Ultra-rapid opiate detoxification followed by nine months of naltrexone maintenance therapy in Iran.
BACKGROUND
The aim of this retrospective study was to assess ultra-rapid opiate detoxification (UROD) and to estimate the retention rate in naltrexone maintenance treatment.


METHODS
45 opiate-addicted male patients (DSM-IV 304.00; opiate per oral or per inhalation n=40, heroin intravenous n=5; concomitant cannabis abuse n=6) were detoxified by 6 h of naloxone infusion under general anesthesia with midazolam, propofol, clonidine and atracurium. Withdrawal signs were evaluated by the objective opiate withdrawal scale (OOWS, range 0-13) up to 24 h after awakening. After UROD, naltrexone 50 mg/day was prescribed for 9 months with assessments in 4-week intervals.


RESULTS
Adverse events after UROD were prolonged unconsciousness (n=1), transient confusion (n=8) and depressive mood (n=6). The total sample showed a median OOWS score of 2 (mild withdrawal syndrome). The only two extreme outliers were found only in the subgroups "intravenous" (score 8) and "cannabis" (score 11). 96% (43/45) of the patients could be discharged the day after UROD. Thirty-six patients (80%) continued naltrexone therapy for the entire 9-month observation period.


CONCLUSIONS
UROD and subsequently induction of naltrexone maintenance therapy can be regarded as safe and effective in patients with pure opiate addiction. Owing to cultural and economical factors our Iranian results may not correspond to European and American treatment modalities.
Naderi-Heiden
A
A
Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria. angela.naderi-heiden@meduniwien.ac.at
Naderi
A
A
Naderi
M M
MM
Rahmani-Didar
F
F
Salimi
A-R
AR
Gleiss
A
A
Kasper
S
S
Frey
R
R
D000328:Adult; D000768:Anesthesia, General; D005500:Follow-Up Studies; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control; D055815:Young Adult
D009292:Narcotic Antagonists; D009271:Naltrexone