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A pilot study of naltrexone-accelerated detoxification in opioid dependence

Bell, Jon F; Young, M; Masterman, S; Morris, Alan; Mattick, Richard P; Bammer, Gabriele

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Objective: 1. To determine whether naltrexone-accelerated detoxification with minimal sedation is an acceptable and effective form of induction onto naltrexone. 2. To monitor outcomes of detoxified patients. Design: Observational study. Setting: Medical ward of a general hospital (for detoxification) and a community clinic (for follow-up) in Sydney, NSW, 1998. Patients: 15 heroin users and 15 people seeking withdrawal from methadone. Intervention: Detoxification used naltrexone (12.5 or 50 mg),...[Show more]

dc.contributor.authorBell, Jon F
dc.contributor.authorYoung, M
dc.contributor.authorMasterman, S
dc.contributor.authorMorris, Alan
dc.contributor.authorMattick, Richard P
dc.contributor.authorBammer, Gabriele
dc.date.accessioned2015-12-13T23:23:14Z
dc.date.available2015-12-13T23:23:14Z
dc.identifier.issn0025-729X
dc.identifier.urihttp://hdl.handle.net/1885/91822
dc.description.abstractObjective: 1. To determine whether naltrexone-accelerated detoxification with minimal sedation is an acceptable and effective form of induction onto naltrexone. 2. To monitor outcomes of detoxified patients. Design: Observational study. Setting: Medical ward of a general hospital (for detoxification) and a community clinic (for follow-up) in Sydney, NSW, 1998. Patients: 15 heroin users and 15 people seeking withdrawal from methadone. Intervention: Detoxification used naltrexone (12.5 or 50 mg), with flunitrazepam (2-3 mg), clonidine (150-750 μg) and octreotide (300 μg) for symptomatic support. Patients remained awake and were discharged when they felt well enough. Follow-up was daily for four days and then weekly for up to three months for supportive care. Main outcome measures: Acute side effects; patient ratings of severity and acceptability of withdrawal; nights of hospitalisation; rates of induction onto naltrexone; retention in treatment over three months; and relapse to opioid use. Results: Acute withdrawal with delirium lasted about four hours. Octreotide was crucial for controlling vomiting; with octreotide no patient required intravenous fluids. There were no major complications. Eighteen patients (60%) reported that it was a 'quite' acceptable procedure, 18 (60%) required only one night's hospitalisation, and 24 (80%) were successfully inducted onto naltrexone (defined as taking naltrexone on Day 8). Three months later, six (20%) were still taking naltrexone (with four of these occasionally using heroin) and seven (23%) were abstinent from opioids, including five not taking naltrexone. Eleven had gone onto methadone maintenance, seven had relapsed to heroin use, and one had died of a heroin overdose. Conclusions: Rates of induction onto naltrexone were comparable with those reported for accelerated detoxification under sedation, suggesting that it can he performed successfully with minimal sedation. As in other studies of naltrexone maintenance, retention was low, and relapse to heroin use was common.
dc.publisherAustralasian Medical Association
dc.sourceMedical Journal of Australia
dc.source.urihttps://www.mja.com.au/journal/1999/171/1/pilot-study-naltrexone-accelerated-detoxification-opioid-dependence
dc.subjectKeywords: clonidine; flunitrazepam; methadone; naltrexone; octreotide; opiate; opiate antagonist; stomach secretion inhibitor; adult; article; Australia; clinical article; delirium; detoxification; drug overdose; female; follow up; human; male; methadone treatment;
dc.titleA pilot study of naltrexone-accelerated detoxification in opioid dependence
dc.typeJournal article
local.description.notesImported from ARIES
local.description.refereedYes
local.identifier.citationvolume171
dc.date.issued1999
local.identifier.absfor111706 - Epidemiology
local.identifier.ariespublicationMigratedxPub22698
local.type.statusPublished Version
local.contributor.affiliationBell, Jon F, CSIRO, Australia Telescope National Facility
local.contributor.affiliationYoung, M, Queensland Health
local.contributor.affiliationMasterman, S, Sydney Hospital
local.contributor.affiliationMorris, Alan, University of New South Wales
local.contributor.affiliationBammer, Gabriele, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationMattick, Richard P, University of New South Wales
local.bibliographicCitation.startpage26
local.bibliographicCitation.lastpage30
dc.date.updated2015-12-12T09:14:38Z
local.identifier.scopusID2-s2.0-0033526822
CollectionsANU Research Publications

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