A STUDY OF ANESTHESIA-ASSISTED HEROIN DETOXIFICATION

海洛因依赖在20世纪90年代的S再次成为一个重大的公共卫生问题，随着那次事件的发生，人们对改进阿片类药物戒毒方法重新产生了兴趣。戒毒是并将继续是治疗海洛因依赖者的常见第一步。在过去的十年中，全麻在拮抗剂催促的阿片类药物戒断急性期的应用受到了相当广泛的关注，但还没有关于麻醉辅助戒毒技术的对照研究。特别是，没有关于在全身麻醉下戒毒的患者的随访数据。这项研究旨在比较麻醉辅助快速阿片类药物脱毒(AROD)和两种替代脱毒技术，既关注急性戒断措施，也关注长期戒断和纳曲酮维持的依从性。我们的计划是对159名患者进行为期三年的研究，随机采用三种戒毒方法之一，然后进行为期12周的门诊治疗，结合纳曲酮维持和手动指导的复发预防/应对技能培训心理治疗。Arod技术将直接与丁丙诺啡介导的快速阿片戒毒(Brod)和可乐定辅助阿片类药物戒毒(COD)进行比较。我们纳入了对戒断严重程度、认知和运动能力的全面评估，以及超过12周的随访数据。我们方法的优势在于在一致的条件下对三种戒毒技术进行受控评估。我们期望提供有关麻醉辅助脱毒的安全性和即时和中期疗效的信息。我们认为，这一信息对政策制定者和患者非常重要，因为麻醉辅助戒毒技术在美国和世界各地激增，使患者面临麻醉的成本和风险，但没有任何证据表明，选择麻醉作为戒毒手段的海洛因依赖者的结果有所改善。

Heroin dependence has reemerged as a significant public health problem in the 1990's, and with that, there has been renewed interest in improving methods of opioid detoxification. Detoxification is and will continue to be a common first step in the treatment of individuals with heroin dependence. During the past decade, there has been considerable popular attention focused on the utilization of general anesthesia during the acute phase of antagonist-precipitated opioid withdrawal, but there have been no controlled studies of anesthesia-assisted detoxification techniques. In particular, follow-up data on the patients detoxified under general anesthesia are not available. The research proposed here aims to compare anesthesia-assisted rapid opioid detoxification (AROD) with two alternative detoxification techniques, with attention both to acute measures of withdrawal and to longer-term abstinence and compliance with naltrexone maintenance. Our plan is to carry out a three-year study of 159 patients randomized to one of three detoxification techniques, followed by 12 weeks of outpatient treatment combining naltrexone maintenance and manual-guided relapse prevention/coping skills training psychotherapy. The AROD technique will be compared directly with a buprenorphine-mediated rapid opiate detoxification (BROD), and with a clonidine-assisted opioid detoxification (COD). We incorporate comprehensive assessments of withdrawal severity and cognitive and motor performance, as well as follow-up data over 12 weeks. The strength of our approach lies in the controlled evaluation of the three detoxification techniques under consistent conditions. We expect to provide information about the safety and immediate- and intermediate-term efficacy of anesthesia-assisted detoxification from heroin. We believe that this information is very important for policy makers and patients, as anesthesia-assisted detoxification techniques have proliferated in this country and throughout the world, exposing patients to the costs and risks of anesthesia, without any evidence of improved outcome for the heroin-dependent individuals who choose anesthesia as a means to detoxification.