Forced opioid withdrawal under anesthesia

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The accelerated opioid withdrawal under anesthesia ( FOEN ; also: antagonist-induced anesthesia-assisted opiate quick withdrawal , AINOS ; briefly only: forced opioid withdrawal , forced detoxification ; colloquially: Ultra-Short withdrawal ( UKE ), Turbo withdrawal ; Engl. Ultra Rapid Opiate Detoxification , abbreviated: UROD or URD ; rapid detoxification with an opioid antagonist under general anesthesia , abbreviated: RD-GA ) is an (ultra) rapid withdrawal for opioid addicts under anesthetic conditions or strong sedation and administration of an opioid antagonist . The FOEN method is only suitable for patients who suffer from sole dependence on opioids, are highly motivated, are very afraid of intense withdrawal symptoms or have failed several previous withdrawals. In addition, it is required that the patients are well integrated into their social environment. Neither short-term nor long-term success is guaranteed and serious complications can occur.

execution

The opioid-dependent patients are given anesthetics such as propofol , midazolam , and atracurium . They are also given a short-acting opioid antagonist such as naloxone or a long-term antagonist ( naltrexone ), each of which occupies the opioid receptors without triggering an effect (apart from an opioid withdrawal syndrome ).

This combination makes it possible in some cases to eliminate the physical withdrawal symptoms after just a few hours. However, a withdrawal syndrome that lasts for days is also described.

Aftercare

After discharge, it is necessary to continue the drug treatment with opiate antagonists for six to nine months, whereby naltrexone can also be administered subcutaneously (under the skin) as a depot . The subsequent, accompanying psychotherapeutic support or psychosocial care is decisive for long-term success : With withdrawal, especially with one under anesthesia, behavior that enables "life without drugs" cannot be practiced.

Further treatment with an antagonist in a now physically healthy (“clean”) person causes the opioid receptors to be occupied and prevents this substance from docking when the opioid is taken again. The euphoric effect sought by the consumer does not occur. If the half-life of the antagonist is shorter than that of the opioid, the temptation of the user to “add” more substance can lead to a (possibly fatal) overdose. This therapy uses a long-acting antagonist whose primary task is to make the patient aware of the ineffectiveness of opioids. The temptation to relapse should be relieved in advance; and so the antagonist primarily has an effect on the patient's psyche.

Risks

Highly motivated patients in particular can (together with their helpers) succumb to the illusion that after perhaps the only true “healing sleep” they wake up healthy and have left their previous life behind. Thus, a resource-intensive method can help to continue to avoid the existing problems.

Even if the anesthesia protocol is followed exactly, serious complications can arise. One death has been described.

Success rates

The long-term success of forced withdrawal under anesthesia does not differ significantly from conventional methods.

A study by the Cochrane Collaboration from 2006 advises against further use of this method. Although the method has been known for years, anesthesia does not have any advantages over light sedation. A possible benefit bears no relation to the potential risks and the high costs - not only in terms of financial resources; the medical resources are to be used more effectively elsewhere.

literature

Web links

Individual evidence

  1. ^ Mathias Berger (Ed.): Mental illnesses - clinic and therapy. Elsevier, 3rd edition. 2009
  2. ↑ Richard P. Mattick et al. a .: Pharmacotherapies for the Treatment of Opioid Dependence: Efficacy, Cost-Effectiveness and Implementation Guidelines. In: Informa , 2009
  3. ↑ a b R Pfab, Chr Hirtl u. a .: The antagonist-induced-anesthesia-assisted opiate rapid withdrawal (AINOS). Risky and unproven benefits. ( Memento of the original from November 30, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF) In: Münchner Medizinische Wochenschrift , November 22, 1996 @1@ 2Template: Webachiv / IABot / www.toxinfo.org
  4. ↑ Eric D. Collins, Herbert D. Kleber et al. a .: Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction - A Randomized Trial . In: JAMA , 2005, 294, pp. 903-913.
  5. ^ Clare Dyer: Addict died after rapid opiate detoxification . In: BMJ , January 17, 1998, 316, pp. 167-172
  6. ↑ Jonathan Rabinowitz, Hagit Cohen, Shmuel Atias: Outcomes of Naltrexone Maintenance Following Ultra Rapid Opiate Detoxification Versus Intensive Inpatient Detoxification . In: American Journal on Addictions 2002, Vol. 11, No. 1, pp. 52-56, doi: 10.1080 / 10550490252801639
  7. ^ Cor AJ De Jong, Robert JF Laheij, Paul FM Krabbe: General anaesthesia does not improve outcome in opioid antagonist detoxification treatment: a randomized controlled trial .  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (PDF) In: Addiction , 100, 2005, pp. 206–215@1@ 2Template: Dead Link / www.theta-research.nl  
  8. ↑ B Favrat, G Zimmermann, D Zullino, S Krenz, F Dorogy, J Muller, A Zwahlen, B Broers, J. Besson: Opioid antagonist detoxification under anesthesia versus traditional clonidine detoxification combined with an additional week of psychosocial support: a randomized clinical trial . In: Drug Alcohol Depend . 2006 Feb 1, 81 (2), pp. 109-116, Epub 2005 Jul 15, PMID 16024184 .
  9. ^ L Gowing, R Ali, J. White: Opioid antagonists under heavy sedation or anesthesia for opioid withdrawal . Cochrane Database Syst Rev. 2006 Apr 19; (2): CD002022.