A comparison of rapid (opioid) detoxification with clonidine-assisted detoxification for heroin-dependent persons

Authors

  • Diane E. Arnold-Reed, PhD
  • Gary K. Hulse, PhD

DOI:

https://doi.org/10.5055/jom.2005.0007

Keywords:

rapid opioid detoxification, naloxone/naltrexone, clonidine-assisted withdrawal

Abstract

This study compares two methods of detoxification available to heroin users in Western Australia: clonidine-assisted detoxification (CD) or clonidine-naloxonepre-cipitated withdrawal under sedation (rapid opioid detox-ification [ROD]). Oral naltrexone was made available to all participants following detoxification. Eighty heroin-dependent persons were randomly assigned to either ROD or CD. Most undertaking ROD commenced and completed this treatment. Less than one-third undertaking CD completed this treatment. There was no significant difference in those treated by CD or ROD in subjective assessment of degree or duration of pain, severity of withdrawal and craving, nor was there an increase in the withdrawal sequelae after treatment. Induction of oral naltrexone following ROD was greater, but oral naltrexone compliance levels and abstinence from heroin four weeks following detoxification were similar between ROD and CD groups. The level of patient satisfaction between the two treatments was also similar. The authors discuss why ROD is considered more effective than CD.

Author Biographies

Diane E. Arnold-Reed, PhD

Research Fellow, Unit for Research and Education in Drugs and Alcohol, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, Australia.

Gary K. Hulse, PhD

Coordinator of Alcohol and Drug Education and Training, Unit for Research and Education in Drugs and Alcohol, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, Australia.

References

Mattick RP, Hall W: Are detoxification programmes effective? Lancet. 1996; 347: 97-100.

Lipton DG, Maranda MJ: Detoxification from heroin dependency: An overview of methods of effectiveness. Adv Alcohol Subst Abuse. 1983; 2: 31-55.

Weinstein A, Wilson SC, Bailey J, et al.: Imagery of craving in opiate addicts undergoing detoxification. Drug Alcohol Depend. 1997; 48: 25-31.

Bell JR, Young MR, Masterman SC, et al.: A pilot study of nal-trexone-accelerated detoxification in opioid dependence: Med J Aust. 1999; 171: 26-30.

Resnick RB, Kestenbaum RS, Washton A, et al.: Naloxone-precipitated withdrawal: A method for rapid induction onto naltrexone. Clin Pharmacol Ther. 1977; 21: 409-413.

O’Connor PG, Kosten TR: Rapid and ultrarapid opioid detoxification techniques. JAMA. 1998; 279(3): 229-234.

Lerner A, Sigal M, Bacalu A, et al.: A naltrexone double blind placebo controlled study in Israel. IsrJ Psychiatry Relat Sci. 1992; 29: 36-43.

Palmer B: Alcohol and Drug Withdrawal: A Practical Approach. A Manualfor Doctors to Assist in Treatment of Patients Withdrawing from Alcohol and Other Drugs. Mount Lawley, Australia: Next Step Specialist Drug and Alcohol Services, 2000.

Darke S, Ward J, Hall W, et al.: The Opiate Treatment Index (OTI) Researchers’ Manual. Sydney: National Drug and Alcohol Research Centre, 1991.

Darke S, Hall W, Wodak A, et al.: Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: The Opiate Treatment Index. Br J Addict. 1992; 87: 733-742.

Sutherland G, Edwards G, Taylor C, et al.: The measurement of opiate dependence. Br J Addict. 1986; 81: 485-494.

Tiffany ST, Field L, Singleton E, et al.: The development of a heroin craving questionnaire. 1997 (in preparation).

Rawson RA, McCann MJ, Shoptaw S, et al.: Naltrexone for opioid dependence: Evaluation of a manualized psychosocial protocol to enhance treatment response. Drug Alcohol Rev. 2001; 20: 67-80.

McGregor C, Ali R, White JM, et al.: A comparison of antago-nist-precipitated withdrawal under anesthesia to standard inpatient withdrawal as a precursor to maintenance naltrexone treatment in heroin users: Outcomes at 6 and 12 months. Drug Alcohol Depend. 2002; 68: 5-14.

Seoane A, Carrasco G, Cabre L, et al.: Efficacy and safety of two new methods of rapid intravenous detoxification in heroin addicts previously treated without success. Br J Psychiatry. 1997;171: 340345.

Tucker TK, Ritter A, Maher C, et al.: Natrexone maintenance for heroin dependence: Uptake, attrition, and retention. Drug Alcohol Depend. 2004; 23: 299-300.

Cucchia AT, Monnat M, Spagnoli J, et al.: Ultra-rapid opiate detoxification using deep sedation with oral midazolam: Short and long-term results. Drug Alcohol Rev. 1998; 52: 243-250.

Ali R, Thomas P, White J, et al.: Antagonist-precipitated heroin withdrawal under anaesthetic prior to maintenance naltrexone treatment: Determinants of withdrawal severity. Drug Alcohol Rev. 2003; 22: 425-431.

Misra, AL: Metabolism of opiates. In Aldler ML, Manara L, Samanin R (eds.): Factors affecting the action of narcotics. New York: Raven Press, 1978.

Nutt JG, Jasinski DR: Methadone-naloxone mixtures for use in methadone maintenance programs. I. An evaluation in man of their pharmacological feasibility. II. Demonstrations of acute physical dependence. Clin Pharmacol Ther. 1974; 15: 156-166.

Gerra G, Zaimovic A, Rustichelli P: Rapid opiate detoxication in outpatient treatment: Relationship with naltrexone compliance. J Subst Abuse Treat. 2000; 18: 185-191.

Downloads

Published

03/01/2005

How to Cite

Arnold-Reed, PhD, D. E., and G. K. Hulse, PhD. “A Comparison of Rapid (opioid) Detoxification With Clonidine-Assisted Detoxification for Heroin-Dependent Persons”. Journal of Opioid Management, vol. 1, no. 1, Mar. 2005, pp. 17-23, doi:10.5055/jom.2005.0007.

Issue

Section

Articles