Rapid Opiate Detoxification Under General Anesthesia: A New Challenge for Anesthesiologists and Intensivists

  • M. Hensel
  • W. J. Kox
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 1999)


The social and economical consequences of opiate addiction are a permanently increasing problem within society [1]. To solve drug related problems and to provide effective treatment for these patients represents a considerable challenge. For successful therapy, the physical, as well as the psychological, components of opiate dependancy have to be taken into account [2].


Locus Coeruleus Withdrawal Symptom Methadone Maintenance Treat Heroin Addict Opiate Withdrawal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Freye E (1998) Der opioidabhängige Patient — Der Konsum nimmt zu. Anästhesiologie Intensivmedizin 2:73–86.Google Scholar
  2. 2.
    Tretter F (1996) Von der Phantasie, die Sucht auszuschlafen. Münch Med Wschr 138:76–77.Google Scholar
  3. 3.
    Presslich O, Loimer N (1989) Opiate detoxification under general anesthesia by large doses of naloxone. J Toxicol Clin Toxicol 27:263–270.PubMedCrossRefGoogle Scholar
  4. 4.
    Brewer C (1997) Ultra-rapid, antagonist-precipitated opiate detoxification under general anesthesia or sedation. Addict Biol 2/3:291–302.CrossRefGoogle Scholar
  5. 5.
    Brewer C, Laban M, Schmulian C, Gooberman L, Kasvikis Y, Maksoud NA (1996) Rapid opiate detoxification and naltrexone induction under general anesthesia and assisted ventilation: Experience with 510 patients in four countries. Suppl Royal College of Psychiatrists, London, England. July: 1–5.Google Scholar
  6. 6.
    Dettling M, Tretter F (1996) Der Opiatentzug in Narkose (forcierter Narkoseentzug, ‘Turboentzug’) bei Opiatabhängigkeit. Nervenarzt 67:805–810.PubMedCrossRefGoogle Scholar
  7. 7.
    Pfab T, Hirtl C, Hibler A, Felgenheuer N, Chlistalla J, Zilker TH (1996) Der Antagonist-induzierte, Narkose-gestützte Opiat-Schnellentzug (AINOS). Münch Med Wschr 138:781–786.Google Scholar
  8. 8.
    Herman BH, Czechowicz D (1996) NIDA scientific report of Ultra Rapid Detoxification with Anesthesia (UROD). Opinion of the consultants and criteria relating to evaluating the safety and efficacy of UROD. American National Institute on Drug Abuse (NIDA) Report, February 23:1–8.Google Scholar
  9. 9.
    Kienbaum P, Thiirauf N, Michel MC, Scherbaum N, Gastpar M, Peters J (1998) Profound increase in epinephrine concentration in plasma and cardiovascular stimulation after μ-opioid receptor blockade in opioid-addicted patients during barbiturate-induced anesthesia for acute detoxification. Anesthesiology 88:1154–1161.PubMedCrossRefGoogle Scholar
  10. 10.
    Sharma SK, Klee WA, Nirenberg M (1975) Dual regulation of adenylate cyclase accounts for narcotic dependence and tolerance. Proc Natl Acad Sci USA 72:3092–3096.PubMedCrossRefGoogle Scholar
  11. 11.
    Pei G, Kieffer BL, Lefkowitz RJ, Freedman NJ (1995) Agonist dependent phosphorylation of the mouse d-opioid receptor: Involvement of G protein coupled receptor kinases but not protein kinase C. Mol Pharmacol 48:173–177.PubMedGoogle Scholar
  12. 12.
    Law PY, Horn DS, Loh HH (1983) Opiate receptor down-regulation and desensitization in neuroblastoma X glioma NG108-15 hybrid cells are two separate cellular adaptation processes. Mol Pharmacol 24:413–424.PubMedGoogle Scholar
  13. 13.
    Law PY, Horn DS, Loh HH (1984) Down regulation of opiate receptor in neuroblastoma X glioma NG108-15 hybrid cells: Chloroquine promotes accumulation of tritiated encephalin in the lysosomes. J Biol Chem 270:4096–4104.Google Scholar
  14. 14.
    Avidor-Reiss T, Bayewitch M, Levy R, Matus-Lebovitch N, Nevo I, Vogel Z (1995) Adenylyl cyclase supersensitization in μ-opioid receptor transfected Chinese hamster ovary cells following chronic opioid treatment. J Biol Chem 270:2972–2978.Google Scholar
  15. 15.
    Vachon L, Costa T, Herz A (1987) GTPase and adenylate cyclase desensitize at different rates in NG108-15 cells. Mol Pharmacol 31:159–168.PubMedGoogle Scholar
  16. 16.
    Maldonado R, Stinus L, Gold LH, Koob GF (1992) Role of different brain structures in the expression of the physical morphine withdrawal syndrome. J Pharmacol Exp Ther 261:669–677.PubMedGoogle Scholar
  17. 17.
    Wise RA (1988) The neurobiology of craving: Implications for the understanding and treatment of addiction. J Abnorm Psychol 97:118–132.PubMedCrossRefGoogle Scholar
  18. 18.
    Koob GF, Bloom FE (1988) Cellular and molecular mechanisms of drug dependence. Science 242:715–723.PubMedCrossRefGoogle Scholar
  19. 19.
    Rasmussen K, Beitner-Johnson D, Aghajanian GK, Nestler EJ (1990) Opiate withdrawal and the rat locus coeruleus: behavioral, electrophysiological, and biochemical correlates. J Neurosci 10:2308–2317.PubMedGoogle Scholar
  20. 20.
    Maldonado R (1997) Participation of noradrenergic pathways in the expression of opiate withdrawal: biochemical and pharmacological evidence. Neurosci Biobehav Rev 21:91–104.PubMedCrossRefGoogle Scholar
  21. 21.
    Thomas JM, Hoffman BB (1987) Adenylate cyclase supersensitivity: A general means of cellular adaptation to inhibitory agonists? Trends Pharmacol Sci 8:308–311.CrossRefGoogle Scholar
  22. 22.
    Gossop M, Griffiths P, Bradley B, Strang J (1989) Opiate withdrawal symptoms in response to 10-day and 21-day methadone withdrawal. Br J Psychiatry 154:360–363.PubMedCrossRefGoogle Scholar
  23. 23.
    Suzuki T, Koike Y, Yanaura S, George FR, Meisch RA (1987) Genetic differences in the development of physical dependence on pentobarbital in four inbred strains of rats. Jpn J Pharmacol 45:479–486.PubMedCrossRefGoogle Scholar
  24. 24.
    Jage J (1989) Methadone — Pharmacokinetics and pharmacodynamics of an opiate. Anaesthesist 38:159–166.PubMedGoogle Scholar
  25. 25.
    Latowsky M (1996) Improving detoxification outcomes from methadone maintenance treatment: the interrelationship of affective states and protracted withdrawal. J Psychoactive Drugs 28:251–257.PubMedCrossRefGoogle Scholar
  26. 26.
    Satel SL, Kosten TR, Schuckit MA, Fischman MW (1993) Should protracted withdrawal from drugs be included in DSM-IV? Am J Psychiatry 150:695–704.PubMedGoogle Scholar
  27. 27.
    Legarda JJ, Gossop M (1994) A 24-h detoxification treatment for heroin addicts: a preliminary investigation. Drug Alcohol Depend 35:91–93.PubMedCrossRefGoogle Scholar
  28. 28.
    Freye E (1992) Medikamenteninteraktion bei der Methadontherapie: Z Ärztl Fortbild 86: 731–736.Google Scholar
  29. 29.
    Jaffe H (1995) Pharmacological treatment of opioid dependence: current techniques and new findings. Psychiatry Ann 25:369–375.Google Scholar
  30. 30.
    Kosten TR, Morgan C, Kleber HD (1992) Phase II clinical trials of buprenorphine: Detoxification and induction onto naltrexone. NIDA Res Monogr 121:101–119.PubMedGoogle Scholar
  31. 31.
    Gerra G, Marcato A, Caccavari R, et al (1995) Clonidine and opiate receptor antagonists in the treatment of heroin addiction. J Subst Abuse Treat 12:35–41.PubMedCrossRefGoogle Scholar
  32. 32.
    O’Connor PG, Waugh ME, Carrol KM, Rounsaville BJ, Diagkogiannis IA, Schottenfeld RS (1995) Primary Care — Based ambulatory opioid detoxification: The results of a clinical trial. J Gen Intern Med 10:255–260.PubMedCrossRefGoogle Scholar
  33. 33.
    Senft RA (1991) Experience with clonidine-naltrexone for rapid opiate detoxification. J Subst Abuse Treat 8:257–259.PubMedCrossRefGoogle Scholar
  34. 34.
    Sawicki T (1995) The miracle cure? A revolutionary and highly controversial treatment for heroin addiction is achieving astounding success in Israel, and is now set to go overseas. The Jerusalem Report. July: 20–21.Google Scholar
  35. 35.
    Taff RH (1983) Pulmonary edema following naloxone administration in a patient without heart disease. Anestesiology 59:576–577.CrossRefGoogle Scholar
  36. 36.
    Brewer C (1987) Blood pressure monitoring at home for rapid opioid withdrawal with clonidine and naltrexone. The Lancet 1:621.CrossRefGoogle Scholar
  37. 37.
    San L, Puig M, Bulbena A, Farre M (1995) High risk of ultrashort noninvasive opiate detoxification. Am J Psychiatry 152:956.PubMedGoogle Scholar
  38. 38.
    Seoane A, Carrasco G, Cabré L, et al (1997) Efficacy and safety of two new methods of rapid intravenous detoxification in heroin addicts previously treated without success. Br J Psychiatry 171:340–345.PubMedCrossRefGoogle Scholar
  39. 39.
    Stephenson J (1997) Experts debate merits of 1-day opiate detoxification under anesthesia. JAMA 277:363–364.PubMedCrossRefGoogle Scholar
  40. 40.
    Fishbain DA, Rosomoff HL, Cutier R, Rosomoff RS (1993) Opiate detoxification. A clinical manual. Ann Clin Psychiatry 5:53–65.CrossRefGoogle Scholar
  41. 41.
    Gold MS (1993) Opiate addiction and the locus coeruleus. The clinical utility of clonidine, naltrexone, methadone, and buprenorphine. Psychiatry Clin North Am 16:61–73.Google Scholar
  42. 42.
    Goldstein A, Herrera J (1995) Heroin addicts and methadone treatment in Albuquerque: a 22-year follow-up. Drug Alcohol Depend 40:139–150.PubMedCrossRefGoogle Scholar
  43. 43.
    Rabinowitz J, Cohen H, Tarrasch R, Kotler M (1997) Compliance to naltrexone treatment after Ultra Rapid Opiate Detoxification. An open label naturalistic study. Drug Alcohol Depend 47:77–86.PubMedCrossRefGoogle Scholar
  44. 44.
    Kanto JH (1988) Propofol, the newest induction agent of anesthesia. Int J Clin Pharmacol Ther Toxicol 26:41–57.PubMedGoogle Scholar
  45. 45.
    Galletly DC, Short TG (1988) Total intravenous anaesthesia using propofol infusion — 50 consecutive cases. Anaesth Intensive Care 16:150–157.PubMedGoogle Scholar
  46. 46.
    Mackenzie N, Grant IS (1985) Propofol for continuous intravenous anaesthesia. A comparison with methohexitone. Postgrad Med J 61:70–75.PubMedGoogle Scholar
  47. 47.
    Mason ST, King RA, Banks P, Angel A (1983) Brain noradrenaline and anaesthesia: behavioural and electrophysiological evidence. Neuroscience 10:177–185.PubMedCrossRefGoogle Scholar
  48. 48.
    Eddieston JM, Shelly MP (1991) The effect on serum lipid concentrations of a prolonged infusion of propofol — hypertriglyceridaemia associated wit propofol administration. Intensive Care Med 17:424–426.CrossRefGoogle Scholar
  49. 49.
    Vining E, Kosten TR, Kleber HD (1988) Clinical utility of rapid clonidine-naltrexone detoxification for opioid abusers. Br J Addict 83:567–575.PubMedCrossRefGoogle Scholar
  50. 50.
    Dinh-Xuan AT, Regnard J, Matran R, Mantrand P, Advenier C, Lockhart A (1988) Effects of clonidine on bronchial responses to histamine in normal and asthmatic subjects. Eur Respir J 1:345–350.PubMedGoogle Scholar
  51. 51.
    Deutschman CS, Harris AP, Fleisher LA (1994) Changes in heart rate variability under propofol anesthesia: a possible explanation for propofol-induced bradycardia. Anesth Analg 79:373–377.PubMedGoogle Scholar
  52. 52.
    Wang RIH, Wiesen RL, Lamid S, Roh BL (1974) Rating the presence and severity of opiate dependence. Clin Pharmacol Ther 16:653–658.PubMedGoogle Scholar
  53. 53.
    Handelsman L, Cochrane KJ, Aronson MJ, Ness R, Rubinstein KJ, Kanof PD (1987) Two new rating scales for opiate withdrawal. Am J Drug Alcohol Abuse 13:293–308.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1999

Authors and Affiliations

  • M. Hensel
  • W. J. Kox

There are no affiliations available

Personalised recommendations