What
is naltrexone induced heroin detoxification under general
anesthesia?
Naltrexone induced heroin detoxification under
general anesthesia refers to a heroin or methadone (or
other opiate) detoxification procedure where an opiate
antagonist, naltrexone or naloxone, is administered to
compress the duration of withdrawal to within four to six
hours. Naltrexone administration induces severe
withdrawal symptoms, therefore the patient is
anesthetized for the procedure.
What
is the difference between naltrexone and naloxone?
Functionally, they are the same type of drug. They
compete with heroin at the receptor level and block the
effect of heroin. Naloxone is administered intravenously
and lasts for approximately 20 minutes. Naltrexone is
administered orally (pill form) and can last for 1 to 2
days.
Is
naltrexone beneficial for other types of addiction?
Naltrexone may decrease the craving for alcohol.
Cocaine and amphetamine addiction would not be treated
with this drug. Naltrexone should be beneficial for any
type of opiate addiction, including drugs like heroin,
morphine, methadone, dilaudid, percocet, demerol,
fentanyl, and vicodin. Currently, the studies in the
medical literature that have evaluated naltrexone
detoxification have included patients who were using
either methadone or heroin.
What
evidence is there that naltrexone induced detoxification
under general anesthesia works?
There are six studies in the medical literature where
this procedure was evaluated. These studies have been
reviewed and the results are available in this website (medical literature). It has been
reported that thousands of successful detoxifications
have occurred. Unfortunately, the group that claims this
success has not published their results for critical
review. As the discussion forum
contained in this website develops, you may be able to
read about individual experiences with the procedure.
Even though the discussion forum will be moderated,
comments for and against the procedure are encouraged.
How
does naltrexone reduce the duration of withdrawal?
This is a difficult question to answer since the
mechanism for opiate tolerance, dependence, and
withdrawal is not clearly understood. Evidence does exist
that implicates the locus coeruleus (a group of cells in
the brainstem that release a substance similar to
adrenaline) as a major contributor. This data has been summarized and is
presented in this website.
Is
naltrexone induced heroin detoxification under general
anesthesia safe?
No adverse events were reported in the studies
evaluating naltrexone detoxification. Caution should be
exercised, though, in providing this procedure to a
patient without a protected airway (a breathing tube in
the windpipe). San has published a
report describing a patient who vomited while
anesthetized for naltrexone detoxification. The patient
became hypoxemic (low oxygen in the blood) and probably
aspirated (stomach contents in the lungs). This is a very
serious complication that is avoided by placement of a
"breathing tube".
General anesthesia does have risks, although when
compared to the mortality and morbidity associated with
heroin use, it is relatively safe when administered by a
specialist trained in the delivery of anesthesia.
Caution should also be exercised in deciding who
administers the anesthetic. Currently, it is legal in the
United States for a nurse anesthetist to administer an
anesthetic without the supervision of an anesthesiologist
as long as a physician supervisor is available. As a
result, some addiction specialists providing this service
may hire a nurse anesthetist and choose to supervise the
nurse him or herself. This would be a cost saving
measure. An addiction specialist (unless also trained as
an anesthesiologist) is NOT capable of providing
anesthetic support or consultation should an adverse
event occur during the peri-detoxification period. Be
sure that an anesthesiologist (a doctor trained in the
administration of anesthetics) is either providing the
detoxification or supervising the nurse anesthetist.
Detoxification is only part of treating the addicted
patient. Identifying appropriate patients and providing
post-detoxification rehabilitation are mandatory.
Therefore, make sure that an addiction specialist (doctor
specifically trained in the management of addicted
patients) is part of the team providing the
detoxification service.
Other issues concerning safety also exist, i.e. liver
toxicity, pulmonary edema, and opiate overdose. If these
issues interest you, please send your question and I will respond.
Is
naltrexone induced heroin detoxification under general
anesthesia likely to increase the recidivism rate?
The withdrawal syndrome may be beneficial in
motivating addicts to stay clean after a successful
detoxification. Since patients do not experience
withdrawal symptoms with naltrexone induced
detoxification under general anesthesia, it is possible
that the recidivism rate may increase. On the other hand,
up to 50 or 60 percent of addicts who want to stop using
heroin fail to successfully complete detoxification and
subsequently never get a chance to benefit from
rehabilitation. A prospective randomized controlled
clinical trial will be necessary to effectively answer
this question.
Can I place a web link in an article posted to the discussion forum? Not by yourself. Please write your link in the format http://www."site name"."domain"; ie. (http://www.heroin-detox.com). The link will then be made by me using administrator software. You may also want to send me a reminder to process your link. My e-mail address is gonzales@heroin-detox.com.
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