Opioid dependence is a very difficult disease to be treated. (Singh J, 2004) New ideas are being added in its process of treatment. Some of the new management procedures used now are rapid opioid detoxification and ultra-rapid opioid detoxification. (Charney et al., 1986) The treatment and management of opioid withdrawal are very stressful. (LeoLinzmayerJosefGrünberger, n.d.)
Some patients do not try to leave the opioids due to such painful sufferings. That's why scientists tried to make a strategy to reduce the duration of suffering. Blachley et al was among the pioneers who started administering anesthesia in treatment for making the management quite easy.
This method of using anesthesia was first developed by Loimer. (Loimer et al., 1989) Afterward, several modifications led to the development of a new technique known as Ultra-RAPID Opioid Withdrawal.
Aims and Goals
· To decrease the duration of the detoxification process
· To reduce the physical discomfort
· To decrease the time lag between last induction and maintenance dose
Spanagel et al, (Spanagel, 2000) reports that there is no evidence of the redisposition of normal neurobiological homeostasis with an opioid antagonist. But, the use of anesthesia has shown a decrease in withdrawal signs. (Streel & Verbanck, 2003)There is an explanation that the anesthesia interferes with the glutamate, which in return affects the noradrenergic over-activity which reduces the withdrawal symptoms.
Johnson and Carrclassified the naltrexone-induced process as under: (CARR, 2003)
Management with UROD
Its treatment with ultra-rapid opioid detoxification consists of three steps which are as follows:
1. Assessment of the patient which includes history taking
2. Formation of a treatment plan and finding out the requirement of UROD
3. Taking an informed consent form
Along with physical examinations, the other tests are also recommended with includes ECG, haemogram, hepatic function tests, renal function tests, and tests for hepatitis, HIV, and other infectious diseases.
For the reduction of withdrawal symptoms, the alpha-2 receptor agonist is used. (Lorenzi et al., 1999)
The intravenous route can use the drug Dexmedetomidine as it has a shorter duration of action and is selective in action. It is easier to titrate as compared to clonidine.
Other drugs used are anti-emetic which include ondansetron or droperidol and buprenorphine.
EEG threshold monitoring was used by Hansel et al. (Hensel & Kox, 2000) He used this method of monitoring for two reasons which are as under:
· To manage the depth of anesthesia
· To decrease the proper dose of propofol
· To decrease the time of recovery
· To reduce the objective withdrawal symptoms
Induction and maintenance
Propofol or thiopentone is used for the induction of anesthesia. Mivacurium or succinylcholine acts as the muscle relaxant in this therapy.
For maintenance, a combination of propofol and midazolam is used. The test dose of the antagonist (opioid) is followed by an infusion of nalmefene or naltrexone or naloxone in a base of normal saline through a “nasogastric tube.”
The main sign of withdrawal with anesthesia is “piloerection." Most of the signs are hidden by the use of alpha-2 agonists.
Post treatment monitoring and discharge
Mostly the patients are discharged within one to two days. The patients with long term withdrawal symptom complaints are kept for some more days. A complete checkup is done for withdrawal, psychiatric and anesthetic complications before discharge.