Methadone combined with clonidine versus clonidine alone in opiate detoxification

The availability and use of a methadone/clonidine combination versus clonidine alone in opiate detoxification were studied. In Phase I of the study, a sequential combination of methadone followed by clonidine was utilized in those patients presenting with a primary diagnosis of opiate dependence. During the Phase II of the study, only clonidine was available. Medications were administered only if the history and clinical findings indicated impending or acute opiate withdrawal syndrome. Overall, there was no difference between the Phase I and Phase II groups when the number of opiate dependent admissions, patients completing detoxification, and the patients completing a follow-up rehabilitation program were compared. However, the patients in Phase I whose clinical symptomatology warranted the use of methadone were more likely to complete the detoxification program when compared to the patients in Phase II who received clonidine only. There was no difference between the two groups in completion of a follow-up rehabilitation. Detoxification with clonidine alone was more likely to be successful if the patient has had prior detoxification experience with methadone or if there was a secondary dependence of alcohol, sedative, or tranquilizer present coexisting with the primary opiate dependence diagnosis.     

美沙酮、丁丙诺啡、可乐定、纳曲酮“阶梯式”疗法治疗海洛因依赖脱毒后复吸患者33例

采用美沙酮、丁丙诺啡、可乐定、纳曲酮为主药的“阶梯式戒毒疗法”，治疗３３例戒毒后屡次复吸的海洛因依赖者。成功戒断８例，已操守０．５ａ以上，停服纳曲酮２个月以上；仍在服纳曲酮１６例，已分别服用１－４个月，操守率７２．７％；失败９例，其中服纳曲酮１－２个月后又复吸海洛因４例，治疗中失去联系而脱试３例，服纳曲酮１次后，戒断症状重而中止，改为自然康复２例，失败率２７．３％；配合心理疏导，有显著抗复吸作用，心理依赖降低，戒毒效果良好。     

可乐宁快速无成瘾性戒毒治疗的效能评估研究

通过对可乐宁与美沙酮不同戒毒效能的比较及可乐宁对于不同等级戒断症状戒毒效能的研究,可以看出可乐宁对于海洛因成瘾者的戒毒治疗是一种有效的方法。它对于各级别戒断症状都有明显的作用。由于可乐宁本身不具成瘾性,所以它是一种值得推广的戒毒治疗药物。其应用剂量以1 mg·d~(-1)左右为宜,个别戒断症状较严重的病例可将剂量提高到1.5 mg·d~(-1),或于戒毒治疗第1,2 d分别给于阿片片剂100 mg和50 mg,以提高戒断症状缓解速度。当可乐宁服用较大剂量时应加强护理,随时观察血压和脉搏的变化。避免突然直立而引起的直立性虚脱。在用药的前3 d,嗜睡、头晕、乏力等症状比较突出,但随剂量逐渐减少,这些症状也随之缓解。可乐宁戒毒治疗的突出不良反应是低血压,虽加用较小剂量三环类抗抑郁药和中药生脉饮,但尚未能得到满意效果,对此在今后的工作中需进一步进行研究并加以解决,以提高戒毒者耐受能力,使可乐宁戒毒治疗方法更加完善。     

A comparison of residential heroin detoxification patients and methadone maintenance patients

Interviews were conducted with 101 heroin dependent persons entering a residential drug-free detoxification unit in 1989. These self-report data were compared with those previously collected in 1985-6 from 457 methadone maintenance patients. The detoxification patients injected less frequently, used less heroin, had been physically dependent for a shorter period and were more likely to be single, unemployed and to have been charged with a criminal offence in the last 12 months. It is suggested that these findings may indicate that addicts who use more heroin are less likely to seek drug-free detoxification. The wider implication of the finding is that future surveys of injecting drug users should assume that there are significant differences between heroin users entering different modalities of treatment.     

美沙酮替代递减法用于海洛因依赖者戒毒治疗的评估性研究

本文对海洛因成瘾者用美沙酮进行戒毒的不同治疗方案进行评估。A组53例采用18-21 d给药的经验方案;B组69例采用14 d个体化给药方案。结果表明,美沙酮两种给药方案均有肯定的戒毒效果。B组的戒断症状较轻,波动小,症状控制及治疗时间均优于A组。     

Outcomes after detoxification for heroin dependence: findings from the Australian Treatment Outcome Study (ATOS)

As part of the Australian Treatment Outcome Study (ATOS), 177 (88%) heroin users entering detoxification (DTX) and 66 (83%) heroin users not in treatment (NT) were interviewed at baseline and 3 months to examine drug use, risk-taking, overdose, crime and psychopathology outcomes. The majority (76%) of the DTX group had entered additional treatment at 3 months, mainly further detoxification, and 54% were currently in treatment, mainly maintenance and residential rehabilitation. There were reductions in heroin use and other drug use in those entering detoxification. Forty-two per cent were abstinent at 3 months compared to 20% in the NT group. There were also reductions in crime among those entering DTX, and less marked reductions in the NT group. Psychopathology showed less change. Detoxification may, in some part, function as a gateway to further treatment and those entering DTX showed modest but significant improvements across drug use and crime at 3 months. [Teesson M, Havard A, Ross J, Darke S. Outcomes after detoxification for heroin dependence: findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Rev 2006;25:241 - 247]     

可乐定加安定治疗海洛因成瘾125例临床总结

１２５例海洛因成瘾者经用可乐定加安定进行戒毒，并按戒断症状严重程度不同而采用不同给药方案，结果表明，总戒断率为９６．８％，其中戒断１０５例，显效１６例，减轻４例。戒毒过程中，用药量递减顺利，护理较方便，便于病房管理，估计可能与可乐定不致瘾特性有关。戒断出院后经追踪随访，发现因各种心理或生理因素导致再成瘾者比率仍相当高，这确是全世界都认为最严重的一个问题，我们也应在这方面给以更多重视。     

泰康宁胶囊对海洛因依赖患者脱毒疗效与安全性的临床观察

目的:观察泰康宁胶囊对海洛因依赖患者的脱毒效果及用药安全性。方法:采用开放试验设计,对50例海洛因依赖患者进行了观察。泰康宁胶囊常规口服剂量为1.5～3.0g,3次/d,根据戒断症状控制及不良反应情况增减剂量,最多可至4.0g,3次/d,连续用药10d。脱毒药效评价指标采用戒断症状逐日总体评分、主要戒断症状逐日分别评分、Hamilton焦虑量表(HAMA)评定。用药期间监测不良反应。结果:每日戒断症状总分、主要戒断症状逐日评分以及HAMA评分与用药前比较,差异均具有统计学意义(P<0.001)。不良反应主要有恶心呕吐、腹泻、口干、复视。对呼吸、心率、血压无影响。结论:泰康宁胶囊用于海洛因依赖患者脱毒治疗安全有效。     

Pharmacological maintenance treatments of opiate addiction

For people seeking treatment, the course of heroin addiction tends to be chronic and relapsing, and longer duration of treatment is associated with better outcomes. Heroin addiction is strongly associated with deviant behaviour and crime, and the objectives in treating heroin addiction have been a blend of humane support, rehabilitation, public health intervention and crime control. Reduction in street heroin use is the foundation on which all these outcomes are based. The pharmacological basis of maintenance treatment of dependent individuals is to minimize withdrawal symptoms and attenuate the reinforcing effects of street heroin, leading to reduction or cessation of street heroin use. Opioid maintenance treatment can be moderately effective in suppressing heroin use, although deviations from evidence-based approaches, particularly the use of suboptimal doses, have meant that treatment as delivered in practice may have resulted in poorer outcomes than predicted by research. Methadone treatment has been ‘programmatic’, with a one-size-fits-all approach that in part reflects the perceived need to impose discipline on deviant individuals. However, differences in pharmacokinetics and in side-effects mean that many patients do not respond optimally to methadone. Injectable diamorphine (heroin) provides a more reinforcing medication for some ‘nonresponders’ and can be a valuable option in the rehabilitation of demoralized, socially excluded individuals. Buprenorphine, a partial agonist, is a less reinforcing medication with different side-effects and less risk of overdose. Not only is it a different medication, but also it can be used in a different paradigm of treatment, office-based opioid treatment, with less structure and offering greater patient autonomy.     

Emergency management of inadvertent accelerated opiate withdrawal in dependent opiate users

Six opiate-dependent drug users presented to the local emergency department within a 10-day period with symptoms of severe opioid withdrawal immediately following intravenous use of recently acquired street 'heroin'. The withdrawal picture was similar to that described in patients undergoing rapid opioid detoxification, suggesting that the substance injected was contaminated with an opiate antagonist. A number of potential compounds are discussed, including naltrexone and buprenorphine, and recommendations for the medical management of severe opiate withdrawal within an emergency setting are outlined. [Lubman DI, Koutsogiannis Z, Kronborg I. Emergency management of inadvertent accelerated opiate withdrawal in dependent opiate users. Drug Alcohol Rev 2003;2:433 - 436]     

二氢埃托啡与美沙酮联合用药对海洛因依赖者的戒毒效果

海洛因依赖者２４０例。随机分成美沙酮组，二氢埃托啡组和二药联合用药组。在三个自愿戒毒机构按统一的评价量表进行对海洛因依赖者戒毒效果的观察。结果表明，联合用药组起效快，控制症状彻底，过程平稳，停药后基本无反跳现象，一般无脱试者，效果满意。     

Bridges and barriers to recovery: Clinical observations from an opiate recovery project

Clinical issues are described in opiate addicts attempting to taper off methadone maintenance, and techniques are suggested to help this patient population. The observations were generated in an experimental “Tapering Network” project, in which opiate addicts on methadone maintenance had the opportunity to receive individual and group counseling, relapse prevention training, self-help groups, and other services. Vignettes illustrate clinical problems with intimacy and social isolation, identity as a former addict, and a “post methadone syndrome” characterized by vulnerability, dramatic swings in mood, and disordered thinking for a period of up to six months after detoxification. To counteract these barriers to recovery, a program model is suggested that uses curricula available in the emerging literature on treatment of substance abuse. These techniques can provide bridges to recovery.     

快速脱毒加纳曲酮栓植入治疗海洛因依赖疗效观察

目的:寻找一种安全、有效、可靠、病人能够接受的治疗方法,以降低海洛因依赖病人的复吸率。方法:使用全麻下快速药物拮抗脱毒加纳曲酮栓植入方法,治疗海洛因依赖69例,并通过随访的方式跟踪治疗效果。结果:植入长效纳曲酮缓释栓6个月后,患者对海洛因渴求程度分值从植入前2.21±s0.58降至0.21±s0.14,再尝试海洛因率从81.25%降至5.00%。肝功能与植入前相比无明显变化。结论:全麻快速脱毒加长效纳曲酮缓释栓植入的治疗方法安全、有效、可靠,值得推广使用。     

美沙酮与丁丙诺啡联合用于海洛因依赖者脱毒治疗临床评估性研究

本文采用美沙酮与丁丙诺啡联合用药方案治疗海洛因依赖患者６０例，并与单药美沙酮组３０例，单药丁丙诺啡组３０例进行比较，结果显示联合用药组控制　断症状满意，两药过渡平衡，减药时症状反复较少，方法简便，１０ｄ左右可完成脱毒治疗．脱毒成功率为８３．３％。     

Pharmacological options for management of opioid dependence

Methadone is currently the only opioid available for the pharmacotherapy of opioid dependence. Cross-tolerance between methadone and other opioids constitutes the pharmacological basis for substitution and attenuating the effects of illicit opioid use. However, these principles limit the utility of methadone. Potential alternative opioids include long-acting partial agonists such as buprenorphine and pure antagonists such as naltrexone. Buprenorphine is an alternative to methadone with intermediate intrinsic efficacy. It has a large margin of safety, yet displays some agonist actions similar to methadone. It has greater potential than methadone to safely and effectively block the actions of illicit opioids. Naltrexone is a safe, convenient opioid-antagonist for use following detoxification from opioid agonists. Its main use is to block the actions of other opioids, thereby attenuating or eliminating illicit use during treatment. However, it is poorly accepted by many clients, limiting its application to a sub-group who are highly motivated to detoxify. The distinct pharmacological properties of these opioids can overcome some of the drawbacks of methadone, but other limitations may emerge. Non-opioid adjuncts such as alpha2-adrenoceptor agonists can also have a role during detoxification. These drugs might be of use for specific groups of opioid users, providing therapists with the flexibility to tailor pharmacotherapy to the individual needs of clients.     

Lofexidine versus clonidine in rapid opiate detoxification

The aim of the present study is to evaluate lofexidine and clonidine, in an accelerated opiate detoxification procedure (3 days), without anaesthesia. Forty heroin-dependent individuals were detoxified, evaluating withdrawal symptoms, craving levels, mood changes, urine toxicologic screens, and dropout during therapy with either (1) clonidine, oxazepam, baclofen, and ketoprofene, with naloxone and naltrexone for 3 days (20 subjects) or (2) lofexidine, oxazepam, baclofen, and ketoprofene with naloxone and naltrexone for 3 days (20 subjects).Both clonidine and lofexidine rapid detoxifications were found effective. The subjects treated with lofexidine showed significantly lower levels of withdrawal symptoms, fewer mood problems, less sedation and hypotension. No significant differences in craving levels, morphine metabolites in urine, or dropout rate were evidenced between the two groups. The early use of naltrexone during detoxification in combination with either alpha-2-agonist facilitated the acceptance for long-term naltrexone treatment. Lofexidine appeared to be more useful than clonidine in a 3-day accelerated opiate detoxification, not only to counteract withdrawal symptoms, but also in the treatment of dysphoria and mood changes. Because lofexidine does not produce hypotension, safe outpatient treatment, without hospital support, could be possible.     

Advances in dihydroetorphine: From analgesia to detoxification

Dihydroetorphine is the first narcotic analgesic successfully developed and approved for production in China. As an analgesic, it has been used safely and effectively in clinical practice for 12 years. In recent years, it has been used successfully for substitution therapy in detoxification from opiates. As a drug for detoxification from opiates, the main advantages of DHE are its quick onset of effect and thorough control of the abstinence symptoms. DHE can detoxify heroin dependence in 7–10 days and does not cause dependence in reasonable therapeutic regimens. Drug Dev. Res. 39:131–134. © 1997 Wiley-Liss, Inc.     

Neuropsychological performance in opiate addicts after rapid detoxification

Neuropsychological performance before and after a rapid (1 week) detoxification treatment, was studied in heroin addicts. Ninety-three opioid dependents (DSM-III) were evaluated with a brief test battery assessing attention, memory and verbal fluency performance prior to their admission to a Detoxification Unit. Significant differences were noted between the addicts' performance and a group of 30 comparable normals, whose intellectual ability was similar. At re-evaluation addicts showed improvement in most measures, including general clinical status. Moreover, no differences between the sample of detoxificated addicts and controls on measures of neuropsychological performance were then detected. No relationship was found between psychopathological symptoms and neuropsychological functioning after the pharmacological detoxification of addicts. The length of addiction or drug consumption were not predictive of neuropsychological impairment in the present sample of heroin addicts.     

可乐宁治疗海洛因成瘾临床疗效观察

使用α-受体激动剂可乐宁对60例海洛因成瘾者戒毒治疗,并与亚冬眠疗法对照进行观察。戒毒期间,可乐宁使用有效率为96.6%,与对照组(71.6%)比较,具有非常显著性差异,证明可乐宁的治疗效果可靠。根据海洛因戒断症状的临床表现和体征,本文将可乐宁治疗分为两组,对药物效能进行观察,治疗后72 h两组疗效结果提示,治疗早期配合使用抗焦虑类药物可以明显提高治疗药物的抑制效能,并能缓解与之伴随的主观不适诸症。结果说明可乐宁适用于各种类型的海洛因成瘾者的戒毒治疗。