are presented. This technique entails rapid opioid reversal with the opioid antagonist; naloxone while under general anesthesia. The procedures were not technically difficult to perform and both children were successfully detoxified at the end of the procedure. In the weeks following the procedure, the first child exhibited accelerated neurode-velopment. Ultrarapid opioid detoxification is possible in children and may have a neurodevelopmental advantage over a prolonged wean.     

延生口服液对吗啡依赖性大鼠的脱毒治疗作用

目的:评价延生口服液对吗啡依赖性大鼠模型脱毒治疗作用.方法:采用剂量递增法皮下注射吗啡14d和30d,分别建立大鼠吗啡依赖模型,观察延生口服液大、中、小3个剂量对纳洛酮催促和自然戒断的吗啡依赖大鼠戒断症状及体重的影响.结果:延生口服液能显著减轻吗啡依赖大鼠ip纳洛酮引起的催促戒断症状(P＜0.05)和体重下降(P＜0.01),不能明显抑制自然戒断大鼠体重下降(P＞0.05).结论:延生口服液对吗啡依赖性大鼠戒断后所产生的戒断综合征具有明显的脱毒治疗作用.     

Tramadol versus Methadone for Treatment of Opiate Withdrawal: A Double-Blind,Randomized, Clinical Trial

The aim of this study was to compare the efficacy and safety of tramadol versus methadone for treatment of opiate withdrawal. Seventy patients randomly were assigned in two groups to receive either prescribed methadone (60 mg/day) or tramadol (600 mg/day). The withdrawal syndrome of patients was evaluated before and after rapid opiate detoxification using the Objective Opioid Withdrawal Scale (OOWS). No significant differences existed in overall OOWS scores between two groups (P = 0.11). Dropout rates were similar in both groups. Side effects in the tramadol group were as or less common than in the methadone group, with the exception of perspiration. Tramadol may be as effective as methadone in the control of withdrawal and could be considered as a potential substitute for methadone to manage opioids withdrawal.     

Single Dose of 24 Milligrams of Buprenorphine for Heroin Detoxification: An Open-label Study of Five Inpatients

Abstract

Previous studies indicate that buprenorphine has efficacy in medically supervised opioid withdrawal, but the optimal dosing for maximum tolerability and ease of administration remains undetermined. Five heroin-dependent individuals entered this open-label study of inpatient detoxification with a single 24mg dose of buprenorphine. The mean Clinical Opiate Withdrawal Scale (COWS) score prior to buprenorphine administration was 17.6 (SD = 3.36). COWS scores declined significantly thereafter. There was one episode of precipitated withdrawal that resolved within four hours. Use of ancillary medications was minimal. This study suggests that a single high dose of buprenorphine can be used safely and effectively for inpatient detoxification.     

丁丙诺啡脱毒过程催瘾反应相关因子的研究

目的:观察丁丙诺啡在脱毒过程中的催瘾反应及与其相关因子的关系.方法:在相同剂量的丁丙诺啡治疗条件下,前瞻性的观察治疗后的催瘾反应,并对催瘾组和非催瘾组进行相关因子值的比较.结果:丁丙诺啡(首日剂量2.7 mg)在脱毒过程中的催瘾发生率为28.37%,症状在使用药物后平均56.59分钟出现,催瘾症状严重程度分布:轻度6例,中度8例,重度7例.催瘾组与非催瘾组的相关因子值的比较显示:催瘾组体重显著轻于非催瘾组(P＜0.05),催瘾组末次吸毒量明显高于非催瘾组(P＜0.01),催瘾组所吸海洛因纯度较非催瘾组高(P＜0.01),催瘾组与非催瘾组用药时间无显著性差异(P＞0.05).结论:丁丙诺啡在脱毒中出现的催瘾反应是脱毒开始阶段的主要障碍.吸毒者体重较轻,所吸毒品纯度较高,末次吸毒量较高者容易出现催瘾反应,催瘾发生与用药时间的先后无直接关联.     

阿片类戒断综合征的中医辨证计量诊断

目的:探讨阿片类戒断综合征的中医辨证计量诊断.方法:在对423例阿片依赖戒断者调查的基础上,进行了阿片类戒断综合征计量诊断研究,采用最大似然法判别分析模型,建立阿片类戒断综合征中医辨证计量诊断的指数表,继而运用DME方法,对毒瘀内阻寒热错杂证、毒瘀热阻证和毒瘀寒阻证进行了诊断效能的评价,在此基础上又进一步对毒瘀寒热互阻虚证、毒瘀虚热证和毒瘀虚寒证进行了诊断效能的评价.结果:毒瘀寒热互阻虚证评价结果为:灵敏度87.32%,特异度96.88%,误诊率3.13%,漏诊率12.68%,诊断指数184.2%,Youden指数84.2%,阳性预告值84.93%,阴性预告值97.43%,粗符合率95.27%,阳性似然比2.7898,阴性似然比0.1309;毒瘀虚热证评价结果为:灵敏度96.00%,特异度98.74%,误诊率1.26%,漏诊率40.00%,诊断指数194.74%,Youden指数94.74%,阳性预告值82.76%,阴性预告值99.75%,粗符合率98.58%,阳性似然比79.1905,阴性似然比0.4051;毒瘀虚寒证评价结果为:灵敏度95.00%,特异度99.01%,误诊率0.99%,漏诊率5.00%,诊断指数108.01%,Youden指数8.01%,阳性预告值82.61%,阴性预告值99.75%,粗符合率98.82%,阳性似然比95.9596,阴性似然比0.0005.结论:阿片类戒断综合征中医辨证计量诊断指数表具有良好的诊断效能,该方法有一定的推广使用价值.     

Effects of a High-Dose,Fast Tapering Buprenorphine Detoxification Program on Symptom Relief and Treatment Retention

Abstract

A large number of patients with heroin dependency fail to enter a treatment program because of dropping out during or immediately after detoxification. This article presents an open study of symptom relief of 10 patients withdrawing from heroin with a high-dose rapid tapering buprenorphine detoxification protocol. It also presents a pseudo-experimental comparison between 208 patients treated with a clonidine/dextropropoxiphene detoxification protocol and 246 patients treated with the high-dose rapid tapering buprenorphine detoxification protocol to evaluate differences in patients' ability to continue in treatment of addiction immediately after detoxification. The results indicate that 24 mg of sublingually administered buprenorphine beginning when the patient judges himself to be in a withdrawal state followed by another three days of daily administered and rapidly decreased doses resulted in a significant reduction of withdrawal symptoms. Also, when the clonidine/dextropropoxiphene protocol was replaced with this buprenorphine protocol the number of patients continuing in treatment immediately after discharge from the detoxification ward increased from 41.3% to 58.1%. Buprenorphine given in high doses with rapid tapering when withdrawal symptoms occur seems to offer an effective symptom-alleviating treatment, probably also decreasing the number of drop-outs after detoxification.     

吉祥戒毒液对海洛因依赖大鼠戒断症状的抑制作用

目的：研究中药吉祥戒毒液(一种复方的传统中药)对海洛因依赖大鼠戒断症状的疗效。方法：建立海洛因依赖大鼠模型，观察腹腔注射纳洛酮催促戒断以及自然戒断后，吉祥戒毒液对大鼠戒断症状的抑制作用。结果：无论是对纳洛酮催促戒断还是自然戒断的大鼠，吉祥戒毒液高、中、低三个剂量组戒断症状综合积分值均低于生理盐水对照组，但只有高、中剂量的吉祥戒毒液能抑制体重的下降。结论：吉祥戒毒液能明显减轻海洛因依赖大鼠的戒断症状，并且对海洛因依赖大鼠的体重下降有一定的缓解作用。因此，该药是治疗海洛因依赖的有效药物。     

头针治疗海洛因依赖者戒断症状94例的临床研究

目的:比较头针 美沙酮、体针 美沙酮、单纯美沙酮疗法对改善海洛因依赖者脱毒期戒断症状的临床疗效,为今后头针参与戒毒治疗,降低复吸率进行积极的探索。方法:对94例海洛因依赖者用上述三种疗法治疗,随机分为三组,动态观察10天的戒断症状。使用戒断症状量表观察脱毒的疗效。结果:治疗10天后评分显示:头针组控制戒断症状的效果最为完全,体针组也有一定的效果,但不及头针组,两组比较有统计学意义(P<0.01)。两组针刺组的治疗效果均好于单纯美沙酮组(P<0.01)。在脱毒期失眠、焦虑症状的改善方面,头针组和其它两组比较表现出明显的优势(P<0.01)。在脱毒期躯体症状的改善方面,头针组和体针组无统计学差异(P>0.05)。在脱毒期焦虑症状的改善方面,体针组和美沙酮组比较无统计学意义(P>0.05)。结论:头针减轻了海洛因依赖者脱毒期戒断症状,特别是在改善患者的失眠、焦虑等精神依赖方面具有明显的优势,在目前尚无特效的戒毒疗法的情况下,针灸参与戒毒具有疗效肯定、无副作用、经济安全的特点,头针结合药物产生了一定的协同作用。     

Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients

Approximately 16–31% of patients in the intensive care unit (ICU) have an alcohol use disorder and are at risk for developing alcohol withdrawal syndrome (AWS). Patients admitted to the ICU with AWS have an increased hospital and ICU length of stay, longer duration of mechanical ventilation, higher costs, and increased mortality compared with those admitted without an alcohol‐related disorder. Despite the high prevalence of AWS among ICU patients, no guidelines for the recognition or management of AWS or delirium tremens in the critically ill currently exist, leading to tremendous variability in clinical practice. Goals of care should include immediate management of dehydration, nutritional deficits, and electrolyte derangements; relief of withdrawal symptoms; prevention of progression of symptoms; and treatment of comorbid illnesses. Symptom‐triggered treatment of AWS with γ‐aminobutyric acid receptor agonists is the cornerstone of therapy. Benzodiazepines (BZDs) are most studied and are often the preferred first‐line agents due to their efficacy and safety profile. However, controversy still exists as to who should receive treatment, how to administer BZDs, and which BZD to use. Although most patients with AWS respond to usual doses of BZDs, ICU clinicians are challenged with managing BZD‐resistant patients. Recent literature has shown that using an early multimodal approach to managing BZD‐resistant patients appears beneficial in rapidly improving symptoms. This review highlights the results of recent promising studies published between 2011 and 2015 evaluating adjunctive therapies for BZD‐resistant alcohol withdrawal such as antiepileptics, baclofen, dexmedetomidine, ethanol, ketamine, phenobarbital, propofol, and ketamine. We provide guidance on the places in therapy for select agents for management of critically ill patients in the presence of AWS.     

Effects of a Single Lyric Analysis Intervention on Withdrawal and Craving With Inpatients on a Detoxification Unit: A Cluster-Randomized Effectiveness Study

Background: For patients hospitalized on inpatient detoxification units, reducing negative symptoms such as withdrawal and craving is a key treatment area. Although lyric analysis is a commonly utilized music therapy intervention for clients in substance abuse rehabilitation, there is a lack of randomized controlled music therapy studies systematically investigating how lyric analysis interventions can affect patients on a detoxification unit. Objective: The purpose of this cluster-randomized effectiveness study was to measure the effects of single-session group lyric analysis interventions on withdrawal and craving with patients on a detoxification unit. A secondary purpose of this study was to determine if relationships existed between treatment effects and participants’ familiarity with the song. Methods: Participants (N = 144) were cluster-randomized to experimental (posttest only) or wait-list control (pretest only) conditions to provide treatment to all participants in an inclusive single-session design. Results: Although participants in the experimental condition had lower withdrawal and craving means than participants in the control condition, these differences were not significant. Familiarity of the song in the lyric analysis was not related to withdrawal or craving. Conclusion: Group-based lyric analysis interventions may be effective for temporarily relieving withdrawal and craving in patients on a detoxification unit. Familiarity of the song did not affect results. Implications for clinical practice, suggestions for future research, and limitations are provided.     

Factor Analytical Investigation of Krathom (Mitragyna speciosa Korth.) Withdrawal Syndrome in Thailand

Krathom (Mitragyna speciosa Korth.) is an addictive and illicit substance used in Thailand and other Southeast Asian countries. It has become the most commonly used substance among villagers. The study aimed to explore the factor structure of the krathom withdrawal syndrome based on the findings of an earlier qualitative study. The current study was divided into two stages. Cross-sectional data collections were employed in both phases. The samples comprised, respectively, 196 and 330 krathom users aged over 25 years. The characteristics of krathom withdrawal symptoms and signs were identified and the factor structure examined using exploratory factor analysis (EFA). Confirmatory Factor Analysis (CFA) was used to examine the construct validity and multivariate linear regression was used to identify factors predicting the intensity of krathom withdrawal symptoms. The final scale comprised 20 items with four factors: craving-fatigue syndrome; musculoskeletal system and insomnia; mood symptoms; and autonomic nervous system/physical sickness. Symptoms and signs of krathom withdrawal similar to those of the withdrawal syndrome of opioid substances appear to be present in regular krathom users. The krathom withdrawal intensity is predicted by duration of krathom use, frequency, and daily amount of krathom use.     

Reducing Bias in Observational Research on Alcohol Withdrawal Syndrome

Observational methods are often used to study alcohol withdrawal syndrome. Observational cohorts and case–control studies are useful in research on prognosis and in situations where ethical concerns might prevent the use of clinical trial designs. In addition, case–control studies are appropriate for studying the rare but serious complications of alcohol withdrawal syndrome. Despite their appeal and suitability, these methods are subject to a number of biases that can render their results suspect. Susceptibility, diagnostic suspicion, and exposure suspicion bias are among the important biases to consider in observational studies on alcohol withdrawal syndrome. Strategies for reducing these biases include the creation of inception cohorts, the use of operational definitions, and blinding. Increased attention to these strategies should help clinicians and researchers improve the practice of caring for patients with alcohol withdrawal syndrome.     

Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature

The authors evaluated all available evidence on the use of propofol as an adjuvant for the treatment of resistant alcohol withdrawal syndrome (AWS) in comparison to other therapies. A comprehensive PubMed search (1966–December 2015) was conducted using the search terms propofol, alcohol withdrawal, and drug therapy. Articles were cross‐referenced for other citations. Clinical studies, case series, and case reports published in the English language assessing the use of propofol in adult patients for treatment of AWS were reviewed for inclusion. Propofol is a sedative‐hypnotic that exerts its actions through agonism of GABA_A receptors at a different binding site than benzodiazepines and reduces glutamatergic activity through N‐methyl‐d ‐aspartase (NMDA) receptor blockade. Dosages from 5 to 100 μg/kg/minute reduced AWS symptoms with frequent development of hypotension and requirement for mechanical ventilation. Patients on propofol often experienced longer durations of mechanical ventilation and length of stay, which may be attributed to more‐resistant cases of AWS. When propofol was compared with dexmedetomidine as adjuncts in AWS, both agents showed similar benzodiazepine‐ and haloperidol‐sparing effects. Dexmedetomidine was associated with more numerical rates of bradycardia, while propofol was associated with more numerical instances of hypotension. Dexmedetomidine was used more frequently in nonintubated patients. The available data assessing the utility of propofol for AWS exhibited significant heterogeneity. Propofol may be useful in a specific population of patients with AWS, limited to those who are not clinically responding to first‐line therapy with benzodiazepines. Specifically, propofol should be considered in patients who are refractory to or not candidates for other adjuvant therapies, patients already requiring mechanical ventilation, or those with seizure activity or refractory delirium tremens. In severe, refractory AWS, adjuvant therapy with propofol may be considered but requires further research to recommend its use either preferentially or as monotherapy.     

早期给予右美托咪定对重症监护酒精戒断综合征患者苯二氮

摘 要 目的：评估右美托咪定的早期给予对重症监护酒精戒断综合征患者苯二氮卓类药物需求的影响。方法: 重度酒精戒断综合征成年患者60例,随机分成A、B两组,每组30例。A组接受苯二氮卓类药物的同时早期给予右美托咪定,B组只接受常规苯二氮卓类药物治疗。记录患者第一次注射右美托咪定后24 h对苯二氮卓类药物的累计需求量、ICU和住院时间、机械通气情况、低血压和心率过缓发生率等。 结果: A组患者注射后24 h 对苯二氮卓类药物的需求明显低于B组[（8.6±1.2）mg vs (25.6±4.9)mg, P<0.05]。两组患者使用机械通气的例数相近,但A组患者插管持续时间明显低于B组[（24.9±3.1)h vs(48.8±6.9) h, P<0.05]。A组患者相对于B组表现出更高的心动过缓发生率（57% vs13%, P<0.05）。结论:作为治疗戒酒综合征的辅助用药,早期给予右美托咪定可显著降低ICU患者对苯二氮卓类药物的需求。