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24-hour opiate detoxification and antagonist induction at home - the "Asturian method": a report on 1368 procedures
(Désintoxication en 24 heures et administration à domicile d'antagoniste - "la mèthode des Asturies" : une étude de 1368 cas.)
Auteur(s) :
J. E. CARRENO ;
J. BOBES ;
C. BREWER ;
C. E. ALVAREZ ;
G. I. SAN NARCISO ;
M. T. BASCARAN ;
SANCHEZ DEL RIO J.
Article en page(s) :
243-250
Refs biblio. :
45
Domaine :
Drogues illicites / Illicit drugs
Langue(s) :
Anglais
Thésaurus mots-clés
OPIACES
;
DESINTOXICATION
;
CURE DE DESINTOXICATION
;
ANTAGONISTE
;
NALTREXONE
;
TRAITEMENT AMBULATOIRE
;
METHODE
;
EFFICACITE
Note générale :
Addiction Biology, 2002, 7, (2), 243-250
Note de contenu :
graph. ; tabl.
Résumé :
ENGLISH :
The technique of domiciliary rapid opiate detoxification (ROD) developed in Asturias since 1994 enables patients dependent on heroin and/or methadone (or other opiates) to start antagonist maintenance with a full dose of naltrexone (50 mg) and largely recover from the acute opiate withdrawal syndrome in a few hours at home without direct medical or nursing involvement. Detailed information on 1368 procedures is presented but in Asturias, over 3000 procedures have been completed to date without any deaths or serious medical or psychiatric complications. We also describe some recent modifications to the procedure involving the use of octreotide as an antidiarrhoeal and the insertion of subcutaneous naltrexone implants to prevent early relapse. Rather than domiciliary ROD, we think the procedure is more usefully conceptualized as domiciliary rapid antagonist induction (RAI), because treatment with well-supervised naltrexone is known to be effective in reducing relapse rates. Now that controlled studies uniformly describe greatly increased rates of transfer to naltrexone maintenance treatment following RAI, compared with conventional slower withdrawal and naltrexone induction procedures, it is important that the safety, acceptability and simplicity of this "Asturian" RAI/ROD technique become more widely known. (Author' s abstract)
ENGLISH :
The technique of domiciliary rapid opiate detoxification (ROD) developed in Asturias since 1994 enables patients dependent on heroin and/or methadone (or other opiates) to start antagonist maintenance with a full dose of naltrexone (50 mg) and largely recover from the acute opiate withdrawal syndrome in a few hours at home without direct medical or nursing involvement. Detailed information on 1368 procedures is presented but in Asturias, over 3000 procedures have been completed to date without any deaths or serious medical or psychiatric complications. We also describe some recent modifications to the procedure involving the use of octreotide as an antidiarrhoeal and the insertion of subcutaneous naltrexone implants to prevent early relapse. Rather than domiciliary ROD, we think the procedure is more usefully conceptualized as domiciliary rapid antagonist induction (RAI), because treatment with well-supervised naltrexone is known to be effective in reducing relapse rates. Now that controlled studies uniformly describe greatly increased rates of transfer to naltrexone maintenance treatment following RAI, compared with conventional slower withdrawal and naltrexone induction procedures, it is important that the safety, acceptability and simplicity of this "Asturian" RAI/ROD technique become more widely known. (Author' s abstract)
Affiliation :
Clinica Medico Psicologica Asturias, CMPA, Gijon, Asturias, Psychiatry Dprt, Faculty of Medicine, Oviedo
Espagne. Spain.
Espagne. Spain.
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