Efficacy of clonidine and of methadone in the rapid detoxification of patients dependent on heroin

The efficacy of a rapid detoxification schedule (8 to 10 days) with clonidine or methadone was evaluated in 30 patients addicted to heroin. The dose of study drug was preestablished according to the subject's weight and the amount of opioid consumption, and the total daily dose was reduced by approximately 15% during the study. All subjects completed the detoxification program and stayed in the hospital for at least 12 days. Clonidine and methadone therapies proved to be highly effective. There was a marked reduction in anxiety during opioid detoxification, although subjects' experiences differed according to the drug used. On the day of discharge, subjects who had received methadone still had attenuated withdrawal symptoms, whereas there were no such symptoms in the clonidine group. Muscular aching, flatulence, and daily drowsiness were more common among subjects in the methadone group, while subjects in the clonidine group had more sleep disturbances and weeping. Syncopal episodes and bradycardia occurred more frequently in the clonidine group.     

社区阿片类药物依赖者自愿美沙酮脱毒治疗护理干预

目的：探讨社区阿片类药物依赖者应用美沙酮脱毒治疗的护理干预效果。方法对阿片类药物依赖者应用美沙酮脱毒治疗期间采用家庭关系疏导、心理护理、集体心理治疗、认知行为治疗、电话随访以及健康教育等措施进行护理干预。结果经过相应的护理干预后,患者治疗依从性显著提高,增加了脱毒信心,生活质量明显改善。结论对社区阿片类药物依赖者应用美沙酮脱毒治疗过程中进行综合护理干预,能增强患者戒毒的信心,提高患者及家庭的生活质量,帮助患者回归社会。     

Successful treatment of erythromelalgia with intrathecal hydromorphone and clonidine

OBJECTIVE: The objective of this study was to determine if intractable pain from erythromelalgia could be successfully treated with intrathecal hydromorphone and clonidine. DESIGN: A single case of pain from erythromelalgia refractory to multiple treatment modalities was examined and treated. SETTING: The setting is an outpatient pain clinic at a major university teaching hospital. PATIENT: Our patient is an 82-year-old woman with hypertension and peripheral vascular disease. INTERVENTION: Intrathecal opioid and an alpha2-agonist were administered. OUTCOME MEASURES: Outcome was determined by means of patient self-report during office follow-up visits. RESULTS AND CONCLUSIONS: Administration of intrathecal opioid and an alpha2-agonist can be effective in the treatment of the pain of erythromelalgia and offers an alternative pain treatment modality for patients with unremitting pain refractory to more conservative therapy.     

Plasma methadone measurements and their role in methadone detoxification programs.

We monitored eight patients who were receiving a decreasing dose of methadone for treatment for opioid addiction (detoxification). Patients with plasma concentrations of methadone less than 0.05 mg/L experienced withdrawal symptoms, relapsed, and re-abused illicit drugs. Four patients took extra methadone (illicitly obtained) during detoxification. None of the eight patients in our study were successfully weaned off methadone: all left the methadone detoxification program before the completion of treatment. Two patients subsequently returned to a fixed methadone program elsewhere, and four relapsed and returned to illicit drug misuse. Plasma measurements may help clinicians assess patients during methadone detoxification.     

美沙酮脱毒期间体位性低血压的观察及护理

目的观察美沙酮脱毒期间体位性低血压的情况。方法测量海洛因依赖患者入院时和使用美沙酮脱毒第4天血压的情况。结果入院时和使用美沙酮脱毒第4天体位性低血压的发生率差异无统计学意义(P>0.05)。结论我院治疗期间并未见由美沙酮引起的体位性低血压。临床上经常有美沙酮脱毒期间患者出现体位性低血压的报道,可能是由其他因素造成,如服用药物(氯氮平、美舒郁、乐孚亭等)、治疗个体的生活方式(长时间卧床)等引起。对可能出现的体位性低血压患者应加强护理,以防意外发生。     

美沙酮维持治疗者滥用甲基苯丙胺的因素分析

目的 探讨美沙酮维持治疗(methadone maintenance treatment,MMT)者滥用甲基苯丙胺的影响因素。 方法 选取2013年1月-2016年6月在MMT门诊接受治疗的255例患者为调查对象,自拟调查问卷统计社会学特征、对甲基苯丙胺的认知情况、MMT治疗情况,进行单因素及多因素Logistic回归分析。 结果 255例MMT患者中,甲基苯丙胺尿检阳性者28例,占11.0%,单因素分析结果表明不同性别、年龄、居住方式、对甲基苯丙胺的了解情况、甲基苯丙胺对性行为影响的认知、近3个月是否吸食毒品的患者,其甲基苯丙胺尿检阳性率存在统计学差异,多因素Logistic回归分析结果表明年龄(OR=2.190)、甲基苯丙胺对性行为影响的认知(OR=1.237)及近3个月吸食毒品(OR=2.876)是造成甲基苯丙胺滥用的危险因素。 结论 针对MMT患者滥用甲基苯丙胺的危险因素,应当加强教育,以减少甲基苯丙胺的使用,预防艾滋病感染。     

治疗社区模式在美沙酮维持治疗中的应用

治疗社区（therapy community，TC）是20世纪50年代后期在美国戴托普发展起来的一种能有效治疗和帮助药物滥用者戒毒的康复模式。美沙酮维持治疗（methadone maintenance trear ment，MMT）MMT要求海洛因成瘾人员每天到指定地点，在工作人员监督下口服一定剂量的美沙酮，从而减少非法毒品的使用和相关高危行为的发生。由于MMT是一种替代疗法而不是根治疗法，因此病人可能需要无限期地保持在治疗中，即终生参加维持治疗。是针对海洛因（乙醋吗啡）等阿片类毒品依赖者采取的一种替代治疗方法。相关报道：1998年9月28日我国第一个TC-云南戴托普药物依赖治疗康复中心成立，2003年10月16日北京公安局安康医院向日葵治疗社区建立。2004年4月-2005年12月，我国共批准美沙酮维持治疗试点门诊已达128家。美沙酮维持治疗试点门诊的建立是促使海洛因成瘾者的行为、方式、生活态度改变的一种重要的治疗场所。社区护理已成为护理范围内不可缺少的一部分。而社区护理中，病人健康教育又是社区护理中最基本、最重要的组成部分之一。通过国内外TC经验，结合本单位的实际情况，把美沙酮社区药物维持治疗与治疗社区模式有机结合，了解治疗社区模式可否完全在美沙酮社区维持治疗中应用。现将治疗社区模式的应用情况介绍如下。     

The experience of chronic severe pain in patients undergoing methadone maintenance treatment

Recent studies indicate that severe chronic pain is common among patients in methadone maintenance treatment (MMT), but no qualitative studies have examined such patients' experiences of pain and pain treatment. This study used qualitative methods to explore the experiences of MMT patients with chronic pain. Twelve patients screening positive for chronic severe pain on the Brief Pain Inventory were interviewed for the study. Results suggest that chronic severe pain has major consequences in the lives of methadone maintenance patients and may be linked to illegal drug use, social isolation, and role failure. A variety of barriers limited access to effective treatment. A common complaint with care was providers' lack of concern or inability to "listen." Patients who were satisfied with treatment focuses on the psychosocial dimensions of care. These preliminary results suggest that treatment approaches should emphasize emotional support, negotiation of explanatory models, and an emphasis on the psychosocial sequelae of pain. However, more research is needed to guide the development of effective treatment strategies.     

循序式肌肉放松法对强制戒毒患者焦虑和抑郁情绪的影响

目的观察循序式肌肉放松法对强制隔离戒毒患者焦虑、抑郁情绪的影响。方法将76例戒毒患者按入戒毒所顺序分为观察组和对照组各38例,两组患者均接受常规治疗护理、健康宣教和习艺劳动,观察组在此基础上进行循序式肌肉放松法训练。采用抑郁自评量表、焦虑自评量表进行测评分析。结果干预3月后,两组抑郁、焦虑自评均分比较有统计学意义。结论循序式肌肉放松法能有效缓解强制隔离戒毒患者的焦虑、抑郁情绪。     

Massive hydromorphone dose delivered subcutaneously instead of intrathecally: guidelines for prevention and management of opioid, local anesthetic, and clonidine overdose

Increasing numbers of patients with refractory pain are receiving intrathecal drug delivery systems (IDDS). We describe a case to illustrate the clinical manifestations and management implications of inadvertent overdose with drugs used in IDDS, including opioids, clonidine, baclofen, and local anesthetics. An IDDS patient received a bimonthly dose of intrathecal hydromorphone subcutaneously. The patient received a total of 540 mg hydromorphone into the subcutaneous pocket around the intrathecal pump. She was treated with naloxone intravenously over 12 hours, and had no major adverse sequelae. Such occurrences may happen more frequently with the expanded use of IDDS and clinicians should be prepared to take quick action. Counteracting an opioid with naloxone until the opioid is metabolized and excreted can be done safely. Inadvertent subcutaneous administration of other types of drugs could be more difficult to manage.     

Double-blind parallel comparison of multiple doses of apraclonidine, clonidine, and placebo administered intra-articularly to patients undergoing arthroscopic knee surgery

OBJECTIVE: This clinical study assessed and compared the potential analgesic and adverse effect of IA apraclonidine with IA clonidine. METHODS: Eighty patients scheduled for arthroscopic knee surgery under general anesthesia were randomized to receive, in a double-blind manner, either IA normal saline (group 1), 50 microg IA apraclonidine (group 2), 150 microg IA apraclonidine (group 3), or 150 microg IA clonidine (group 4), all in a volume of 20 mL subsequent to surgery. Visual analog pain scores (VAS), the duration of analgesia as defined by the time to first demand for supplemental analgesics, the subsequent 24-hour consumption of postoperative supplementary analgesics, and patient adverse effects were evaluated. RESULTS: The patients from groups 3 and 4 demonstrated a longer duration of analgesia and used fewer analgesics in the first postoperative 24 hour period compared with group 1 and 2 patients (P < 0.05). The VAS scores corresponding to the periods 1, 2, and 4 hours postoperatively were significantly lower for group 3 than for group 1 patients. The VAS scores at 1 and 4 hours postoperatively were also lower for group 3 than for group 2 patients (P < 0.05). There was no significant difference in the incidence of side effects among the 4 groups. DISCUSSION: The IA application of 150 microg apraclonidine and 150 microg clonidine provide similar degree of postoperative analgesia following knee arthroscopic surgery without any difference in adverse events.     

Peginterferon alfa-2a does not alter the pharmacokinetics of methadone in patients with chronic hepatitis C undergoing methadone maintenance therapy

OBJECTIVE: Our objective was to quantify the pharmacokinetics of methadone and the pharmacokinetics and pharmacodynamics of peginterferon alfa-2a (40 kd) in patients with chronic hepatitis C undergoing methadone maintenance therapy. METHODS: Adults with chronic hepatitis C who had been receiving a consistent methadone maintenance regimen for at least 3 months were eligible for this open-label, multicenter, nonrandomized drug interaction study. All patients received 180 microg subcutaneous peginterferon alfa-2a once weekly for 4 weeks and continued their methadone regimen. Serial blood samples were collected at baseline and immediately before and for up to 168 hours after study drug administration for the purposes of quantifying methadone and peginterferon alfa-2a serum concentrations, measuring serum 2',5'-oligoadenylate synthetase activity, and determining hepatitis C virus ribonucleic acid levels. RESULTS: Twenty-four patients were enrolled. Methadone exposure, as measured by maximum serum concentration (C(max)) and area under the concentration-time curve (AUC) normalized to a 100-mg/d dose, after 4 doses of peginterferon alfa-2a increased by 10% to 15% when compared with baseline. The week 4/baseline ratio of the mean C(max) was 1.11 (90% confidence interval [CI], 1.02-1.22), and for AUC from time 0 to 24 hours, the week 4/baseline ratio was 1.15 (90% CI, 1.08-1.23). The mean accumulation ratios (week 4/first dose) for C(max) and AUC from time 0 to 168 hours of peginterferon alfa-2a were 2.1 and 2.3, respectively. CONCLUSIONS: Peginterferon alfa-2a does not appreciably alter the pharmacokinetics of methadone.     

The role of detoxification using methadone reduction in a drug treatment service

Introduction and Methods Drug treatment services in the UK are currently being encouraged to reduce their waiting lists for treatment. This paper describes the reorganization of the services offered by an inner‐city community drug team in order to offer immediate access to detoxification, and so reduce overall waiting times for assessment and treatment. In describing the outcomes of the first year of the service, we aimed to determine the degree of effectiveness of methadone reduction as a detoxification technique, and to highlight some of the sociodemographic and drug‐related factors that predict detoxification success.

Results A total of 19 out of 82 (23.2%) participants were opiate‐free at the end of the detoxification period, confirmed by both self‐report and urinary drug screen. Completion rates were lower for participants opting to continue methadone reduction below 10?mgs per day than for those opting for lofexidine or dihydrocodeine. The rate of reduction of methadone made no difference to the likelihood of completing the detoxification, but being female, having a drug‐using partner, having current financial difficulties and committing crime in the month prior to detoxification were predictive of noncompletion of the programme.

Conclusions The reorganization of the service reduced the waiting times for treatment and was acceptable to both participants and staff. Methadone reduction doesn't appear to be the optimum detoxification strategy, and even within a reduction programme of fixed duration there was a tendency for the period of detoxification to become extended.     

Detoxification of nonopiate drugs in the chronic pain setting and clonidine opiate detoxification.

Although the pain physician is most familiar with the treatment of the opiate withdrawal syndrome, other drugs are abused by the chronic pain patient. The pain physician should then be familiar with the withdrawal syndromes associated with other drug groups. The withdrawal syndromes associated with hypnosedatives, psychotomimetics, nicotine, stimulants, ergot alkaloids, beta adrenergic blocking agents, antidepressants, muscle relaxants, and alpha-adrenergic agonists are described. Drug detoxification protocols for these drugs are reviewed. Additionally, the rationale for clonidine opiate detoxification is discussed, and current clonidine detoxification protocols are reviewed.     

Relief of incident dyspnea in palliative cancer patients: a pilot, randomized, controlled trial comparing nebulized hydromorphone, systemic hydromorphone, and nebulized saline

Acute episodic breathlessness in patients receiving palliative care is a distressing symptom with little evidence-base to inform management. This pilot, double-blind, controlled, crossover study compared the effects of nebulized hydromorphone, systemic hydromorphone and nebulized saline for the relief of episodic breathlessness in advanced cancer patients. On three occasions of acute breathlessness, patients randomly received either nebulized hydromorphone, a systemic breakthrough dose of hydromorphone or nebulized saline together with a blinding agent. Breathlessness was scored before and 10, 20, 30, and 60 minutes post-treatment completion using a 100 mm visual analog scale. Twenty patients completed the trial. Ratings did not differ significantly across pretest treatments. Change in ratings from pretest to 10 minutes after completion of nebulization (about 20 minutes after administration of systemic hydromorphone) indicated that each of the treatments resulted in statistically significant improvements in breathlessness, with no significant differences between treatments. Over time, breathlessness decreased significantly for all treatments, with no significant differences between treatments. Only nebulized hydromorphone produced a rapid improvement in breathlessness that reached a magnitude considered to be clinically important. Interpretation of these results is considered in relation to our definition of clinical significance, the dose of hydromorphone used and the possibility of a placebo effect. This study can serve to inform the design of future trials to investigate the management of incident breathlessness.     

Double-blind crossover study of the efficacy and acceptability of oxazepam Expidet tablets compared to placebo in patients undergoing gynaecological surgery

In a double-blind crossover trial, the hypnotic efficacy and acceptability of oxazepam Expidet, a fast-dissolving tablet, was compared to placebo in patients undergoing minor gynaecological surgery. Patients received 30 mg oxazepam Expidet or placebo the night before their operation and the alternate medication the night after. A sleep questionnaire was completed the morning after both nights and acceptability was assessed the morning after the second night. Data were available for analysis on seventy-two patients aged 18-50 years. There was a significant improvement in sleep onset and quality and less awakenings after oxazepam compared to placebo (p less than or equal to 0.01). There was no significant difference in the occurrence or type of dreams, or morning-after symptoms. There was a significant preference for oxazepam compared to placebo and for the fast-dissolving Expidet form compared to conventional tablets or capsules (p less than or equal to 0.01). There were no adverse reactions in the oxazepam group. It was concluded that oxazepam Expidet was an effective and acceptable hypnotic in this group of patients.     

Profiles of self-reported HIV-risk behaviors among injection drug users in methadone maintenance treatment, detoxification, and needle exchange programs

OBJECTIVE: Injection drug use has accounted for more than one third of acquired immune deficiency syndrome cases in the United States. The purpose of this study was to compare the demographic characteristics, types, and frequency of human immunodeficiency virus (HIV)-risk behaviors among injection drug users (IDUs) recruited from a needle exchange program (NEP), methadone maintenance treatment (MMT), and detoxification (detox) program. DESIGN: A cross-sectional, correlational design was used to determine whether the selected HIV-risk behaviors and demographic characteristics of IDUs varied by site of recruitment. SAMPLE AND MEASUREMENTS: Confidential questionnaires were completed by 445 IDUs in Philadelphia, Pennsylvania. RESULTS: Data analysis revealed that HIV sexual and injection-risk behavior varied by recruitment site. Subjects recruited from the NEP were more likely to engage in HIV-risk behaviors than subjects recruited from the MMT or detox sites. CONCLUSIONS: Interventions occurring in program and treatment sites need to be sensitive to various demographic characteristics and behaviors if they are to reach those at highest risk of HIV infection. Targeting HIV prevention interventions based upon risk group membership alone (e.g. IDUs) fails to address the distinct risk behaviors and demographic characteristics of enrollees in different programs.     

集体心理治疗对美沙酮维持治疗阿片依赖者服药依从性的影响

目的：了解集体心理治疗对美沙酮维持治疗阿片依赖者服药依从性的影响。方法将104例美沙酮维持治疗阿片依赖者随机分为两组,两组均予以美沙酮维持治疗,研究组在此基础上联合集体心理治疗,观察6个月。于治疗前后评估患者服药依从性。结果研究组维持治疗率为84．6％、脱失率为15．4％,对照组分别为40．4％、59．6％。研究组维持治疗率显著高于对照组（P＜0．01）。结论集体心理治疗能显著改善美沙酮维持治疗阿片依赖者的服药依从性。