Bell J R, Young M R, Masterman S C, Morris A, Mattick R P, Bammer G
Langton Centre, Sydney, NSW.
Med J Aust. 1999 Jul 5;171(1):26-30. doi: 10.5694/j.1326-5377.1999.tb123493.x.
Observational study.
Medical ward of a general hospital (for detoxification) and a community clinic (for follow-up) in Sydney, NSW, 1998.
15 heroin users and 15 people seeking withdrawal from methadone.
Detoxification used naltrexone (12.5 or 50 mg), with flunitrazepam (2-3 mg), clonidine (150-750 micrograms) and octreotide (300 micrograms) for symptomatic support. Patients remained awake and were discharged when they felt well enough. Follow-up was daily for four days and then weekly for up to three months for supportive care.
Acute side effects; patient ratings of severity and acceptability of withdrawal; nights of hospitalisation; rates of induction onto naltrexone; retention in treatment over three months; and relapse to opioid use.
Acute withdrawal with delirium lasted about four hours. Octreotide was crucial for controlling vomiting; with octreotide no patient required intravenous fluids. There were no major complications. Eighteen patients (60%) reported that it was a "quite" acceptable procedure, 18 (60%) required only one night's hospitalisation, and 24 (80%) were successfully inducted onto naltrexone (defined as taking naltrexone on Day 8). Three months later, six (20%) were still taking naltrexone (with four of these occasionally using heroin) and seven (23%) were abstinent from opioids, including five not taking naltrexone. Eleven had gone onto methadone maintenance, seven had relapsed to heroin use, and one had died of a heroin overdose.
Rates of induction onto naltrexone were comparable with those reported for accelerated detoxification under sedation, suggesting that it can be performed successfully with minimal sedation. As in other studies of naltrexone maintenance, retention was low, and relapse to heroin use was common.
观察性研究。
1998年新南威尔士州悉尼一家综合医院的内科病房（用于脱毒）和一家社区诊所（用于随访）。
15名海洛因使用者和15名寻求美沙酮脱毒的人。
脱毒使用纳曲酮（12.5毫克或50毫克），并使用氟硝西泮（2 - 3毫克）、可乐定（150 - 750微克）和奥曲肽（300微克）进行症状支持。患者保持清醒，感觉状况良好时即可出院。随访为期四天，每天一次，之后每周一次，持续长达三个月以提供支持性护理。
急性副作用；患者对脱毒严重程度和可接受性的评分；住院天数；纳曲酮诱导率；三个月内的治疗留存率；以及阿片类药物复吸情况。
伴有谵妄的急性脱毒持续约四小时。奥曲肽对于控制呕吐至关重要；使用奥曲肽后没有患者需要静脉补液。没有出现重大并发症。18名患者（60%）报告这是一个“相当”可接受的程序，18名患者（60%）仅需住院一晚，24名患者（80%）成功诱导使用纳曲酮（定义为在第8天服用纳曲酮）。三个月后，6名患者（20%）仍在服用纳曲酮（其中4名偶尔使用海洛因），7名患者（23%）戒除了阿片类药物，包括5名未服用纳曲酮的患者。11名患者开始接受美沙酮维持治疗，7名患者复吸海洛因，1名患者死于海洛因过量。
纳曲酮诱导率与在镇静状态下加速脱毒的报告率相当，表明可以在最低限度镇静的情况下成功进行。与其他纳曲酮维持治疗研究一样，留存率较低，海洛因复吸情况常见。
