Ultra-rapid opiate detoxification using deep sedation and prior oral buprenorphine preparation: long-term results.
BACKGROUND
New methods of ultra-rapid opiate detoxification (URD) under intravenous sedation have been criticized because of limited data on safety and long-term follow-up. Premedication with buprenorphine has been advocated to improve safety by decreasing vomiting. Prior research has not explored URD in socially impaired patients.


METHODS
Sixteen patients were detoxified with URD and prospectively evaluated over at least 30 months. Data of this procedure were compared with those of our previous study without buprenorphine preparation (Drug Alcohol Depend. 52(3) (1998) 243). The 16 patients were followed up by a general practitioner (GP) before and after URD. The GPs also supervised the 7-day course of buprenorphine treatment prescribed for the 16 patients prior to URD.


RESULTS
During the procedure, only one episode of vomiting occurred instead of 13 out of 20 in our previous study. Post-procedure, only two patients experienced moderate withdrawal symptoms, such as persistent nausea, abdominal cramps and vomiting lasting from 24 to 48 h, in comparison with most patients in the previous study without buprenorphine. After a period of at least 30 months (36.0+/-6.38), the 16 patients were still alive and were regularly monitored by their GP. Only two of the 16 never relapsed after URD and reported total opiate abstinence. Fourteen patients relapsed; 12 of these were prescribed a licensed methadone substitution program and two were still using heroin.


CONCLUSIONS
In this small sample, the data indicated that URD with buprenorphine preparation was safe and that it markedly decreased post-procedure morbidity. No patient died over a minimum 30-month follow-up period. Furthermore, the procedure was employed with socially impaired patients. In the long term, a few patients were still free of opiates, while the majority opted for a methadone maintenance program, showing that URD can serve as one possible step in a long-term treatment program.
Bochud Tornay
C
C
Department of Adult Psychiatry, Cery Hospital, 1008, Prilly-Lausanne, Switzerland.
Favrat
B
B
Monnat
M
M
Daeppen
J B
JB
Schnyder
C
C
Bertschy
G
G
Besson
J
J
D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage*; D016292:Procedural Sedation; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009294:Narcotics / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010043:Outcome and Process Assessment, Health Care; D011292:Premedication; D012008:Recurrence; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014839:Vomiting / Q000209:etiology / Q000517:prevention & control
D009292:Narcotic Antagonists; D009294:Narcotics; D002047:Buprenorphine; D009271:Naltrexone