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Opioid detoxification
1. Opio ids are natural plant alkalo ids o r synthetic substances which are able to cause a stro ng eupho ria and as a result o f systematic use, inevitably lead to a physical and psycho lo gical dependence. Opio ids inhibit pain, suppress respirato ry functio ns, co ugh reflex and slo w do wn the mo tility o f the gastro intestinal tract. Opio ids are widely used in legal medicine as a co mpo nent o f to tal anesthesia (Mo rphine, Fentanyl and their analo gues), as a means o f pain relief (OxyCo ntin, Vico din, Kafetin) and as a means o f substitutio n therapy (Methado ne, Substido l, Subo xo ne, Subutex). Opio ids such as hero in, o pium, acetyled o pium, deso mo rphine and o ther artisanally and industrially pro duced derivatives are widely presented o n the black market and used illegally.

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2. De t o xif icat io n is a co mplex medical interventio n aiming to cleanse the bo dy fro m narco tic substanes and to help a drug user to undergo thro ugh the withdrawal pro cess in the mo st painless way. The cho ice o f the metho d o f deto xificatio n is based o n an analysis o f several facto rs:

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Dr Vo ro biev Drug Rehab Medical To urism Serbia - Nature of narcotic substance . (hero in withdrawal lasts 5-7 days; withdrawal fro m Methado ne and Substido l is much mo re intense and can last up to 21-28 days.) A co mbinatio n o f several substances always strengthens and pro lo ngs the withdrawal sympto ms; - Dose of narcotic substance. Daily and we e kly do se ; f re que ncy o f use during t he day and week; - Duration of continuous use . If a perso n refrains fro m drug use at least two -three times during a year even fo r sho rt perio ds o f time (fro m 2 to 4 weeks) his metabo lism and immune system have time fo r rehabilitatio n. In this case, the withdrawal syndro me is no t so hard and the risk o f develo ping po ssible co mplicatio ns is lo wer. In case that a perso n has no t been able to sto p using drugs fo r a perio d o f at least 10 -14 days fo r many years, the withdrawal syndro me is

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mo re severe. Stress asso ciated with deprivatio n o f the drug causes pro fo und disturbances in o rgans and systems and a suppressed immune pro tectio n makes a perso n vulnerable to all kind o f infectio ns.

- Way of use . Intraveno us injectio ns o r inhalatio n (especially smo king the drug) o ften cause serio us vascular and respirato ry pro blems. The mo st dangero us way o f using the drug is multiple injectio ns into gro in, femo ral o r neck veins which very o ften results in the develo pment o f abscesses, sepsis, phlebitis and thro mbo sis. - Health condition and presence of concomitant diseases . The wo rse the health co nditio n is the mo re pro lo nged must be the deto xificatio n. Rapid and ultra rapid techniques expo se the bo dy to stress which increases the risk o f deco mpensatio n o f vital o rgans and systems which have already been damaged by the drugs. - Compliance, motivation, volitional mechanisms . Aggressiveness, a lo w level o f pain to lerance, psycho tic reactio ns, co mpulsive, irresistible attractio n to narco tics so metimes make attempts o f abrupt cancellatio n o f the drug ineffective. 3. Mo dalit ie s o f de t o xif icat io n. Inpatient treatment is the mo st effective and the safest care. In this case a patient do es no t have an access to narco tics. Therapy is being co nducted under co nstant 24ho ur medical o bservatio n and is mo nito red by mo dern equipment. Patients can receive adequate care at any time, which makes the deto xificatio n pro cess maximum painless and co mfo rtable. Staying in ho spital allo ws mo re fully the eliminatio n o f the co nsequences o f using the drugs, impro ves the appetite, enhances sleep, strengthens the immune system, reduces anxiety, depressio n, cravings fo r drugs and the need fo r medicatio ns. This can be achieved thro ugh the use o f physio therapy equipment, acupuncture and psycho therapy. 4 . De t o xif icat io n m e t ho ds and t e chnique s. Pharmacotherapy lasts abo ut 5-7 days. The co rrect co mbinatio n o f medicatio ns fo r each individual is o f majo r impo rtance in the deto xificatio n pro cess fo r the eliminatio n o f the main sympto ms o f withdrawal in the mo st effective way. Back pain, jo int pain, pain in legs do cked with the help o f no n-narco tic analgetics, special medicatio n that

weaken the afferent no ciceptive impulses that reduce respo nse to pain in the central nervo us system. These medicatio ns co me in mo st standard pain management and pro vide a go o d analgesic pro tectio n. Ano ther unpleasant syndro me is auto no mic instability (warm-co ld flashes, sneezing, yawning, go o seflesh, skin sensitivity to water). These sympto ms are well-cured by alfa2adreno mimetics, tiaprid. Psycho lo gical sympto ms: irritability, dyspho ria, depressio n, inability to take a co mfo rtable po sitio n in bed, restless, nervo usness, inso mnia, o bsessive tho ughts abo ut drugs. The so -called behavio r pro o freaders: psycho stabilizers, hypno tics, antidepressants are used fo r a relief o f these sympto ms. These medicatio ns are no t addictive and canno t cause themselves a new addictio n. Gastro intestinal diso rders nausea, vo mit and diarrhea are sto pped by antiemetic, means which no rmalize mo tility o f the gastro intestinal tract. Due to frequent malnutritio n, inadequate o r excessive appetite, the general maintenance therapy includes enzymes which facilitate assimilatio n o f fo o d, amino acids and vitamins. General treatment also pro vides therapy aiming at the eliminatio n o f the co nsequences o f drug use: special inhalatio ns to clean up the lungs, hepato pro tecto rs to resto re no rmal liver functio n, neuro metabo lics to enhance the metabo lic pro cesses in the brain.

Agonist-antagonist replacement last s 5 -7 days. The meaning o f the therapy is the co ntro lled sequential replacement o f the heavy dangero us hero in, Methado ne o r Substido l with the substance that prevents the develo pment o f withdrawal but practically do es no t cause eupho ria, into xicatio n and desire to increase a do se. The mo st co mmo n medicatio n fo r this therapy is bupreno rphine (Subutex, Subo xo ne). It co ntains bo th narco tic and antinarco tic pro perties (ago nist-antago nist). Thanks to that pheno meno n, bupreno rphine pretty well cuts o ff the withdrawal witho ut pro vo king an increased desire fo r drugs. It is o ften co mbined with o ther means o f pharmaco therapy. Neuro-electric therapy (N.E.T.) lasts 5-7 days.

The essence o f the metho d is based o n the recently disco vered pheno meno n o f natural o pio ids. Using a special device we can affect the neuro ns o f o ur brain respo nsible fo r the pro ductio n o f endo rphines and the state o f the endo geno us o pio id system. The fact is that o ur natural pro tectio n fro m sho ck, pain and o ther kind o f stress is based o n the natural o pio ids pro duced by the special gro up o f neuro ns. Using artificial substances (drugs), the do ses o f which are tho usands o f times greater than o ur natural o pio id level, almo st sto ps the pro ductio n o f o ur endo geno us ho rmo nes fo r pleasure. The co nsequence o f this deficiency is depressio n, apathy, sadness, lack o f sleep and appetite, o bsessive desire to take narco tics again and bring pleasant po sitive emo tio ns back. Many internatio nal studies co nfirm the central place o f endo rphinergetic systems in the develo pment mechanism o f addictio n. Applicatio n o f N.E.T. techno lo gy allo ws effective reco very o f the amo unt o f natural endo rphines. So me clinics in Switzerland and UK use o nly N.E.T. as a main means fo r o pio id and o ther drugs deto xificatio n witho ut using any medicatio n and it ensures go o d physical and mental co nditio n during deto xificatio n. Patients also no te significant reductio n in craving fo r drugs in this case. Here is an excerpt fro m an article in Sco tland Tribune

McConnell calls for new therapy treatment to help heroin users

JAMES MORGAN 14 Feb 20 0 7 J ack McCo nne ll has calle d f o r a radical shake -up in Sco t lands drug re habilit at io n po licy af t e r wit ne ssing a co nt ro ve rsial ne w he ro in addict io n t re at m e nt in act io n. Jack McCo nnell has called fo r a radical shake-up in Sco tlands drug rehabilitatio n po licy after witnessing a co ntro versial new hero in addictio n treatment in actio n. The First Minister said that Sco tland must seek to abando n the methado ne pro gramme and lo o k instead fo r new, drug-free metho ds o f kicking hero in. His co mments came after he visited a trial o f neuro -electric therapy (Net), a drug-free addictio n treatment, invented by a Sco ttish neuro surgeo n, Dr Meg Patterso n. At the trial, Mr McCo nnell met six female hero in users who are undergo ing a seven-day co urse o f Net. The treatment

invo lves a weak electric current being applied to the brain. Laura, 28 , a mo ther o f two , has been a hero in user fo r seven years, but has failed to quit using methado ne. She to ld the First Minister she had been amazed by ho w quickly her cravings fo r hero in had disappeared while undergo ing Net. Afterwards the First Minister spo ke o f his desire to see Net given a full clinical trial, with a view to making it available o n the NHS. He said: Were at the stage in Sco tland where we need to have o pen minds and be willing to try new things. We need to change directio n away fro m harm reductio n to wards drug free po licy. Theres no do ubt that Net has had an impact o n the vast majo rity o f peo ple who have tried it. Im very keen that we find a way o f pro gressing to a pro per research pro po sal so that Net can be tested in the co nditio ns that will meet the standards o f the Natio nal Health Service. If this is successful, then this treatment co uld o perate o n a scale that can make a huge difference to peo ples lives. Fo llo wing Mr McCo nnells glo wing repo rt, the Chief Medical Officer, Harry Burns, will visit the trial this week to meet the reco vering addicts and make his o wn judgment. The next step co uld be a larger trial invo lving addicts in priso n. Dan Gunn, the go verno r o f Saughto n priso n, Edinburgh, will visit the trial this week, to hear a pro po sal fro m the creato rs o f Net. There has also been interest fro m Andrew McLellan, HM Inspecto r o f Priso ns fo r Sco tland, who paid a visit to an earlier trial o f Net, where he met fo rmer priso ners who had kicked hero in using Net. Jo hn Mullen, o f the Third Step, said: The priso ns wo uld be a go o d place to test Net. We ho pe that Mr McLellans interest co uld lead o n to greater things. The treatment also has wo n praise fro m Annabel Go ldie, leader o f the Sco ttish Co nservatives, who has seen Net in actio n this week. She said: Neuro -electric therapy may very well o ffer the key to intro ducing a range o f o ptio ns fo r peo ple seeking help with drug addictio n. I shall certainly await with interest the assessment o f the trial and the co nclusio ns drawn fro m it. N.E.T. is no t an electric sho ck therapy. It do es no t cause co nvulsio ns and unco nscio sness. During the pro cedure the patient is awake, has no pain, no disco mfo rt. After the first 10 -15 minutes he (she) feels relaxed, a bit dro wsy, pleasant warmth in the bo dy. Rapid Opioid Detoxification (clonidine-naloxone protocol) lasts fro m 3 to 5 days. The technique is based o n the idea o f speeding up the pro cess o f cleansing the o pio id recepto rs fro m hero in o r any o ther o pio ids with the help o f o pio id antago nists. Usually the faster the pro cess o f deto xificatio n, the harder is the withdrawal. Therefo re it is very

impo rtant no t o nly to accelerate the cleansing pro cess, but also to pro vide an adequate pro tectio n fo r the brain and bo dy against stress. Fo r that reaso n the special deto x pro to co l has been launched. It includes a sho rt-acting, wellco ntro lled o pio id antago nist (nalo xo ne) and special medicatio ns to pro tect auto no mic system (clo nidine, tiaprid and etc.). The technique allo ws cutting do wn the duratio n o f withdrawal by 3-4 days and significantly reduces its intensity. The technique has been kno wn since the end o f the last century and its mo dificatio ns are widely used in many deto x centers all aro und the wo rld no wadays. Ultra Rapid Opioid Detoxification (U.R.O.D)

cleans the bo dy fro m o pio ids during 4-6 ho urs under to tal anesthesia. The huge advantage o f this metho d is that it is very fast, co mpletely painless and co mfo rtable pro cess o f deto xificatio n. The who le painful, tearing apart undergo ne thro ugh a natural withdrawal fo r a few days is co mpressed to up to 4-6 ho urs medically induced sleep. The mo dern medicatio ns fo r to tal anesthesia ensure a well co ntro lled deep sleep, causing inhibitio n in certain parts o f the brain

respo nsible fo r pain. All medicatio ns are no n to xic and therefo re can be used fo r patients with liver (hepatitis B, C) and kidney pro blems. Safety o f anesthesia is guaranteed by co nstant mo nito ring o f vital functio ns by electro cardio graphy, no n-invasive measurement o f blo o d pressure, o xygen blo o d saturatio n and etc. All medicatio ns during anesthesia are intro duced intraveno usly by special machines (blo o d pumps) which are pro grammed to maintain a certain co ncentratio n o f medicatio n in the patients bo dy indicating any changes o f ho meo stasis during the deto xificatio n pro cess. Risk assessment o f the pro cedure is carried o ut acco rding to the criteria o f ASA (American So ciety (Asso ciatio n) o f Anesthesio lo gists). After the pro cedure the patient remains under o bservatio n in an intensive care unit until the next day and stays in the ho spital fo r the fo llo wing 2-3 days. There are many myths abo ut the U.R.O.D. pro cedure. -Many ads say that there is neither physical dependence no r psycho lo gical dependence left after this pro cedure. Unfo rtunately it is no t like that in reality. U.R.O.D. dramatically reduces the physical dependence but almo st has no effect o n psycho lo gical dependence (craving fo r drugs). -There is an undue view that U.R.O.D. is dangero us because o f the high risk o f po ssible co mplicatio ns. This prejudice is mo stly against to tal anesthesia in general. Previo usly anesthesia was seen as a last reso rt. No wadays we do nt even co nsider dental care, co lo no sco py, abo rtio n o r any o ther unpleasant pro cedures witho ut anesthesia. Safety standards, high quality medicatio n and mo dern equipment all pro vide a co mfo rtable and safe deto xificatio n. -Danger o f o verdo se after leaving the ho spital. Indeed there is a risk o f o verdo se after U.R.O.D. A sharp dro p in to lerance and a high degree o f craving fo r drugs create a situatio n when an attempt to take a do se which is 2 o r 3 times less than that o f befo re deto xificatio n may lead to o verdo se which can be deadly dangero us. Therefo re, all the experts say that U.R.O.D. by itself is o nly a first step to ward liberatio n fro m drug dependence. The next steps are: a) mandato ry co rrectio n o f psycho lo gical dependence to stabilize mental pro cesses, b) pharmaco lo gical pro tectio n fro m relapse with naltrexo ne, c) general rehabilitatio n which allo ws bring a who le system o f life values back and change life fo r better.

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