High-dose methadone detoxification in a hospital unit. Clinical experience
DOI:
https://doi.org/10.20882/adicciones.266Keywords:
detoxification from methadone, addiction, opiatesAbstract
The increase in opiate addicts in treatment with methadone, coupled with improved survival of HIV patients, has meant an increase in the demand for detoxification from this substance in our environment. It is common practice in hospital detoxification units to request a maximum dose of methadone (around 40 mg) on beginning detoxification treatment. However this is not always possible, due to the time needed for a gradual decrease for outpatients making daily visits to the methadone dispensing centres, due to the appearance of withdrawal symptoms, or because the patient starts out from very high doses of methadone. Reported here is an experience with 22 inpatients who over the last two years underwent detoxification from methadone without requesting from their treatment centres a maximum-limit dose at the start of their treatment. During the detoxification they are given treatment with clonidine and benzodiazepines (dosage being adjusted according to concomitant use of alcohol, benzodiazepines and cocaine) and non-opiate-based painkillers. On the seventh day they are given 50 mg of naltrexone. Of these addicts, 21 completed the detoxification adequately.References
Agencia Antidroga. Consejería de Sanidad y Servicios Sociales. Comunidad de Madrid. Memoria 1998.
Agencia Antidroga. Plan Regional sobre Drogas. Comunidad de Madrid. Memoria 2005.
Senay EC, Dorus W, Goldberg F, Thornton W. Withdrawal from methadone maintenance. Rate of withdrawal and expectation. Arch Gen Psychiatry 1977; 34: 361-367.
Fernández Miranda JJ, Gutiérrez Cienfuegos E, Bobes García J. Tratamientos de mantenimiento con metadona. En: Manual de evaluación y tratamiento de drogodependencias. Eds: Julio Bobes García, Miguel Casas Brugué, Miguel Gutierrez Fraile. Psiquiatría Editores SL 2003; 232-257.
Stine SM, Kosten TR. Use of drug combinations in treatment of opioid withdrawal. J Clin Psychopharmacol 1992; 12: 203-209.
Fernández Miranda JJ. Efectividad de los programas de mantenimiento con metadona. Una revisión de los resultados de los estudios de evaluación. Med Clin 2001; 116: 150-154.
Strang J, Gossop M. Comparison of linear versus inverse exponential methadone reduction curves in the detoxification of opiate addicts. Addict Behav 1990; 15:541-547.
Parrino MW. Manual de tratamiento de metadona. Grup Igia. Barcelona; 1997.
Gold MS, Pottash AC, Sweeney DR, Kleber HD. Opiate withdrawal using clonidine: A safe, effective and rapid non opiate treatment. JAMA 1980; 243: 343-346.
Charney DS Heninger GR, Kleber HD. The combined use of clonidine and naltrexone as a safe, rapid and effective treatment of abrupt withdrawal from methadone. Am J Psychiatry 1986; 143: 831-837.
Kleber HD. Detoxification from narcotics. In Lowinson JH, Ruiz P (eds): Substance abuse: Clinical problems and perspectives. Maryland. Williams & Wilkins. 1991; 24: 317-338.
Senft AR. Experience with clonidine-naltrexone for rapid opiate detoxification. J Subs Abuse Treatment 1991; 8: 257-259.
Janiri L, Mannelli P, Persico AM, Serretti A, Tempesta E. Opiate detoxification of methadone maintenance patients using lefetamine, clonidine and buprenorphine. Drug Alcohol Depend 1994; 36: 139-145.
Baca-García E, García A, Ochoa E. Historia Psiquiátrica Estructurada en la Interconsulta Hospitalaria a Toxicomanías/Sida. Revista Española Drogodependencias 1999; 2481: 60-70.
Baca-García E, Madoz-Gúrpide A. Protocolos de recogida de datos en una unidad de toxicomanías con “Clínica de naltrexona”. En: Ochoa Mangado E. Antagonistas opiáceos en las dependencias. Clínica de la Naltrexona. Col. Psiquiatría 21. Dir. Prof. Sáiz Ruiz J. Barcelona: Ed. Ars Medica. Psiquiatría Editores SL; 2001.
Gossop M. The development of a Short Opiate Withdrawal Scale (SOWS). Addict Behav. 1990; 15: 487-490.
Olmos Espinosa R, Madoz-Gúrpide A, Ochoa E. Evolución al año de los adictos a opiáceos que realizan desintoxicación en UDH y continúan tratamiento ambulatorio. Adicciones 2001; 13: 173-178.
Hensel M. Safety, efficacy, and long-term results of a modified version of rapid opiate detoxification under general anaesthesia: a prospective study in methadone, heroin, codeine and morphine addicts. Acta Anaesthesio Scandinava 2000; 44: 326-333.
Prieto IJ, Poyo-Guerrero R, Fernandez R, Ochoa E. Ultrarapid high-dose methadone detoxification. Psychopharma-cology 2003; 165: 430.
Magura S, Rosenblum A. Leaving methadone treatment: lessons learned, lessons forgotten, lessons ignored. The Mount Sinai Journal of Medicine 2001; 68: 62-74.
Masson CL, Barnett PG, Sees KL, Delucchi KL, Rosen A, Wong W, Hall SM. Cost and cost-effectiveness of standard methadone maintenance treatment compared to enriched 180-day methadone detoxification.
Addiction 2004;99:718-726.
Fernández Miranda JJ, Torrens M (Eds). Monografía opiáceos. Adicciones 2005; 17.
