Clonidine and naltrexone in the outpatient treatment of heroin withdrawal.

Clonidine hydrochloride (an alpha-2 adrenergic agonist) and naltrexone hydrochloride (an opioid antagonist), given in combination, provided a safe and effective treatment of abrupt opioid withdrawal over 5 days in an outpatient/day setting. Before starting the clonidine, a naloxone challenge test was used to verify and quantify opioid dependence, and the naloxone challenge test score was then used to determine initial medication doses. Initial naloxone challenge test scores predicted subsequent patient discomfort during the 5-day clonidine-naltrexone protocol. Twelve of 14 (86%) heroin users successfully withdrew from opioids and simultaneously initiated naltrexone maintenance.

Clonidine in outpatient detoxification from methadone maintenance.

Inpatient narcotic detoxification with clonidine hydrochloride has been used since 1978. Outpatient withdrawal, potentially more useful, has not been adequately studied. This report describes a double-blind random assignment of 49 methadone hydrochloride-maintained patients whose dose had been lowered to 20 mg. Twenty-five were detoxified using methadone at 1-mg decrements, 24 by abrupt substitution with clonidine. Approximately 40% of both groups achieved successful detoxification, with one third maintaining abstinence over the subsequent six months. The groups were also largely equivalent on withdrawal symptoms, but the clonidine group experienced symptoms in the first half of the study and the methadone group in the second half. Clonidine appears to be a safe and efficacious outpatient treatment for opiate withdrawal, although the results were less favorable than those obtained in open or inpatient studies.

Methylphenidate (Ritalin) treatment of cocaine dependence--a preliminary report.

The authors report on three cases of cocaine dependence treated with methylphenidate. All patients treated showed marked to dramatic improvement with regard to toxic/abstinence signs and symptoms, craving behavior and other behavioral disturbances associated with heavy and chronic cocaine abuse. The authors explore the possibility that cocaine dependence is associated with pre-existing or resulting psychopathology, particularly mood disturbances. Emphasis is also placed on a predisposing or de novo attention deficit disorder (ADD) as possibly contributing to heavy or continued reliance on cocaine.

Imipramine as treatment for depression in addicts.

This report describes the results of a placebo-controlled double-blind clinical trial evaluating imipramine hydrochloride, a tricyclic antidepressant, as treatment for depression in methadone-maintained opiate addicts. Forty-six subjects were assigned randomly to either the imipramine or placebo group for up to eight weeks. All patients also received mandatory once weekly group therapy as part of the methadone program. Outcome measures included attrition, depressive symptoms, global improvement, side effects, social functioning, and urine specimen results positive for illicit drugs. The therapeutic response in the two conditions was similar. Addicts receiving either imipramine or placebo experienced a substantial reduction of depressive symptoms during the eight weeks of the study. These findings are compared with other studies that treat depression in addicts and nonaddicts.

Clonidine and naltrexone. A safe, effective, and rapid treatment of abrupt withdrawal from methadone therapy.

Clonidine hydrochloride and naltrexone hydrochloride, given in combination, were found to provide a safe, effective, and extremely rapid treatment of abrupt withdrawal from methadone hydrochloride therapy. Under controlled inpatient conditions established to assess dosage guidelines and to examine specific signs and symptoms of withdrawal, ten (91%) of 11 patients were able to withdraw completely from methadone therapy by the end of a six-day period. Six days of clonidine hydrochloride treatment, with a peak mean dose of 2.9 mg/day on treatment day 2, attenuated the withdrawal-inducing effects of naltrexone. Naltrexone hydrochloride was gradually increased from an initial 1-mg dose on treatment day 2 to 50-mg maintenance dose on treatment day 5 without an associated increase in withdrawal symptoms. Clonidine significantly decreased BP without producing clinical problems. The withdrawal symptoms of anxiety, restlessness, and muscular aching were most resistant to treatment, but at discharge most patients were completely asymptomatic.

The treatment of narcotic withdrawal: a historical review.

The history of narcotic withdrawal treatment is filled with "cures" enthusiastically received and then quietly dropped when they turned out to be either ineffective, dangerous, or both. Methods reviewed include the Towns-Lambert belladonna treatment, sodium thiocyanate, bromide sleep treatment, Narcosan, insulin, autogenous serum, ECT, hibernation, methadone, phenothiazines, propranolol, propoxyphene, acupuncture, vitamin C, and the naloxone flush. There is need to be aware of the psychologic as well as physical aspects of withdrawal. Better detoxification techniques would help patients who are ready to discontinue the use of methadone as well as those who want to start naltrexone treatment.

Multiple family therapy and naltrexone in the treatment of opiate dependence.

The effect of multiple family therapy on client compliance and retention in a high intervention, naltrexone treatment program was examined retrospectively. The population consisted of 65 opiate-dependent individuals consecutively treated with naltrexone and a standard program of counseling and supportive psychotherapy. Twenty-five of these individuals, in addition, received multiple family therapy. The data presented are suggestive of the efficacy of combining multiple family therapy and high intervention in patients being treated with naltrexone. Analysis of the data demonstrated that the group receiving multiple family therapy had a larger continuous time of naltrexone ingestion and remained in the treatment program longer than clients who did not receive multiple family therapy. These effects were independent of race and employment status. The implication of the results for treatment and avenues for future research are discussed.

The use of clonidine in detoxification from opiates.

Use of clonidine hydrochloride in detoxification from opiates has demonstrated that this substance can rapidly suppress the signs and symptoms associated with opiate withdrawal. Clonidine hydrochloride, an alpha-adrenergic agonist, is a non-opiate substance. Studies to date indicate that clonidine is useful for withdrawal from methadone maintenance, where it can help in detoxifying the patient in less than 14 days (instead of the usual three to six months) with a high rate of success in achieving zero dosage. The results of a clinical investigation of clonidine are presented and discussed in this paper. It has been shown to suppress signs and symptoms of opiate withdrawal in patients taking up to 75 mg of methadone daily. Shorter-acting narcotics may be withdrawn in less than a week. To prevent relapse, post-detoxification counselling and the use of the narcotic antagonist, naltrexone, are recommended.

Successful detoxification from methadone maintenance. Follow-up study of 38 patients.

Thirty-eight patients were successfully detoxified from maintenance with methadone hydrochloride. Contrary to results of most previous studies, a substantial number of individuals were found to have remained drug-free, employed, and uninvolved with the criminal justice system since detoxification. Almost half of those who returned to drug use have become reinvolved in treatment. Escalated alcohol use occurred during and following methadone maintenance.