Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
Pharmacopsychiatry. 2010 Jun;43(4):130-7. doi: 10.1055/s-0029-1242820. Epub 2010 Jan 25.
The aim of this retrospective study was to assess ultra-rapid opiate detoxification (UROD) and to estimate the retention rate in naltrexone maintenance treatment.
45 opiate-addicted male patients (DSM-IV 304.00; opiate per oral or per inhalation n=40, heroin intravenous n=5; concomitant cannabis abuse n=6) were detoxified by 6 h of naloxone infusion under general anesthesia with midazolam, propofol, clonidine and atracurium. Withdrawal signs were evaluated by the objective opiate withdrawal scale (OOWS, range 0-13) up to 24 h after awakening. After UROD, naltrexone 50 mg/day was prescribed for 9 months with assessments in 4-week intervals.
Adverse events after UROD were prolonged unconsciousness (n=1), transient confusion (n=8) and depressive mood (n=6). The total sample showed a median OOWS score of 2 (mild withdrawal syndrome). The only two extreme outliers were found only in the subgroups "intravenous" (score 8) and "cannabis" (score 11). 96% (43/45) of the patients could be discharged the day after UROD. Thirty-six patients (80%) continued naltrexone therapy for the entire 9-month observation period.
UROD and subsequently induction of naltrexone maintenance therapy can be regarded as safe and effective in patients with pure opiate addiction. Owing to cultural and economical factors our Iranian results may not correspond to European and American treatment modalities.
本回顾性研究旨在评估超快速阿片类药物脱毒（UROD）并估计纳曲酮维持治疗的保留率。
45 名男性阿片类药物成瘾患者（DSM-IV 304.00；口服或经鼻纳洛酮 n=40，静脉注射海洛因 n=5；同时滥用大麻 n=6）在咪达唑仑、丙泊酚、可乐定和阿曲库铵全身麻醉下接受 6 小时纳洛酮输注进行脱毒。在苏醒后 24 小时内，通过客观阿片类药物戒断量表（OOWS，范围 0-13）评估戒断症状。UROD 后，给予纳曲酮 50mg/天，持续 9 个月，并在 4 周间隔进行评估。
UROD 后出现的不良事件有：长时间无意识（n=1）、短暂意识混乱（n=8）和抑郁情绪（n=6）。总样本的 OOWS 中位数为 2（轻度戒断综合征）。仅在“静脉”（评分 8）和“大麻”（评分 11）亚组中发现了两个极端异常值。96%（43/45）的患者可以在 UROD 后第二天出院。36 名患者（80%）继续接受纳曲酮维持治疗，整个 9 个月的观察期。
UROD 后，随后诱导纳曲酮维持治疗，可以被认为是安全有效的，适用于单纯阿片类药物成瘾患者。由于文化和经济因素，我们伊朗的结果可能与欧洲和美国的治疗模式不一致。
