Vitamin and mineral supplements are often given. Rapid detoxification methods Clonidine-naltrexone detoxification This method29-31 combines a rapid, precipitated withdrawal by naltrexone producing severe withdrawal symptoms, with high doses of clonidine and benzodiazepines before and after the naltrexone to ameliorate the symptoms. While shortening withdrawal to 2 to 3 days, evidence is lacking of longer abstinence or naltrexone
retention.32 Rapid opioid withdrawal under general anesthesia To decrease further Inhibitors,research,lifescience,medical the time needed for withdrawal, a rapid detoxification procedure using general anesthesia was developed33 and gradually improved.34-37 A variety of medications have been used, including naltrexone or nalmefene, propofol anesthesia or heavy midazolam sedation, the antiemetic ondansetron, the antidiarrheal octreotide, and clonidine and benzodiazepines for other withdrawal symptoms, and has been carried Inhibitors,research,lifescience,medical out on either an inpatient or outpatient basis. Post-procedure
therapy varies widely. Claims of high rates of abstinence months after detoxification have been made, but no objective verification exists, and the samples are not representative.38 Significant withdrawal symptoms may persist for days or even weeks after the procedure in humans15,39, 40 or in rats,41 and there appears to be no longer-term improved outcome at 1 to 3 months Inhibitors,research,lifescience,medical later.15,42, 43 Internationally, over one dozen deaths have been reported, usually within 72 hours of the procedure, with pulmonary edema a common complication.44-47 Pregnancy Illicit opioid use during pregnancy can Inhibitors,research,lifescience,medical have numerous
harmful effects on the woman, fetus, and neonate. Residential abstinent treatment is usually not available. Methadone maintenance is thus the standard approach.48 While the infant will be physically dependent on methadone and about half need to be withdrawn, no birth defects are associated with such exposure, if prenatal care is adequate. Withdrawal from methadone maintenance is usually not preferable, Inhibitors,research,lifescience,medical but if carried out it should occur during the second trimester at no greater than 5 mg/week. Methadone metabolism is increased during pregnancy, and plasma half -life decreased. The clinician must balance the risk of illicit opioid use if the dose is too low, and the risks of the neonatal abstinence syndrome (NAS) mafosfamide if the dose is too high. This can be somewhat ameliorated by split dosing. Studies of pregnant methadone-maintained women found decreased narcotic use and improved health and prenatal care. Fetal growth and perinatal outcomes also improved. These benefits dimmish with continued use/abuse of licit (alcohol and tobacco) or illicit (cocaine and marijuana) substances.49 Maintenance on buprenorphine is a more recent development with published reports of over 300 pregnancies, with good fetal outcomes. Buprenorphine appears comparable to methadone on outcome GDC-0994 research buy measures as assessed by NAS and maternal and neonatal safety.