Rapid opioid detoxification succesful way for drug abuse prevention

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Rapid opioid detoxification succesful way for
drug abuse prevention

• Robertas Badaras
• Vilnius Toxicology Clinic

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Psychoactive substances abuse

• USA health problem No.1
• Combining medication and
  psychosocial treatment for addictions 2001
• Treatment usually begins when compete
  psychological and physical addiction occurs,
  though early stage remains invisible during long
  time

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Perfect desirable model
Society

• Drugs

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Real model
Society

• Drugs

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Improvement of protection
Society
Drugs
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Harm reduction
Society
Drugs
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Chance of distribution
Society
Drugs
8
Increasing number of drug users
Society
Drugs
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Necessity of treatment

• Chemical addictions chronic CNS diseases, so
  hope of complete and fast recovery is naive
• Without treatment this illness will spread more
  quick, and outcomes will be more problematic
• The treatment of addict patients protect healthy
  people

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Efficiency of treatment

• Addiction is a treatable disease...
• Overall, treatment of addiction is as successful
  as treatment of other chronic diseases, such as
  diabetes, hypertension, and asthma. Drug
  treatment reduces drug use by 40 to 60...
• Leshner A. I. JAMA, October 13,
  1999

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Components of Comprehensive Addiction Treatment -
Core elements

• Intake processing and/or assessment
• Improvement of motivation
• Treatment plan
• Pharmacotherapy
• Behavioral therapy and counseling
• Substance use monitoring
• Self-help and peer support groups
• Continuing care

Modified from Etheridge RM, Hubbard RL
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Components of Comprehensive Addiction Treatment -
Associated services

• Mental health services
• Medical services
• Educational services
• Financial services
• Housing services
• Family services
• Vocational services

Modified from Etheridge RM, Hubbard RL
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Financial sources for addiction treatment

• Signally lesser, than for prevention of drug
  offering and demand
• Major part of them goes to the harm reduction,
  treatment of addiction complications (infectious
  and mental diseases, etc.)

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Opioid addiction treatment
Detox
Rehabilitation Opioid Antagonists
Motivation
Long duration of detox Severe withdrawal Lack of
motivation
Craving Repeated usage Psychological and social
reasons
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Can you draw an analogy between sandglass and
addiction treatment?
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Detoxification techniques

• Without any medical support (dry detox)
• Traditional
• Substitution with reducing doses of opioids
• Rapid opioid detoxification
• under general anesthesia (Ultra Rapid Opioid
  Detoxification)
• under sedation (Rapid Opioid Detoxification)

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Which is the best?

• In advanced family planing clinic, according to
  patients confessional, ethical peculiarities and
  health conditions the great variety of birth
  control techniques can be suggested.All of them
  are available and suitable, if the results are
  achieved. Similar criterion of evaluation must be
  apply to the choise of detoxification
  techniques...

Colin Brewer 2003
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Rapid Opioid Detoxification

• Opioid abstinence precipitated by administration
  of opioid antagonists
• Early blockade of opioid receptors - time of
  introduction onto Naltrexone shorten to 12-24
  hours after heroin intake
• Correction of symptoms of withdrawal
• Duration of detoxification 2-3 days
• High cost-effectiveness

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DRUG COURT chance for choice
Drug- or alcohol-involved offence
Imprisonment
Mulct
Treatment
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DRUG COURT Utopia or alternative?

• Beginning with the Dade County (Miami, FL)
  program in 1989, drug courts have become the
  preferred mechanism for linking drug- or
  alcohol-involved offenders to community-based
  treatment and related clinical interventions
• 
  Office of Justice Programs, 1998
• An estimated 220,000 adults and 9,000 juveniles
  have enrolled through December 2000, and 73,000
  adults and 1,500 juveniles have graduated
  (American University, 2001)
• The National Center on
  Addiction and Substance Abuse 2001
• USA Congress support 1183 drug courts with 50
  million

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Conclusions

• Drug addictions must be treated in comprehensive
  way according humane as well as pragmatic reasons
• Rapid Opioid Detoxification is the succesful way
  for drug abuse prevention