Clinical experience with antagonist-induced opiate withdrawal under anaesthesia

Abstract

Aims: The study describes experience with antagonist-induced opiate withdrawal under anaesthesia in standard clinical conditions.

Design: The study was restricted to patients who had undergone failed withdrawal treatments with usual methods over the past months. No control group was used. SETTING AND PROCEDURE: The patients were selected after history-taking and examination. A multi-axial diagnosis was performed. They were then admitted to an inpatient treatment unit for addicted patients. On the second day they were put into neurological intensive care. There they were intubated, ventilated and anaesthetized with propofol for 6 hours. Shortly after induction of anaesthesia, naloxone and naltrexone were administered. A high amount of fluid was used to balance changes in water and electrolytes. After anaesthesia the patients were transferred back to the addiction ward and sedated with clonidine. The patients were then fully mobilized. On discharge 50 mg naltrexone were given daily.

Participants: Eighty-eight patients were treated. They were long-term opiate users. Preference was given to methadone-substituted patients who were unable to rid themselves of methadone.

Measurements: The account given is based solely on clinical observations.

Findings: The first 14 patients were observed in detail and it is on them that this report is based. It was found that withdrawal from codeine and methadone can be shortened to approximately 2-3 days. No patient was in a condition to go home immediately after anaesthesia. Twelve patients showed significant symptoms on the day following anaesthesia. The majority of patients treated by this method will continue to suffer withdrawal symptoms for a few days after detoxification, after which time most can be treated in an outpatient setting. Dysfunction of the cardiovascular system, the lungs, the kidneys or other organs was not observed. Taking into account all the 88 patients, five had to stay in hospital for a longer period (up to 2 weeks) because of a prolonged withdrawal syndrome.