[High-dose methadone detoxification in a hospital unit. Clinical experience]. / Desintoxicacion de dosis elevadas de metadona en una Unidad de Desintoxicacion Hospitalaria (UDH). Experiencia clinica.

The increase in opiate addicts in treatment with methadone, coupled with improved survival of HIV patients, has meant an increase in the demand for detoxification from this substance in our environment. It is common practice in hospital detoxification units to request a maximum dose of methadone (around 40 mg) on beginning detoxification treatment. However this is not always possible, due to the time needed for a gradual decrease for outpatients making daily visits to the methadone dispensing centres, due to the appearance of withdrawal symptoms, or because the patient starts out from very high doses of methadone. Reported here is an experience with 22 inpatients who over the last two years underwent detoxification from methadone without requesting from their treatment centres a maximum-limit dose at the start of their treatment. During the detoxification they are given treatment with clonidine and benzodiazepines (dosage being adjusted according to concomitant use of alcohol, benzodiazepines and cocaine) and non-opiate-based painkillers. On the seventh day they are given 50 mg of naltrexone. Of these addicts, 21 completed the detoxification adequately.

Desintoxicación de dosis elevadas de metadona en una Unidad de Desintoxicación Hospitalaria (udh). Experiencia clínica / High-dose methadone detoxification in a hospital unit. Clinical experience

El aumento de adictos a opiáceos en tratamiento en metadona, junto con la mayor supervivencia de los pacientes VIH, ha supuesto en nuestro medio un incremento de la demanda de desintoxicación de dicha sustancia. Es práctica habitual en las Unidades de Desintoxicación Hospitalaria (UDH) solicitar una dosis máxima de metadona (alrededor de 40 mg) al ingreso para realizar la desintoxicación. Sin embargo, esto no siempre es posible, bien por el tiempo necesario para la disminución gradual ambulatoria, por aparecer sintomatología abstinencial,o por partir el paciente de dosis muy elevadas de metadona. Se muestra la experiencia en 22 pacientes que en los últimos dos años realizan desintoxicación de metadona sin solicitar a los centros remitentes dosis límite máxima para su ingreso. Reciben durante la desintoxicación tratamiento con clonidina y benzodiacepinas (ajustada la dosis de éstos fármacos según el consumo concomitante de alcohol, benzodiacepinas o cocaína) y analgesia no opiácea. Al séptimo día se administra 50 mg denaltrexona. De estos adictos, 21 realizaron la desintoxicación de forma adecuada

The increase in opiate addicts in treatment with methadone, coupled with improved survival of HIV patients, has meant an increase in the demand for detoxification from this substance in our environment. It is common practice in hospital detoxification units to request a maximum dose of methadone (around 40mg) on beginning detoxification treatment. However this is notalways possible, due to the time needed for a gradual decrease for outpatients making daily visits to the methadone dispensing centres, due to the appearance of with drawal symptoms, or because the patient starts out from very high doses of methadone. Reported here is an experience with 22 inpatients who over the last two years underwent detoxification from methadone without requesting from their treatment centresa maximum-limit dose at the start of their treatment. During the detoxification they are given treatment with clonidine and benzodiazepines (dosage being adjusted according to concomitant use of alcohol, benzodiazepines and cocaine) and non-opiate-based painkillers. On the seventh day they are given 50 mg of naltrexone. Of these addicts, 21 completed the detoxification adequately