Ambulanter Entzug von Opiaten. Eine Praxisstudie mit Katamnese

FRANÇAIS :
Le sevrage d'opiacés se fait traditionnellement dans les centres résidentiels. Le programme décrit ici associe la distribution de méthadone à doses dégressives pendant deux semaines, avec un traitement par l'acupuncture. 14% des patients ont atteint l'objectif d'abstinence. Les facteurs favorables ont été l'absence de consommation parallèle de benzodiazépines et la formation professionnelle préexistante. L'acupuncture a un effet bénéfique contre le manque d'héroïne. Le suivi sur un an et demi montre que 4 des 8 patients abstinents le sont restés. Un programme de substitution long est proposé lorsque ce traitement échoue, mais on note dans ce cas une consommation d'héroïne maintenue.
ENGLISH :
The detoxification of opiate addiction usually requires referral to specialized inpatient facilities. In this study we report on our experience of incorporating an out-patient drug detoxification program for opiate dependent patients into an outpatient family practice setting. Detoxification was attempted through administration of a tapering dose of methadone along with acupuncture offered as an adjunct. 14% of our study population (8 of 56) were able to successfully discontinue all opiate use. Predictors for a successful discontinuation of opiate use were freedom from coincident abuse of benzodiazepines, and having gainful employment. Acupuncture appears to exert a beneficial effect as long as there is strict abstention from continuing heroin use during the detoxification process. Follow up showed 4 of the original 8 patients still free of opiate use after 6 months. In those patients in whom outpatient detoxification was unsuccessful, some decide for a methadone maintenance program. The majority of treatment failures resumed their use of heroin. The investigator concludes that under favorable circumstances outpatient opiate detoxification can be managed with an acceptable probability of success. (Author' s abstract)