A STUDY OF ANESTHESIA-ASSISTED HEROIN DETOXIFICATION

海洛因依赖在20世纪90年代重新成为一个重大的公共卫生问题，因此，人们对改进阿片类药物解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，在拮抗剂沉淀的阿片类药物戒断急性期使用全身麻醉已经引起了相当广泛的关注，但还没有麻醉辅助解毒技术的对照研究。特别是，在全身麻醉下解毒的患者的随访数据是不可用的。本文提出的研究旨在比较麻醉辅助快速阿片类药物解毒（AROD）与两种替代解毒技术，同时关注急性戒断措施和长期戒断以及纳曲酮维持依从性。我们的计划是对159名患者进行为期三年的研究，随机选择三种戒毒技术中的一种，然后进行12周的门诊治疗，结合纳曲酮维持和手册指导的复发预防/应对技能培训心理治疗。AROD技术将直接与丁丙诺啡介导的阿片类药物快速解毒（BROD）和可卡因辅助阿片类药物解毒（COD）进行比较。我们纳入了戒断严重程度、认知和运动表现的综合评估，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解毒技术进行控制评价。我们期望提供有关麻醉辅助海洛因戒毒的安全性和即时和中期疗效的信息。我们相信这些信息对于政策制定者和患者来说是非常重要的，因为麻醉辅助戒毒技术已经在这个国家和世界范围内激增，使患者暴露在麻醉的成本和风险中，没有任何证据表明海洛因依赖者选择麻醉作为一种戒毒手段的结果有所改善。

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.