Tamea Sisco
more opiate – free urine tests and reduced attrition rates. Finally, Hulse and Basso (1999) evaluated treatment outcome at 6 months for 100 heroin dependent patients maintained on naltrexone and found that complete abstinence was not characteristic of many of those patients continuing on naltrexone, in spite of its complete blocking of heroin reinforcement. Thus, periodic heroin use during naltrexone maintenance may occur but this periodic use did not prevent successful outcomes for those maintained on naltrexone.
In more recent years the partial opiate mu receptor agonist, buprenorphine has been used as opioid substitution therapy for opiate dependence in France since 1996 (Obadia et. al. 2001) .It is awaiting approval in the United States as a sublingual combination tablet with Naloxone ( Fudala et. al. 1998).
Additionally, Clonidine and lofexidine atreaopha, receptor agonists and are the most commonly used non-opiate drugs for detoxification from opiates in the US and the UK, respectively. . Activation of the presynaptic alpha 2 results in the inhibition of the sympathetic outflow associated with the opiate withdrawal syndrome.( Gonzalez et. al. 2002)
Rapid Detox
The Against Medical Advice (AMA) rate (the rate at which patients or addicts leave treatment before treatment goals are reached) among hardcore addicts even today approaches 90 percent. The basic concept of a relatively new approach called “rapid detoxification method” is to provide the patient with a pure narcotic antagonist to block the opiate-induced euphoriant effects. At the San Antonio Methadone Clinic according to its director J. T. Payte using this approach results in recidivism rate of over 99 percent due to non-compliance. Once again we believe the noncompliance issue is due to the fact that while the narcotic antagonist blocks the opiate or alcohol induced euphoria (O’Malley et al., 1992 and Volpicelli et al., 1992), the drug has little effect on craving behavior. Moreover, Kirchmayer and associates ( 2002) performed a recent systematic review on the efficacy of naltrexone maintenance treatment in opioid dependence and concluded that from the available clinical trials performed up until 2002 , there is insufficient evidence to justify the use of naltrexone in the maintenance treatment of opioid addicts.
We decided to test the hypothesis that possibly by combining a narcotic antagonist and amino-acid therapy consisting of an enkephalinase inhibitor and neurotransmitter precursors to promote neuronal dopamine release might enhance compliance in methadone patients’ rapidly’ detoxified with the narcotic antagonist Trexan®, In this regard, Thanos et. al. (2001) and associates found
increases in the dopamine D2 receptors (DRD2 ) via adenoviral vector delivery of the DRD2 gene into the nucleus accumbens, significantly reduced both ethanol preference (43%) and alcohol intake (64%) of ethanol preferring rats, which recovered as the DRD2, returned to baseline levels. This DRD2 overexpression similarly produced significant reductions in ethanol non-preferring rats, in both alcohol preference (16%) and alcohol intake (75%). This work further suggests that high levels ofDRD2 may be protective against alcohol abuse ( Blum et. al. 1990, and Nobleet. al. 1991). The DRD2 Al allele has also been shown to associate with heroin addicts in a number of studies O. Moreover, there are a number of studies utilizing amino -acid and enkephalinase inhibition therapy showing reduction of alcohol, opiate, cocaine and sugar craving behavior in human trials. Over the last decade, a new rapid method to detoxify either methadone or heroin addicts utilizing Trexan® (Dupont, Delaware) sparked interest in many treatment centers throughout the United States, Canada, as well as many countries on a worldwide basis.
METHODS
SUBJECTS
We tested our combined therapeutic approach at the San Antonio Methadone Clinic with 1012 hardcore addicts who had abused euphoriants up to 30 years. Entry into the study included both male and female patients who were considered hardcore addicts as diagnosed using the DSM-IV criteria for heroin/opiate dependence. There were X males and X females in the 1000 patients in the non-experimental group and X males and X females in the experimental group. Each patient signed a consent form and the project received IRB approval from the San Antonio Methadone Clinic and from PATH Medical Foundation IRB which approved future research in this area. ( registration # IRB00002334).
RAPID -DETOX METHODOLOGY
Each patient (n=1000) was pre-evaluated by first receiving an injection of 0.4-0.8 mg. of Narcan and their withdrawal was assessed. If they passed this first test, they were administered an oral dose of 12.5 mg of Trexan® and again