Alexander DeLuca, M.D.
Addiction, Pain, & Public Health website

[Home] [Library]  [Slides]  [Search]  [Medline]  [Links]

[Statements of Purpose, Ownership, Sponsorship. Privacy,  Email Confidentiality, and Advertising Policies]

References and Resources:
Detoxification and Patient Engagement

Compiled by Alexander DeLuca: 1998 - 2006.  New documents added on: 2006-03-21 -
Flawed Basis for FDA Safety Decisions: Anti-Depressants and Children
Donald F Klein; Neuropsychopharmacology; 31(4):689-699; 2006
"The data necessary for objective evaluations of post-marketing harm cannot be gathered by the current process. Proper prospective surveillance by linked computerized medical records is a crucial issue that deserves major public and political attention and prompt action."
See also:
FDA Approves Selegiline Patch for Depression
- PRNewswire; 2006-02-28
Unhealthy Alcohol Use -
Richard Saitz, M.D., MPH; NEJM; 352(6): 596-607; 2005-02-10
Detox / Patient Engagement archives
Abstinence / Harm Reduction Academic Lit
Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction
Eric D. Collins, Herbert D. Kleber, Robert A. Whittington, Nicole E. Heitler, JAMA, 294(8): 903-913, 2005-08-24
"[Withdrawal] severities were comparable... [no differences] in rates of completion [or] retention [or urine tox]... The anesthesia procedure was associated with 3 potentially life-threatening adverse events.
Conclusion: These data do not support the use of general anesthesia for heroin detoxification and rapid opioid antagonist induction."

See also:
Methods of Detoxification and Their Role in Treating Patients with  Opioid Dependence
Patrick G. O’Connor, M.D., MPH; JAMA; 294(8): 961-963; 2005-08-24.
What is Ultra-Rapid Opiate detox (UROD) and how is it different from Rapid Opiate detox (ROD)?
Alexander DeLuca, Addiction-related FAQ #18, 2001
Two Doctors May Lose Licenses Over Fast-Detox Method Medicine
Associated Press; 2000-12-31
Heroin Detoxification - Michael M. Miller, Letter to the Editor, JAMA, 295(8): 885-886, 2006

Evidence for Controlled Heroin Use? -- Shewan and Dalgarno, British .J. Health Psych. 2005

Comment  (DeLuca):
In this study, subjects had occupational and educational status comparable to that of general UK pop. Ongoing problems were rare; heroin was not a significant predictor. Use frequency data suggests importance psych factors. The pharmacological properties of opioids, per se, do not inevitably lead to harmful use patterns.

See also:
Occasional and Controlled Heroin Use - Not a Problem? -
Warburton et al., Rowntree Foundation, 2005
Some Eminent Narcotics Addicts  ;  The Heroin Overdose Mystery - Edward Brecher; Chapter 5;12, "Licit and Illicit Drugs"; 1972
How Bad is Heroin Withdrawal? - Jara Krivanek; Chapter in "Heroin, Myths and Realities"; Allen & Unwin, Publishers; 1988


Occasional and Controlled Heroin Use - Not a problem? - Hamish Warburton, Paul J. Turnbull and Mike Hough; Joseph Rowntree Foundation; 2005 -- "The study describes how this largely hidden population maintained stable and controlled patterns of heroin use. It examines reasons for starting to use heroin, previous and current patterns of use, mechanisms and factors that helped to control use, and why this group saw their use as fairly problem-free."

Revised! (2005-12-28)
How Bad is Heroin Withdrawal?
Jara A. Krivanek; Chapter in: "Heroin, Myths and Realities"; Allen & Unwin, Publishers; 1988.Posted 2001-10-09. Modified: 2005-12-28.

An excerpt from the book:  "Heroin, Myths and Reality." Discussion of withdrawal, with particulate reference to the harm that stems from the illegal status of the drug. These include shared paraphernalia, the 'heroin lifestyle' and it's accompanying violence, desperation, poverty, malnutrition and poor hygiene, adulterated drug, and overdose.
See also:
Occasional and Controlled Heroin Use - Not a problem? - Warburton et al., Joseph Rowntree Foundation; 2005.
Evidence for Controlled Heroin Use? - Shewan and Dalgarno, British .J. Health Psych. 2005.

Treatments for schizophrenia: a critical review of pharmacology and mechanisms of action of antipsychotic drugs by Miyamoto et al.; Molecular Psychiatry; 2005. -- "[A] brief review and critique of the current therapeutic armamentarium for treating schizophrenia and drug development strategies and theories of mechanisms of action of antipsychotics, and focuses on novel targets for therapeutic agents for future drug development."

Methadone Maintenance vs 180-day Psychosocially Enhanced Detoxification for Treatment of Opioid Dependence  by Sees, et al. in JAMA 283(10); 1303-1310; 2000. (PDF) -- "Our results confirm the usefulness of MMT in reducing heroin use and HIV risk behaviors. Illicit opioid use continued in both groups but frequency was reduced. Results do not provide support for diverting resources from MMT into long-term detoxification."

Treatment for Opioid dependence by Bruce Rounsaville and Thomas Kosten;  JAMA; 283(10); 1337 3/8/2000. --  "Implementation of primary care treatment for substance use disorders offers the possibility of increased access to care for these common and undertreated disorders. Careful study will be required to maintain and improve the quality of that treatment. "

Heroin addicts benefit from better access to methadone by Reuters Health, 3/8/200. -- "More heroin addicts in the US could get treatment if doctors were allowed to dispense methadone in their office, according to results of a study on such a program in two cities in Scotland."

Patient Selection and Detoxification Protocols; by Alexander DeLuca, M.D.; Smithers Addiction Treatment and Research Center, circa 1999. -- "Expert detoxification is about more than the prevention of medical and psychiatric complications. It is the provision of non-judgmental, compassionate medical care. It is the reassurance of patients who are frightened and ashamed. It is the engagement of patients in a process of recovery that can spare them decades of pain and misery."

Office-Based Opiate Detoxification - An Open Letter to the FDA by Alex DeLuca, M.D; 1998. -- An analysis of the forces promoting the increasing use of outpatient treatment. Methods of opiate detoxification and medications are reviewed. Conclusion: proscription of all opioid medications in the treatment of opiate withdrawal is medically incorrect, ethically questionable, and socially counterproductive.
Alcohol Dependence: Diagnosis, Clinical Aspects, and Biopsychosocial Causes by J.'R. Volpicelli; From the Substance Abuse Library, Copyright © 1997 by Treatment Research Center, University of Pennsylvania.
Coping With Urges; Robert Westermeyer, Ph.D. -- Practical advice about how to deal with urges and temptations of early recovery using the "Three D's," Decatastrophizing, Disputing expectancies, and Distracting.
Inpatient vs. Outpatient Detox? Criteria for deciding by Alex DeLuca, M.D.; 1999. -- How to use assessment tools like the CIWA and the ASAM Patient Placement Criteria towards making a rational decision.
Outpatient Detoxification - Is This Really a Good Idea? by Alex DeLuca, M.D.; 2000. -- From: Smithers Addiction News, Vol. 1, No. 1, Pages 1-2. Discussion of outpatient detoxification guidelines and controlling risks associated with outpatient detox procedures.
High-Frequency Users Of Gamma-Hydroxybutyric Acid At Highest Risk for Withdrawal Symptoms by Anne MacLennan; American Journal on Addictions, Vol. 10, pp 232-4.; 2001 -- "High frequency users of gamma-hydroxybutyric acid are at greatest risk for withdrawal delirium and psychosis if use is stopped abruptly."
Gamma-Hydroxybutyrate Withdrawal Syndrome J.E. Dwyer, et al.; Annals of Emergency Medicine, Vol. 37, No. 2, pp 148-53; 2001. -- "Report on 8 cases in which a severe withdrawal syndrome followed ingestion every 3 hours around the clock. The withdrawal syndrome was accompanied initially by symptoms of anxiety, insomnia, and tremor that developed soon after GHB discontinuation. These initial symptoms may progress to severe delirium with autonomic instability." (PDF)
GHB Dependence, Withdrawal, and Detoxification by Alex DeLuca, M.D.; 2000. -- Answer to a question posed by a person requiring doses of GHB every few hours. Review of (paltry) literature, discussion of several cases, and links to web resources.

Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D., FASAM

[Top of Page]

Originally posted:  2004-08-30

All Email to: 

Statement of Purpose; Privacy policy; Email Confidentiality Policy; Statements of Ownership & Sponsorship; Advertising policy 

Most recently revised: 2006-03-21
Copyright © 1998-2006. All rights reserved.

We subscribe to the HONcode principles of the HON Foundation. Click to    This website is in compliance with the HONcode. Pin # = HONConduct911193. Verify HONcode Status.   We subscribe to the HONcode principles of the HON Foundation. Click to