Heroin dependence has reemerged as a significant public health problem in the 1990's, and with that, there has been renewed interest in improving methods of opioid detoxification. Detoxification is and will continue to be a common first step in the treatment of individuals with heroin dependence. During the past decade, there has been considerable popular attention focused on the utilization of general anesthesia during the acute phase of antagonist-precipitated opioid withdrawal, but there have been no controlled studies of anesthesia-assisted detoxification techniques. In particular, follow-up data on the patients detoxified under general anesthesia are not available. The research proposed here aims to compare anesthesia-assisted rapid opioid detoxification (AROD) with two alternative detoxification techniques, with attention both to acute measures of withdrawal and to longer-term abstinence and compliance with naltrexone maintenance. Our plan is to carry out a three-year study of 159 patients randomized to one of three detoxification techniques, followed by 12 weeks of outpatient treatment combining naltrexone maintenance and manual-guided relapse prevention/coping skills training psychotherapy. The AROD technique will be compared directly with a buprenorphine-mediated rapid opiate detoxification (BROD), and with a clonidine-assisted opioid detoxification (COD). We incorporate comprehensive assessments of withdrawal severity and cognitive and motor performance, as well as follow-up data over 12 weeks. The strength of our approach lies in the controlled evaluation of the three detoxification techniques under consistent conditions. We expect to provide information about the safety and immediate- and intermediate-term efficacy of anesthesia-assisted detoxification from heroin. We believe that this information is very important for policy makers and patients, as anesthesia-assisted detoxification techniques have proliferated in this country and throughout the world, exposing patients to the costs and risks of anesthesia, without any evidence of improved outcome for the heroin-dependent individuals who choose anesthesia as a means to detoxification.
| Collins, Eric D; Kleber, Herbert D; Whittington, Robert A et al. (2005) Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: a randomized trial. JAMA 294:903-13 |
