Efficacy and safety of two new methods of rapid intravenous detoxification in heroin addicts previously treated without success.
BACKGROUND
New methods of rapid opiate detoxification, under intravenous sedation, can detoxify heroin-addicted patients in 24 hours. Their clinical application has been limited by the lack of studies establishing both efficacy and safety.


METHODS
In a randomised, controlled study, 300 treatment-refractory, heroin-addicted patients received rapid intravenous detoxification treatment (naloxone infusion, 0.06-0.08 mg/kg, then oral naltrexone 50 mg/day) under either monitored light intravenous sedation or unmonitored deep intravenous sedation.


RESULTS
All patients were successfully detoxified and 93% remained abstinent one month later. Severity of withdrawal, according to the Wang Scale modified by Loimer, was 4.9 (s.d. 3.0) points in the light sedation group and 4.8 (s.d. 2.9) in the deep sedation group (P = 0.26). Two patients (1.3%) in the light sedation group and four (2.6%) in the deep sedation group required tracheal intubation (P = 0.31). There was only one severe complication, a case of nosocomial aspirative pneumonia which improved with antibiotic treatment.


CONCLUSIONS
Successful rapid intravenous detoxification can be achieved using relatively light levels of sedation.
Seoane
A
A
Quality of Sedation Research Group, SCIAS-Hospital de Barcelona, Spain.
Carrasco
G
G
Cabré
L
L
Puiggrós
A
A
Hernández
E
E
Alvarez
M
M
Costa
J
J
Molina
R
R
Sobrepere
G
G
D000328:Adult; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D003422:Critical Care; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D008658:Inactivation, Metabolic; D007262:Infusions, Intravenous; D007902:Length of Stay; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage; D009271:Naltrexone / Q000008:administration & dosage; D009292:Narcotic Antagonists / Q000008:administration & dosage; D012008:Recurrence; D013375:Substance Withdrawal Syndrome; D017211:Treatment Failure
D009292:Narcotic Antagonists; D009270:Naloxone; D009271:Naltrexone