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Thread: Rapid Detox from OxyContin?

  1. #1
    Senior Member SurfCat's Avatar
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    Rapid Detox from OxyContin?

    Part of my training regimen at Project Walk is to completely detox from all medications including the big-daddy, OxyContin for my central pain.

    I am considering a relatively new procedure called Rapid Detox that completely sets your brains drug receptors to zero in a matter of four hours. Doing it this way you go through all of your withdrawals while under general anesthesia.

    Has anyone done this or heard of anyone doing this? The alternative is to wean myself off of the drug, which will be difficult after five years of my body depending on it.

    Thanks for ANY info you have!

    Surfcat

  2. #2
    surfcat, I am sorry that I did not see your post earlier. Are you referring to the this rapid detox method? As I understand it, patients are withdrawn from opioids over a 5-8 hour period while anesthetized and receiving opiate receptor blockers to prevent craving and to reduce the side-effects of withdrawal. Many centers follow the detox with a period of naltrexone (an opiate receptor blocker) which discourages relapses. On the other hand, according to another part of the above web site, the National Institute of Drug Abuse pointed out in 1996 that the benefits of rapid detox do not overcome the risks and that the procedure is "without ethical, medical, scientific or financial justification".

    I am concerned by misleading claims of easy withdrawal from opioids on internet through rapid detoxification programs. As Shelley Marshall wrote in an article entitled Rapid Detoxification is No Magic Pill, a number of patients died in New Jersey in a rapid detox program, from undetected heart problems. Therefore, all programs today screen patients for cardiac problems.

    Recent clinical trials sponsored by NIDA suggest that the combination treatment of buprenorphine-naloxone (an opioid plus a mu opioid receptor blocker which reduces some withdrawal symptoms without the narcotic effects of mu receptor activation) is practical and safe for medical detoxification of opioid dependence (Amass, et al. 2004). Freye, et al. (2004) reported that gabapentin is useful for attenuating the symptoms that follow rapid opiate detoxification (ROD). Some of the programs use a combination of naltrexone and alpha-2 clonidine to treat the aftermath of ROD but 5 of 20 patients developed delirium and dropped out the study (Golden & Sakhrani, 2004). The clonidine may help reduce the gastrointestinal diarrhea in the aftermath of the ROD program. When the program is carefully supervised, withdrawal symptoms can be minimized but relapses are relatively frequent (Bochud, et al., 2003).

    Most of these post-detoxification treatments can be used for regular weaning programs as well. I don't have direct personal experience any of the rapid detoxification programs (although I was involved in the first high-dose naloxone clinical treatment of acute spinal cord injury in the 1980's and spent a lot of time studying opioid receptors). You need to work with a doctor who is experienced with weaning people off of opioids and understand that there will be a period withdrawal symptoms whether you do it rapidly or through weaning over a period of a week. Some of the methods used to reduce withdrawal symptoms after rapid detoxification should be helpful with slower weaning. I hope that this is helpful.

    Literature cited

    • Amass L, Ling W, Freese TE, Reiber C, Annon JJ, Cohen AJ, McCarty D, Reid MS, Brown LS, Clark C, Ziedonis DM, Krejci J, Stine S, Winhusen T, Brigham G, Babcock D, Muir JA, Buchan BJ and Horton T (2004). Bringing buprenorphine-naloxone detoxification to community treatment providers: the NIDA Clinical Trials Network field experience. Am J Addict. 13 Suppl 1: S42-66. Friends Research Institute, Inc., 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, USA. lamass@friendsresearch.org. In October 2002, the U.S. Food and Drug Administration approved buprenorphine-naloxone (Suboxone) sublingual tablets as an opioid dependence treatment available for use outside traditionally licensed opioid treatment programs. The NIDA Center for Clinical Trials Network (CTN) sponsored two clinical trials assessing buprenorphine-naloxone for short-term opioid detoxification. These trials provided an unprecedented field test of its use in twelve diverse community-based treatment programs. Opioid-dependent men and women were randomized to a thirteen-day buprenorphine-naloxone taper regimen for short-term opioid detoxification. The 234 buprenorphine-naloxone patients averaged 37 years old and used mostly intravenous heroin. Direct and rapid induction onto buprenorphine-naloxone was safe and well tolerated. Most patients (83%) received 8 mg buprenorphine-2 mg naloxone on the first day and 90% successfully completed induction and reached a target dose of 16 mg buprenorphine-4 mg naloxone in three days. Medication compliance and treatment engagement was high. An average of 81% of available doses was ingested, and 68% of patients completed the detoxification. Most (80.3%) patients received some ancillary medications with an average of 2.3 withdrawal symptoms treated. The safety profile of buprenorphine-naloxone was excellent. Of eighteen serious adverse events reported, only one was possibly related to buprenorphine-naloxone. All providers successfully integrated buprenorphine-naloxone into their existing treatment milieus. Overall, data from the CTN field experience suggest that buprenorphine-naloxone is practical and safe for use in diverse community treatment settings, including those with minimal experience providing opioid-based pharmacotherapy and/or medical detoxification for opioid dependence.

    • Freye E, Levy JV and Partecke L (2004). Use of gabapentin for attenuation of symptoms following rapid opiate detoxification (ROD)--correlation with neurophysiological parameters. Neurophysiol Clin. 34: 81-9. Clinics of Vascular surgery and renal transplantation, University of Dusseldorf, Germany. enno.freye@uni-duesseldorf.de. Rapid opiate detoxification (ROD) is a technique whereby the opiate-dependent patient is withdrawn acutely, under anesthesia, from the opioid. Following detoxification, patients experience severe back pain and restlessness often accompanied by a restless-leg-syndrome. We evaluated gabapentin given immediately following detoxification to attenuate these symptoms. In addition, we evaluated the use of the somatosensory-evoked potential (SEP) as a parameter to quantitate pain responses. Patients (n=21; mean age 32.5 +/- 7 SD; 12 males, 9 females) underwent ROD with naltrexone (2 x 50 mg) during propofol anesthesia and artificial ventilation (IPPV). Sympathetic overshoot was attenuated by clonidine, and increased bowl movement was managed by continuous i.v. somatostatin. Back pain, restlessness, and restless-leg-syndrome were treated with gabapentin (1200 mg) in the ICU. Efficacy was assessed by the patient's subjective ratings of restlessness (0-4). In addition, measurements of amplitude (microV), latency (ms) of late N100-peak of the somatosensory evoked potential (SEP), and tolerance to an increased electrical nociceptive stimulus (mA) to the forearm were performed. Data were compared to pre-treatment control and to the period shortly after detoxification. From a mean of 8.4 +/- 2.5 microV, N100-peak increased to a mean of 12.3 microV +/- 3.3 (p < 0.005) following opioid detoxification. Gabapentin reduced amplitude height to a mean of 3.5 +/- 1.5 microV. Also, tolerance to nociceptive stimulus, which had dropped to 4.4 mA, increased to 12.5 mA [p < 0.01), while intensity for restlessness and thrashing of limbs dropped from 3.2 to 1.2 [p < 0.05). The sudden displacement of the opiate from its receptor site induced by naltrexone, resulted in a post inhibitory SEP overshoot with an increase in nociceptive afferent volleys, and a lowering in pain threshold. This was associated with back pain, limb thrashing and a restless-leg-syndrome, all of which could be attenuated by gabapentin. The amplitude of late N100-peak parameter appears to be a potential candidate to quantify the increase of nociception in such patients.

    • Golden SA and Sakhrani DL (2004). Unexpected delirium during Rapid Opioid Detoxification (ROD). J Addict Dis. 23: 65-75. Center for Treatment of Addictive Disorders, VA Medical Center, 116A-H, 7180 Highland Drive, Pittsburgh, PA 15206, USA. goldensa@msx.upmc.edu. Rapid Opioid Detoxification (ROD), using a combination of the long acting opioid antagonist, Naltrexone and the alpha 2 agonist Clonidine, is a method to detoxify patients who are opioid dependent. The daily administration of Naltrexone in increasing dosages decreases the duration of the withdrawal syndrome associated with opioids, especially longer acting drugs such as Methadone. This study is intended to report the frequency of delirium, as defined in DSM IV, during the ROD of Methadone maintained patients. A chart review was conducted of twenty consecutive patients who received in-patient ROD from Methadone maintenance from January 1999 to December 1999. Methadone was tapered and discontinued prior to ROD and Naltrexone was administered in increasing daily doses. Five individuals developed delirium and discontinued the procedure on the first day, fourteen patients completed the protocol, and one dropped out prior to completion. A significant incidence of delirium resulted from the ROD procedure.

    • Ma H, Tang J, White PF, Wender RH, Leverone T, Quon R, Pearce S, Chiao F and Erice S (2003). The effect of clonidine on gastrointestinal side effects associated with ultra-rapid opioid detoxification. Anesth Analg. 96: 1409-12, table of contents. Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas 75390, USA. IMPLICATIONS: Clonidine, an alpha(2)-adrenergic agonist, is used to minimize withdrawal symptoms related to ultra-rapid opioid detoxification procedures. These preliminary data suggest that clonidine possesses dose-related antidiarrheal activity.

    • Bochud Tornay C, Favrat B, Monnat M, Daeppen JB, Schnyder C, Bertschy G and Besson J (2003). Ultra-rapid opiate detoxification using deep sedation and prior oral buprenorphine preparation: long-term results. Drug Alcohol Depend. 69: 283-8. Department of Adult Psychiatry, Cery Hospital, 1008, Prilly-Lausanne, Switzerland. BACKGROUND: New methods of ultra-rapid opiate detoxification (URD) under intravenous sedation have been criticized because of limited data on safety and long-term follow-up. Premedication with buprenorphine has been advocated to improve safety by decreasing vomiting. Prior research has not explored URD in socially impaired patients. METHOD: Sixteen patients were detoxified with URD and prospectively evaluated over at least 30 months. Data of this procedure were compared with those of our previous study without buprenorphine preparation (Drug Alcohol Depend. 52(3) (1998) 243). The 16 patients were followed up by a general practitioner (GP) before and after URD. The GPs also supervised the 7-day course of buprenorphine treatment prescribed for the 16 patients prior to URD. RESULTS: During the procedure, only one episode of vomiting occurred instead of 13 out of 20 in our previous study. Post-procedure, only two patients experienced moderate withdrawal symptoms, such as persistent nausea, abdominal cramps and vomiting lasting from 24 to 48 h, in comparison with most patients in the previous study without buprenorphine. After a period of at least 30 months (36.0+/-6.38), the 16 patients were still alive and were regularly monitored by their GP. Only two of the 16 never relapsed after URD and reported total opiate abstinence. Fourteen patients relapsed; 12 of these were prescribed a licensed methadone substitution program and two were still using heroin. CONCLUSION: In this small sample, the data indicated that URD with buprenorphine preparation was safe and that it markedly decreased post-procedure morbidity. No patient died over a minimum 30-month follow-up period. Furthermore, the procedure was employed with socially impaired patients. In the long term, a few patients were still free of opiates, while the majority opted for a methadone maintenance program, showing that URD can serve as one possible step in a long-term treatment program.

    [This message was edited by Wise Young on 09-21-04 at 01:53 AM.]

  3. #3
    Surfcat - I have a question. You want to get off Oxycontin that you use for your Central Pain. What will you use instead of this, since the Central Pain will still be there? Are you planning to use antiseizure meds like Neurontin or Lyrica? Or use nothing and hope you can handle it without medication?
    I admire those who want to get off medication, but wonder what they do with the problem that originally brought them to medications, namely, neuropathic or central pain?

  4. #4
    Man oh man, neuropathic and central pain is a major major issue in my life also and I dont wish it upon anyone (maybe my worst enemy, yep definitely him. lol) I manage to keep my Oxycontin intake down only because when I pop one I have to lie down as I more often than not slide into a celestial haze of detachment where I cant bear been around people. But yep I take lyrica mostly after experimenting with Neurontin. Lyrica doesn't do much but the alternative (going cold turkey) is out of my mental capabilities unfortunately.
    "When it rains I am thankful I can feel the raindrops". Mr D. Wright

    "Tonight we dine in hell". Leonidas 300

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