Anesthesia-assisted opiate detoxification (AAOD) for heroine addicts during 24-hour ICU admission: complications and results for opiate abstinence at 1-year follow-up

Aim

(1) To list addiction-related health problems in a group of 67 patients addicted to heroin and/or methadone, who were treated with AAOD during 24-hour ICU admission. (2) To evaluate complications of AAOD on the day of treatment and during the first week after AAOD. (3) To evaluate the effect of our post-AAOD treatment programme, consisting of naltrexone combined with cognitive behavioural therapy (CBT) for 1 year after AAOD, on abstinence from opiates, on employment, on training and education, and on criminal behaviour 1 year after the AAOD treatment.

Methods

A retrospective descriptive study of the files of patients who had an AAOD between 10 March 2000 and 10 March 2002. Data was analysed using the χ² test.

Results

(1) The average length of opiate addiction in this group of 67 patients (57 men) was 12.8 years. Sixty-one patients (91%) were in methadone programmes for an average 8.2 years. Thirty-five patients (52%) had three or more failed detoxifications. Nineteen patients (28%) were underweight (body mass index < 20), and 29 (43%) had mild to moderate respiratory problems. Thirty patients (45%) had used intravenous drugs, of whom 13 (43%) were hepatitis C-positive, seven (23%) were hepatitis B-positive, and three (10%) were positive for hepatitis B and hepatitis C. No HIV-positive patients were found. (2) Complications after AAOD: vomiting (more than two times per day) in 10 patients (15%), diarrhoea (more than three times per day) in three patients (4%). No aspiration pneumonia or renal failure was seen. One patient was admitted to a hospital for 2 days to prevent dehydration. (3) The results for abstinence, employment, training and education, and criminal behaviour are shown in Table 1.

Table 1 Table

Conclusion

(1) Although the majority of patients in this group made use of methadone programmes, they still often suffered from health problems common to intravenous drug users such as being underweight, respiratory problems and hepatitis B and hepatitis C. No HIV-positive patients were found. (2) Complications after AAOD were infrequent and not severe. (3) AAOD and naltrexone combined with CBT as provided by our clinic leads to opiate abstinence in 70% of patients after 1 year and to a significantly higher participation in employment, training and education, and a significant decrease in criminal activities.