0
0

Chapter 19. Detoxification of Opioids

Soteri Polydorou, M.D.; Herbert D. Kleber, M.D.
DOI: 10.1176/appi.books.9781585623440.351256

Sections

Excerpt

Your session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Table Reference Number
TABLE 19–1. Signs and symptoms of opioid withdrawal
Table Reference Number
TABLE 19–2. Duration of effects and first appearance of withdrawal
Table Reference Number
TABLE 19–3. Drug relationships for withdrawal
Table Reference Number
TABLE 19–4. Clonidine-aided detoxification
Table Reference Number

Although detoxification allows patients to initially overcome their physical dependence, without follow-up treatment it is unlikely to lead to long-term recovery.

Various medications are used for opioid detoxification, including full opioid agonists (e.g., methadone), partial opioid agonists (e.g., buprenorphine), opioid antagonists (e.g., naltrexone), 2 adrenergic agonists (e.g., clonidine), and adjuvant medications (e.g., clonazepam, ibuprofen, bismuth subsalicylate) for symptomatic relief.

Since its introduction to the United States in 2002, buprenorphine has been effectively used for detoxification and maintenance because it is long-acting, can suppress withdrawal symptoms at least as well as methadone, causes less severe withdrawal than heroin or methadone when abruptly stopped, allows for outpatient use, and is safe when used by experienced physicians.

Recent studies on rapid antagonist induction under general anesthesia have revealed little benefit while leading to significant adverse events.

Various alternatives to current detoxification strategies, including the use of tramadol, ibogaine, acupuncture, and others, require further study before their routine use can be supported.

References

Alling FA, Johnson BD, Elmoghazy E: Cranial electro-stimulation (CES) use in the detoxification of opiate-dependent patients. J Subst Abuse Treat 7:173–180, 1990
[PubMed]
 
Alper KR: Ibogaine: a review. Alkaloids Chem Biol 56:1–38, 2001
[PubMed]
 
Amass L, Ling W, Freese TE, et al: Bringing buprenorphine-naloxone detoxification to community treatment providers: the NIDA Clinical Trials Network field experience. Am J Addict 13:S42–S66, 2004
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
 
Bochud Tornay C, Favrat B, Monnat M, et al: Ultra-rapid opiate detoxification using deep sedation and prior oral buprenorphine preparation: long-term results. Drug Alcohol Depend 69:283–288, 2003
 
Breen CL, Harris SJ, Lintzeris N, et al: Cessation of methadone maintenance treatment using buprenorphine: transfer from methadone to buprenorphine and subsequent buprenorphine reductions. Drug Alcohol Depend 71:49–55, 2003
[PubMed]
 
Brewer C: Ultra-rapid, antagonist-precipitated opiate detoxification under general anaesthesia or sedation. Addict Biol 2:291–302, 1997
 
Brewer C, Rezae H, Bailey C: Opioid withdrawal and naltrexone induction in 48–72 hours with minimal drop-out, using a modification of the naltrexone-clonidine technique. Br J Psychiatry 153:340–343, 1988
[PubMed]
 
Brewington V, Smith M, Lipton D: Acupuncture as a detoxification treatment: an analysis of controlled research. J Subst Abuse Treat 11:289–307, 1994
[PubMed]
 
Brumbaugh AG: Acupuncture: new perspectives in chemical dependency treatment. J Subst Abuse Treat 10:35–43, 1993
[PubMed]
 
Buydens-Branchey L, Branchey M, Reel-Brander C: Efficacy of buspirone in the treatment of opioid withdrawal. J Clin Psychopharmacol 25:230–236, 2005
[PubMed]
 
Cami J, de Torres S, San L, et al: Efficacy of clonidine and of methadone in the rapid detoxification of patients dependent on heroin. Clin Pharmacol Ther 38:336–341, 1985
[PubMed]
 
Carnwath T, Hardman J: Randomised double-blind comparison of lofexidine and clonidine in the out-patient treatment of opiate withdrawal. Drug Alcohol Depend 50:251–254, 1998
[PubMed]
 
Charney DS, Sternberg DE, Kleber HD, et al: The clinical use of clonidine in abrupt withdrawal from methadone: effects on blood pressure and specific signs and symptoms. Arch Gen Psychiatry 38:1273–1277, 1981
[PubMed]
 
Charney DS, Heninger GR, Kleber HD: The combined use of clonidine and naltrexone as a rapid, safe, and effective treatment of abrupt withdrawal from methadone. Am J Psychiatry 143:831–837, 1986
[PubMed]
 
Cicero TJ, Adams EH, Geller A, et al: A post marketing surveillance program to monitor Ultram (tramadol hydrochloride) abuse in the United States. Drug Alcohol Depend 57:7–22, 1999
[PubMed]
 
Collins ED, Kleber HD, Whittington RA, et al: Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: a randomized trial. JAMA 294:903–913, 2005
[PubMed]
 
Comer SD, Sullivan MA, Yu E, et al: Injectable, sustained-release naltrexone for the treatment of opioid dependence: a randomized, placebo-controlled trial. Arch Gen Psychiatry 63:210–218, 2006
[PubMed]
 
Dashe JS, Jackson GL, Olscher DA, et al: Opioid detoxification in pregnancy. Obstet Gynecol 92:854–858, 1998
[PubMed]
 
Dawe S, Griffiths P, Gossop M, et al: Should opiate addicts be involved in controlling their own detoxification? A comparison of fixed versus negotiable schedules. Br J Addict 86:977–982, 1991; erratum in Br J Addict 87:1221, 1992
 
De Jong CAJ, Laheij RJF, Krabbe PFM: General anaesthesia does not improve outcome in opioid antagonist detoxification treatment: a randomized controlled trial. Addiction 100:206–215, 2005
 
Eissenberg T, Greenward MK, Johnson RE, et al: Buprenorphine's physical dependence potential: antagonist-precipitated withdrawal in humans. J Pharmacol Exp Ther 276:449–459, 1996
[PubMed]
 
Epstein DH, Preston KL, Jasinski DR: Abuse liability, behavioral pharmacology, and physical-dependence potential of opioids in humans and laboratory animals: lessons from tramadol. Biol Psychol 73:90–99, 2006
[PubMed]
 
Evangelou A, Kalfakakou V, Georgakas P, et al: Ascorbic acid (vitamin C) effects on withdrawal syndrome of heroin abusers. In Vivo 14:363–366, 2000
[PubMed]
 
Fischer G, Ortner R, Rohrmeister K, et al: Methadone versus buprenorphine in pregnant addicts: a double-blind, double-dummy comparison study. Addiction 101:275–281, 2006
[PubMed]
 
Fudala PJ, Jaffe JH, Dax EM, et al: Use of buprenorphine in the treatment of opioid addiction, II: physiologic and behavioral effects of daily and alternate-day administration and abrupt withdrawal. Clin Pharmacol Ther 47:525–534, 1990
[PubMed]
 
Gerra G, Marcato A, Caccavari R, et al: Clonidine and opiate receptor antagonists in the treatment of heroin addiction. J Subst Abuse Treat 12:35–41, 1995
[PubMed]
 
Gevirtz C: Anesthesiological safety of ultrarapid detoxification. Paper presented at the 7th Stapleford International Conference on Addiction Management, Nijmegen, The Netherlands, 2002
 
Ghodse H, Myles J, Smith SE: Clonidine is not a useful adjunct to methadone gradual detoxification in opioid addiction. Br J Psychiatry 165:370–374, 1994
[PubMed]
 
Gillen C, Haurand M, Kobelt DJ, et al: Affinity, potency and efficacy of tramadol and its metabolites at the cloned human mu-opioid receptor. Naunyn Schmiedebergs Arch Pharmacol 362:116–121, 2000
[PubMed]
 
Gold MS, Redmond DE Jr, Kleber HD: Clonidine blocks acute opiate-withdrawal symptoms. Lancet 2:599–602, 1978
[PubMed]
 
Gossop M, Johns A, Green L: Opiate withdrawal: inpatient versus outpatient programmes and preferred versus random assignment to treatment. Br Med J (Clin Res Ed) 293:103–104, 1986
[PubMed]
 
Gossop M, Bradley B, Phillips GT: An investigation of withdrawal symptoms shown by opiate addicts during and subsequent to a 21-day in-patient methadone detoxification procedure. Addict Behav 12:1–6, 1987
[PubMed]
 
Gowing LR, Farrell M, Ali RL, et al: Alpha2-adrenergic agonists in opioid withdrawal. Addiction 97:49–58, 2002
[PubMed]
 
Gowing L, Ali R, White J: Buprenorphine for the management of opioid withdrawal. Cochrane Database of Systematic Reviews, Issue 2, Article No:CD002025, 2006a
 
Gowing L, Ali R, White J: Opioid antagonists with minimal sedation for opioid withdrawal. Cochrane Database of Systematic Reviews, Issue 1, Article No:CD002021, 2006b
 
Gross A, Jacobs EA, Petry NM, et al: Limits to buprenorphine dosing: a comparison between quintuple and sextuple the maintenance dose every 5 days. Drug Alcohol Depend 64:111–116, 2001
[PubMed]
 
Hamilton RJ, Olmedo RE, Shah S, et al: Complications of ultra-rapid opioid detoxification with subcutaneous naltrexone pellets. Acad Emerg Med 9:63–68, 2002
[PubMed]
 
Hao W, Zhao M: A comparative clinical study of the effect of WeiniCom, a Chinese herbal compound, on alleviation of withdrawal symptoms and craving for heroin in detoxification treatment. J Psychoactive Drugs 32:277–284, 2000
[PubMed]
 
Heishman SJ, Stitzer ML, Bigelow GE, et al: Acute opioid physical dependence in postaddict humans: naloxone dose effects after brief morphine exposure. J Pharmacol Exp Ther 248:127–134, 1989
[PubMed]
 
Hennies HH, Friderichs E, Schneider J: Receptor binding, analgesic and antitussive potency of tramadol and other selected opioids. Arzneimittelforschung 38:877–880, 1988
[PubMed]
 
Herman BH, O'Brien CP: Clinical medications development for opiate addiction: focus on nonopioids and opioid antagonists for the amelioration of opiate withdrawal symptoms and relapse prevention. Semin Neurosci 9:158–172, 1997
 
Hopper JA, Wu J, Martis W, et al: A randomized trial of one-day vs. three-day buprenorphine inpatient detoxification protocols for heroin dependence. J Opioid Manag 1:31–35, 2005
[PubMed]
 
Horowitz R, Mazor SS, Aks SE, et al: Accidental clonidine patch ingestion in a child. Am J Ther 12:272–274, 2005
[PubMed]
 
Hulse GK, O'Neill G, Pereira C, et al: Obstetric and neonatal outcomes associated with maternal naltrexone exposure. Aust N Z J Obstet Gynaecol 41:424–428, 2001
[PubMed]
 
Jaffe JH, Martin WR: Narcotic analgesics and antagonists, in The Pharmacological Basis of Therapeutics. Edited by Goodman LS, Gilman A. New York, Macmillan, 1975, pp 245–324
 
Janiri L, Mannelli P, Persico AM, et al: Opiate detoxification of methadone maintenance patients using lefetamine, clonidine and buprenorphine. Drug Alcohol Depend 36:139–145, 1994
[PubMed]
 
Jarvis MA, Schnoll SH: Methadone treatment during pregnancy. J Psychoactive Drugs 26:155–161, 1994
[PubMed]
 
Jarvis MA, Wu-Pong S, Kniseley JS, et al: Alterations in methadone metabolism during late pregnancy. J Addict Dis 18:51–61, 1999
[PubMed]
 
Jasinski DR, Pevnick JS, Griffith JD: Human pharmacology and abuse potential of the analgesic buprenorphine: a potential agent for treating narcotic addiction. Arch Gen Psychiatry 35:501–516, 1978
[PubMed]
 
Jasinski DR, Johnson RE, Kocher TR: Clonidine in morphine withdrawal: differential effects on signs and symptoms. Arch Gen Psychiatry 42:1063–1066, 1985
[PubMed]
 
Johnson RE, Jones HE, Jasinski DR, et al: Buprenorphine treatment of pregnant opioid-dependent women: maternal and neonatal outcomes. Drug Alcohol Depend 63:97–103, 2001
[PubMed]
 
Jones HE, Johnson RE, Jasinski DR, et al: Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: effects on the neonatal abstinence syndrome. Drug Alcohol Depend 79:1–10, 2005
[PubMed]
 
Jordan JB: Acupuncture treatment for opiate addiction: A systematic review. J Subst Abuse Treat 30:309–314, 2006
[PubMed]
 
Kahn A, Mumford JP, Rogers GA, et al: Double-blind study of lofexidine and clonidine in the detoxification of opiate addicts in hospital. Drug Alcohol Depend 44:57–61, 1997
[PubMed]
 
Kienbaum P, Thurauf N, Michel MC, et al: Profound increase in epinephrine concentration in plasma and cardiovascular stimulation after mu-opioid receptor blockade in opioid-addicted patients during barbiturate-induced anesthesia for acute detoxification (see comments). Anesthesiology 88:1154–1161, 1998
[PubMed]
 
Kienbaum P, Scherbaum N, Thurauf N, et al: Acute detoxification of opioid-addicted patients with naloxone during propofol or methohexital anesthesia: a comparison of withdrawal symptoms, neuroendocrine, metabolic, and cardiovascular patterns. Crit Care Med 28:969–976, 2000
[PubMed]
 
Kleber HD: Detoxification from narcotics, in Substance Abuse: Clinical Issues and Perspectives. Edited by Lowinson JH, Ruiz P. Baltimore, MD, Williams & Wilkins, 1981, pp 317–339
 
Kleber HD: Outpatient detoxification from opiates. Primary Psychiatry 3:42–52, 1996
 
Kleber HD: Ultrarapid opiate detoxification. Addiction 93:1629–1633, 1998
[PubMed]
 
Kleber HD, Riordan CE: The treatment of narcotic withdrawal: a historical review. J Clin Psychiatry 43:30–34, 1982
[PubMed]
 
Kleber HD, Riordan CE, Rounsaville B, et al: Clonidine in outpatient detoxification from methadone maintenance. Arch Gen Psychiatry 42:391–394, 1985
[PubMed]
 
Kleber HD, Topazian M, Gaspari J, et al: Clonidine and naltrexone in the outpatient treatment of heroin withdrawal. Am J Drug Alcohol Abuse 13:1–17, 1987
[PubMed]
 
Kolb L, Himmelsbach CK: Clinical studies of drug addiction, III: a critical review of the withdrawal treatments with method of evaluating abstinence syndromes. Am J Psychiatry 94:759–799, 1938
 
Kontrimaviciute V, Mathieu O, Mathieu-Daude JC, et al: Distribution of ibogaine and noribogaine in a man following a poisoning involving root bark of the Tabernanthe iboga shrub. J Anal Toxicol 30:434–440, 2006
[PubMed]
 
Kosten TR, Krystal JH, Charney DS, et al: Opioid antagonist challenges in buprenorphine maintained patients. Drug Alcohol Depend 25:73–78, 1990
[PubMed]
 
Kosten TR, Morgan C, Kleber HD: Treatment of heroin addicts using buprenorphine. Am J Drug Alcohol Abuse 17:119–128, 1991
[PubMed]
 
Kutz I, Reznik V: Rapid heroin detoxification using a single high dose of buprenorphine. J Psychoactive Drugs 33:191–193, 2001
[PubMed]
 
Lejeune C, Simmat-Durand L, Gourarier L, et al: Prospective multicenter observational study of 260 infants born to 259 opiate-dependent mothers on methadone or high-dose buprenorphine substitution. Drug Alcohol Depend 82:250–257, 2006
[PubMed]
 
Levin FR, Fischman MW, Connerney I, et al: A protocol to switch high-dose, methadone-maintained subjects to buprenorphine. Am J Addict 6:105–116, 1997
[PubMed]
 
Li M, Chen K, Mo Z: Use of qigong therapy in the detoxification of heroin addicts. Altern Ther Health Med 8:50–54, 56–59, 2002
 
Ling W, Amass L, Shoptaw S, et al: A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid detoxification: findings from the National Institute on Drug Abuse Clinical Trials Network. Addiction 100:1090–1100, 2005
[PubMed]
 
Lintzeris N, Bell J, Bammer G, et al: A randomized controlled trial of buprenorphine in the management of short-term ambulatory heroin withdrawal. Addiction 97:1395–1404, 2002
[PubMed]
 
Loimer N, Schmid RW, Presslich O, et al: Continuous naloxone administration suppresses opiate withdrawal symptoms in human opiate addicts during detoxification treatment. J Psychiatr Res 23:81–86, 1989
[PubMed]
 
Lopatko OV, White JM, Huber A, et al: Opioid effects and opioid withdrawal during a 24 h dosing interval in patients maintained on buprenorphine. Drug Alcohol Depend 69:317–322, 2003
[PubMed]
 
Maas U, Strubelt S: Fatalities after taking ibogaine in addiction treatment could be related to sudden cardiac death caused by autonomic dysfunction. Med Hypotheses 67:960–964, 2006
[PubMed]
 
MacGregor TR, Matzek KM, Keirns JJ, et al: Pharmacokinetics of transdermally delivered clonidine. Clin Pharmacol Ther 38:278–284, 1985
[PubMed]
 
Martin WR, Jasinski DR: Physiological parameters of morphine dependence in man: tolerance, early abstinence, protracted abstinence. J Psychiatr Res 7:9–17, 1969
[PubMed]
 
McGregor C, Ali R, White JM, et al: A comparison of antagonist-precipitated withdrawal under anesthesia to standard inpatient withdrawal as a precursor to maintenance naltrexone treatment in heroin users: outcomes at 6 and 12 months. Drug Alcohol Depend 68:5–14, 2002
[PubMed]
 
McLellan AT, Luborsky L, Cacciola J, et al: New data from the Addiction Severity Index: reliability and validity in three centers. J Nerv Ment Dis 173:412–423, 1985
[PubMed]
 
Mello NK, Mendelson JH: Buprenorphine suppresses heroin use by heroin addicts. Science 207:657–659, 1980
[PubMed]
 
Mendelson J, Jones RT: Clinical and pharmacological evaluation of buprenorphine and naloxone combinations: why the 4:1 ratio for treatment. Drug Alcohol Depend 70:S29–S37, 2003
 
Mendelson J, Jones RT, Welm S, et al: Buprenorphine and naloxone interactions in methadone maintenance patients. Biol Psychiatry 41:1095–1101, 1997
[PubMed]
 
National Council Against Health Fraud: Acupuncture: the position paper of the National Council Against Health Fraud. Clin J Pain 7:162–166, 1991
 
O'Connor PG, Kosten TR: Rapid and ultra-rapid opioid detoxification techniques. JAMA 279:229–234, 1998
[PubMed]
 
O'Connor PG, Waugh ME, Carroll KM, et al: Primary care-based ambulatory opioid detoxification: the results of a clinical trial. J Gen Intern Med 10:255–260, 1995
[PubMed]
 
O'Connor PG, Carroll KM, Shi JM, et al: Three methods of opioid detoxification in a primary care setting: a randomized trial. Ann Intern Med 127:526–530, 1997
[PubMed]
 
Petry NM, Bickel WK, Badger GJ: A comparison of four buprenorphine dosing regimens in the treatment of opioid dependence. Clin Pharmacol Ther 66:306–314, 1999
[PubMed]
 
Phillips GT, Gossop M, Bradley B: The influence of psychological factors on the opiate withdrawal syndrome. Br J Psychiatry 149:235–238, 1986
[PubMed]
 
Pini LA, Sternieri E, Ferretti C: Dapiprazole compared with clonidine and a placebo in detoxification of opiate addicts. Int J Clin Pharmacol Res 11:99–105, 1991
[PubMed]
 
Preston KL, Bigelow GE, Liebson IA: Buprenorphine and naloxone alone and in combination in opioid-dependent humans. Psychopharmacology (Berl) 94:484–490, 1988
[PubMed]
 
Reynaud M, Petit G, Potard D, et al: Six deaths linked to concomitant use of buprenorphine and benzodiazepines. Addiction 93:1385–1392, 1998
[PubMed]
 
Riordan CE, Kleber HD: Rapid opiate detoxification with clonidine and naloxone (letter). Lancet 1:1079–1080, 1980
[PubMed]
 
San L, Cami J, Peri JM, et al: Efficacy of clonidine, guanfacine and methadone in the rapid detoxification of heroin addicts: a controlled clinical trial. Br J Addict 85:141–147, 1990
[PubMed]
 
Satel SL, Kosten TR, Schuckit MA, et al: Should protracted withdrawal from drugs be included in DSM-IV? Am J Psychiatry 150:695–704, 1993
[PubMed]
 
Scherbaum N, Klein S, Kaube H, et al: Alternative strategies of opiate detoxification: evaluation of the so-called ultra-rapid detoxification. Pharmacopsychiatry 31:205–209, 1998
[PubMed]
 
Schindler SD, Eder H, Ortner R, et al: Neonatal outcome following buprenorphine maintenance during conception and throughout pregnancy. Addiction 98:103–110, 2003
[PubMed]
 
Senft RA: Experience with clonidine-naltrexone for rapid opiate detoxification. J Subst Abuse Treat 8:257–259, 1991
[PubMed]
 
Smith DE, Wesson DR: A new method for treatment of barbiturate dependence. JAMA 213:294–295, 1970
[PubMed]
 
Sobey PW, Parran TV, Grey SF, et al: The use of tramadol for acute heroin withdrawal: a comparison to clonidine. J Addict Dis 22:13–25, 2003
[PubMed]
 
Spencer L, Gregory M: Clonidine transdermal patches for use in outpatient opiate withdrawal. J Subst Abuse Treat 6:113–117, 1989
[PubMed]
 
Strain EC, Preston KL, Liebson IA, et al: Acute effects of buprenorphine, hydromorphone and naloxone in methadone-maintained volunteers. J Pharmacol Exp Ther 261:985–993, 1992
[PubMed]
 
Strain EC, Preston KL, Liebson IA, et al: Buprenorphine effects in methadone-maintained volunteers: effects at two hours after methadone. J Pharmacol Exp Ther 272:628–638, 1995
[PubMed]
 
Strang J, Gossop M: Comparison of linear versus inverse exponential methadone reduction curves in the detoxification of opiate addicts. Addict Behav 15:541–547, 1990
[PubMed]
 
Tamaskar R, Parran T, Heggi A, et al: Tramadol versus buprenorphine for the treatment of opiate withdrawal: a retrospective cohort control study. J Addict Dis 22:5–12, 2003
[PubMed]
 
Ter Riet G, Kleijnen J, Knipschild P: A meta-analysis of studies into the effect of acupuncture on addiction. Br J Gen Pract 40:379–382, 1990
 
Timofeev MF: Effects of acupuncture and an agonist of opiate receptors on heroin dependent patients. Am J Chin Med 27:143–148, 1999
[PubMed]
 
Tracqui A, Kintz P, Ludes B: Buprenorphine-related deaths among drug addicts in France: a report on 20 fatalities. J Anal Toxicol 22:430–434, 1998
[PubMed]
 
Ulett GA: Beyond Yin and Yang: How Acupuncture Really Works. St Louis, MO, Warren H Green, 1992
 
Vining E, Kosten TR, Kleber HD: Clinical utility of rapid clonidine-naltrexone detoxification for opioid abusers. Br J Addict 83:567–575, 1988
[PubMed]
 
Walsh SL, June HL, Schuh KJ, et al: Effects of buprenorphine and methadone in methadone-maintained subjects. Psychopharmacology (Berl) 119:268–276, 1995
[PubMed]
 
Washburn AM, Fullilove RE, Fullilove MT, et al: Acupuncture heroin detoxification: a single-blind clinical trial. J Subst Abuse Treat 10:345–351, 1993
[PubMed]
 
Wen HL, Cheung SYC: Treatment of drug addiction by acupuncture and electrical stimulation. Am J Acupunct 1:71–75, 1973
 
Whitehead PC: Acupuncture in the treatment of addiction: a review and analysis. Int J Addict 13:1–16, 1978
[PubMed]
 
Wikler A: Diagnosis and treatment of drug dependence of the barbiturate type. Am J Psychiatry 125:758–765, 1968
[PubMed]
 
Zhang B, Luo F, Liu C: Treatment of 121 heroin addicts with Han's acupoint nerve stimulator [in Chinese]. Zhongguo Zhong Xi Yi Jie He Za Zhi 20:593–595, 2000
[PubMed]
 
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
"The phenomenon by which a drug's effectiveness diminishes over time with regular use of the drug" is a definition of. . .
2.
Opioid dependence may develop for a wide range of opioids. One classification of opioids is along the dimension of whether they are naturally occurring, derivative, or synthetic. Which of the following is considered to be a synthetic opioid?
3.
In the case of typical opioid withdrawal (e.g., from chronic use of a short-acting opioid, such as heroin), which of the following symptoms usually occurs first?
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Books
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 48.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 13.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 14.  >
Helping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional Problems: A Resource Book of Medication Information Handouts, 3rd Edition > Chapter 14.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 18.  >
Topic Collections
Psychiatric News
PubMed Articles
A nonopioid procedure for outpatient opioid detoxification. J Addict Med 2011;5(2):110-4.doi:10.1097/ADM.0b013e3181e518cc.
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation