In the clonidine(Drug information on clonidine)-assisted procedure, it was posited that clonidine, an a2-adrenergic agonist, mitigates the withdrawal symptoms in the first week by acting on the locus coeruleus to decrease norepinephrine(Drug information on norepinephrine) release. Naltrexone(Drug information on naltrexone) was administered on day 7, after a naloxone(Drug information on naloxone) (Narcan) short-acting opioid antagonist challenge confirmed the absence of opioid. Naltrexone was initiated at 12.5 mg and increased to 50 mg on day 9.
Collins and colleagues reported that mean withdrawal severity scores were comparable across the three treatments and noted that the anesthesia-assisted group reported the highest severity on day 1 immediately before the procedure. The researchers attributed this to anticipatory anxiety and possibly to receiving less clonazepam(Drug information on clonazepam) before anesthesia.
The groups also had similarly low rates of completing their 12-week programs, with less than 50% remaining in each group by week 3 and an overall dropout rate of 82% by end of study at 12 weeks. The anesthesia- and buprenorphine(Drug information on buprenorphine)-assisted detoxification had significantly greater rates of naltrexone induction (94% and 97%, respectively) than the 21% with clonidine; and the researchers noted a lower dropout rate among those who received the naltrexone.
The findings suggested to Collins and colleagues, "that general anesthesia for rapid antagonist induction does not currently have a meaningful role to play in the treatment of opioid dependence."
Further, the unimpressive outcomes from each procedure led them to emphasize, "physicians must recognize that the method used to achieve opioid abstinence does not appear to affect the course of this chronic relapsing disease."
In an accompanying editorial, Patrick O'Connor, M.D., M.P.H., (2005) from the Yale University School of Medicine concurred with this acknowledgment of the limitations of detoxification procedures, characterizing them as only the very first steps of treatment.
Beyond the comparisons made in this study, detoxification-based approaches that are not followed by effective means of post-detoxification treatment are overwhelmingly likely to fail.
O'Connor argued that buprenorphine is better utilized in the newly authorized office-based maintenance programs than in detoxification procedures and that maintenance therapy should be considered first-line treatment of opioid addiction. Further research on detoxification-based treatments, O'Connor recommended, "should focus on how to provide effective relapse prevention treatment."