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DOCUMENT 2017 HTM file
Drug misuse and dependence: UK guidelines on clinical management
Last published in 2007, there is no more important document for UK clinicians involved in treating problem drug use than the so-called ‘Orange guidelines’. This major update offers detailed guidance on the range of problems, settings and patients clinicians encounter, substantially informing judgements of what constitutes good medical practice.
From the USA’s professional society for clinicians and allied professionals in the field of addiction medicine, comprehensive recommendations on how doctors can use medications to treat addiction to heroin and other opioids.
Further evidence from Iran that rapid withdrawal from opioids under anaesthesia followed by the opioid-blocking drug naltrexone can work for highly motivated caseloads with copious 'recovery capital'. For others this expensive and when not adequately controlled, potentially risky procedure generally ends in overdose-threatening relapse.
Unequivocal backing from UN agencies for methadone and other forms of long term maintenance treatments as the prime modality for the treatment of dependence on heroin and allied drugs. In contrast say the experts, detoxification results in poor long term outcomes.
From some of the same Australian authors who produced classic texts on maintenance prescribing for heroin addiction, a major new text analysing research on all types of drug-based interventions including maintenance, opiate-blocking drugs, and managing withdrawal.
STUDY 2005 PDF file 153Kb
Anaesthesia during rapid opiate detox raises costs but not outcomes
Dutch study finds that anaesthetising patients during accelerated opiate withdrawal is expensive and introduces new risks, but does not help inpatients complete detoxification or sustain drug use reductions on discharge.
STUDY 2004 PDF file 109Kb
Rapid detoxification facilitates transfer to naltrexone but gains fade
Relative to usual procedures, in the Netherlands, Australia and the USA, rapid withdrawal under anaesthesia enabled more opiate dependent patients to transfer to naltrexone and remain opiate free in the short-term, but within a year gains had diminished.
STUDY 2003 PDF file 189Kb
Rapid opiate detoxification feasible at home
Spanish study suggests that given suitable patients and a suitable home environment, rapid detoxification from opiates can be done at home without on-site professional supervision.
STUDY 2003 PDF file 164Kb
Naltrexone implants could reduce the early relapse rate after detoxification
Studies from the UK and Germany suggest that subcutaneous implants of naltrexone which block the effects of heroin for up to seven weeks could help reduce the early relapse rate after detoxification more effectively than the oral form of the medication.
REVIEW 2003 PDF file 178Kb
Lofexidine safe and effective in opiate detoxification
Cochrane review concludes that lofexidine almost matches methadone for opiate detoxification and has fewer side effects than clonidine, making it preferable when opiate-type drugs are contra-indicated. Extended text includes details of relevant studies.
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