The place of detoxification in treatment of opioid dependence

被引:16
作者
Gowing, LR [1 ]
Ali, RL [1 ]
机构
[1] Univ Adelaide, Drug & Alcohol Serv S Australia, Adelaide, SA 5005, Australia
关键词
antagonist-induced withdrawal; buprenorphine; detoxification; opioid dependence;
D O I
10.1097/01.yco.0000218596.54054.a1
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Purpose of review This review summarizes current research on the management of opioid withdrawal and considers the selection of the approach in different situations. Recent findings The recent publication of three controlled trials makes firm conclusions about the relative effectiveness of newer approaches (antagonist-induced withdrawal under anaesthesia or with minimal sedation; buprenorphine) to the management of opioid withdrawal possible. Summary Antagonist-induced withdrawal under anaesthesia should not be pursued as it has an increased risk of life-threatening adverse events and has no additional benefits relative to antagonist-induced withdrawal under minimal sedation. Antagonist-induced withdrawal with minimal sedation is feasible and may be suitable for those who intend to enter antagonist-maintenance treatment with a clear commitment to abstinence and good support. Buprenorphine is suitable for quick withdrawal, supports transition to naltrexone maintenance treatment, is safe and effective in outpatient settings and can be extended into maintenance treatment if the detoxification attempt is unsuccessful. Adrenergic agonists (clonidine and lofexidine) remain an effective option for those who do not want to use an opioid and do not intend to transfer to naltrexone maintenance treatment, with lofexidine being preferable for outpatient settings. Through appropriate choice of approach, detoxification can be a gateway to multiple, long-term treatment options.
引用
收藏
页码:266 / 270
页数:5
相关论文
共 22 条
[1]  
[Anonymous], ADV ALCOHOL SUBSTANC
[2]   Inpatient opiate detoxification in Geneva: follow-up at 1 and 6 months [J].
Broers, B ;
Giner, F ;
Dumont, P ;
Mino, A .
DRUG AND ALCOHOL DEPENDENCE, 2000, 58 (1-2) :85-92
[3]   Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction - A randomized trial [J].
Collins, ED ;
Kleber, HD ;
Whittington, RA ;
Heitler, NE .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2005, 294 (08) :903-913
[4]   Inpatient versus other settings for detoxification for opioid dependence [J].
Day, E ;
Ison, J ;
Strang, J .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2005, (02)
[5]   General anaesthesia does not improve outcome in opioid antagonist detoxification treatment: a randomized controlled trial [J].
De Jong, CAJ ;
Laheij, RJF ;
Krabbe, PFM .
ADDICTION, 2005, 100 (02) :206-215
[6]   AN INVESTIGATION OF WITHDRAWAL SYMPTOMS SHOWN BY OPIATE ADDICTS DURING AND SUBSEQUENT TO A 21-DAY INPATIENT METHADONE DETOXIFICATION PROCEDURE [J].
GOSSOP, M ;
BRADLEY, B ;
PHILLIPS, GT .
ADDICTIVE BEHAVIORS, 1987, 12 (01) :1-6
[7]   LAPSE, RELAPSE AND SURVIVAL AMONG OPIATE ADDICTS AFTER TREATMENT - A PROSPECTIVE FOLLOW-UP-STUDY [J].
GOSSOP, M ;
GREEN, L ;
PHILLIPS, G ;
BRADLEY, B .
BRITISH JOURNAL OF PSYCHIATRY, 1989, 154 :348-353
[8]   CLONIDINE AND THE TREATMENT OF THE OPIATE WITHDRAWAL SYNDROME [J].
GOSSOP, M .
DRUG AND ALCOHOL DEPENDENCE, 1988, 21 (03) :253-259
[9]   OPIATE WITHDRAWAL - INPATIENT VERSUS OUTPATIENT PROGRAMS AND PREFERRED VERSUS RANDOM ASSIGNMENT TO TREATMENT [J].
GOSSOP, M ;
JOHNS, A ;
GREEN, L .
BRITISH MEDICAL JOURNAL, 1986, 293 (6539) :103-104
[10]   Price, cost and value of opiate detoxification treatments - Reanalysis of data from two randomised trials [J].
Gossop, M ;
Strang, J .
BRITISH JOURNAL OF PSYCHIATRY, 2000, 177 :262-266