Drug and Alcohol Dependence 2006 81;2:109-116
Opioid antagonist detoxification under anaesthesia versus traditional clonidine detoxification combined with an additional week of psychosocial support: A randomised clinical trial. Favrat B, Zimmermann G et al.
Dear Colleagues,
February's D&A Dependence journal has a feast of items including a randomised trial of rapid versus traditional detox from Switzerland. While there is a trend for more rapid detox patients to be abstinent at 3 months, by 6 and 12 months there is no difference and the relapse rate is over 95% for both groups. This is consistent with a similar trial from Adelaide some years ago.
But this item tells us more about rapid detox than just abstinence outcomes. Of the 70 "mono-dependence" patients who sought detoxification in the trial only 26 out of 36 (72%) randomised to rapid detox actually took the procedure, despite it being free and performed in a general hospital. And of the remaining 34 who were randomised to 'classical clonidine' detoxification, only 21 were included in the trial (62%). In each group between 4 and 8 patients just did not turn up on the appointed day while a similar number were excluded because they showed up non-opiates in the pre-treatment urine screen and this trial excluded those using drug other than opiates.
The compliance with oral naltrexone was shown to be very poor despite being offered to all patients. In the clonidine group only 2 started naltrexone, compared to 24/36 in the anaesthesia-assisted patients. Yet the drug was so unpopular that it was only taken for an average of 10.8 days in this latter group, where the company recommends 6 months.
There was a death in the rapid detox group at the 3 month follow-up. The authors state this was probably not related to the treatment, however the treatment obviously did not help this subject. We now know that the choice of detoxification is a risk in itself, regardless of how it is achieved. However, in these low-risk, 'mono-addicted' subjects, rapid detox had no benefit except in the short term. It is invasive, costly and in this as other reports, there is a mortality (see ABC link below in which 80 deaths have apparently been reported from a single 'naltrexone' clinic).
Comments by Andrew Byrne ..
The ABC had a very revealing naltrexone item on the 7.30 Report on Friday 13th. See http://www.abc.net.au/7.30/content/2006/s1547424.htm
