麻酔補助対ブプレノルフィンまたはクロニジン補助のヘロイン解毒とナルトレクソン誘導:ランダム化試験
Eric D Collins1, Herbert D Kleber, Robert A Whittington
1Division on Substance Abuse, New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA. edc3@columbia.edu
JAMA
|August 25, 2005
まとめ
オピオイドの解毒のための全身麻酔は,この研究によって支持されていません. 麻酔補助およびブプレノルフィン補助の方法では,ナルトレクソン誘導率が高かったが,クロニジンと比較して保持が改善されなかった.
科学分野:
- 依存症医学 薬物中毒医学
- 薬理学 薬理学とは
- アネステシオロジー アネステシオロジー
背景:
- 麻酔による迅速なオピオイド解毒は,オピオイド依存症の高価で実証されていない治療法です.
- この方法は,全身麻酔下でのオピオイドアンタゴニスト誘導を含む.
研究 の 目的:
- ヘロイン依存症の2つの代替方法に対して,迅速なアンタゴニスト誘導による麻酔補助解毒を比較する.
- この研究は,さまざまな解毒戦略の有効性と安全性を評価することを目的とした.
主な方法:
- ヘロイン依存症の患者106人を無作為的に3つのグループに分けました:麻酔補助,ブプレノルフィン補助,またはクロニジン補助の解毒.
- すべてのグループは72時間の入院治療を受け,その後12週間の門診ナルトレクソンメンテナンスと心理療法を受けた.
- 結果には,離脱の重度,ナルトレクソン誘導率,治療完了,抑留,オピオイド陽性尿検査が含まれていました.
主要な成果:
- 離脱症状の重度は,すべてのグループで同様のものでした.
- 麻酔およびブプレノルフィン補助法では,クロニジン (21%) と比較して,ナルトレクソン誘導率 (94%および97%) が著しく高かった.
- 入院患者の解毒の完了や12週間の治療の継続において,有意な差異は認められなかった. 麻酔は有害事象と関連していた.
結論:
- ヘロインの解毒やオピオイド抗剤の急速な誘導のために全身麻酔は推奨されません.
- 麻酔補助およびブプレノルフィン補助の方法はナルトレクソン誘導を改善しますが,長期的な治療の持続性を高めることはありません.
- ナルトレクソン誘導は,中退のリスクを大幅に低下させた.
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