Addiction is a biological disease. It is associated with several structural and physiological changes in different parts of the brain, especially in the area known as the Reward Centre. At a neurobiological level, different receptors are involved in the process of Addiction, the prominent ones being the Opiate and the Dopamine receptors. Chemical Dependence is certainly not a weakness in the addict’s personality as is commonly believed and so, it is virtually impossible to overcome an addiction merely by locking the addict in a Rehab Centre for weeks to months or by using one’s will power. Addiction to Drugs such as Opiates (including Heroin, Smack or Brown Sugar, Opium, Cough Syrups, Proxyvon, Spasmoproxyvon, Fortwin, Morphine and Buprenorphine injections), Cocaine, Ecstasy, Amphetamines and other stimulants and alcohol dependence are dreaded problems in society the world over.
Till date, very little medical support was available to the chemical addict to get out of the clutches of this vicious disease. The course of the treatment typically included detoxification in Rehabilitation Centres followed by relapse over and over again. The cost incurred worldwide due to this problem runs into hundreds of billions of dollars annually. Unfortunately, the treatment options available in most parts of the world appear sorely inadequate in managing severe addictions. The biggest fear that would prevent an addict from giving up a drug or alcohol is that of the intense discomfort experienced during withdrawal. The conventional procedures of detoxification have only reinforced these fears further. What adds to the addict’s misery is the fact that these procedures would take too much time, making it unbearable for him. This is a major reason for people dropping out of treatment midway.
With the advent of Ultra Rapid Opioid Detoxification, this apprehension is eliminated. However, even if one manages to reach the detoxified state, the addict is usually dumped with the responsibility of staying sober and clean without any appropriate medical help. Unfortunately, will power and determination are not the pillars of Relapse Prevention. Earlier, the failure rate of treatment was about 90 - 95%. That is, a relapse was almost inevitable within a few days to a few weeks after detoxification. But not now!
At some highly specialized centers in the world, the problem of Opiate Addiction is being treated very successfully through the use of Ultra Rapid Opiate Detoxification along with implantable Naltrexone pellets. Naltrexone is a competitive Opiate antagonist that blocks the effects of an opiate taken in any form. Taken orally, theoretically it could be an effective treatment modality but the problem of non – compliance has ensured a failure rate as high as 90 to 95%. This problem is circumvented completely through the use of Naltrexone implants.
Ultra Rapid Opiate Detoxification without Anaesthesia
Naltrexone is a narcotic antagonist. It works by blocking the opioid receptors in the brain and therefore blocking the effects of heroin and other opioids. Those who take it know that they cannot achieve a 'high' from using heroin and that any money therefore spent on heroin will be wasted. It does not directly stop a person wanting to use heroin, although it may reduce or prevent cravings in some people. Naltrexone implants appear to give effective blood levels for 12 weeks to one year. The implant is usually inserted under local anaesthesia after detoxification is over and 2 – 3 doses of the oral Naltrexone have been given to rule out allergy to the medication. It is inserted through a 1 cm incision in the lower abdomen or at the back of the upper arm. The implant is inserted 3-4mm under the skin.
Advantages of Implants
- Makes relapse almost impossible while the implant is effective.
- Avoids the need to supervise Naltrexone and the arguments it can cause.
- Makes it impossible to 'forget' to take Naltrexone.
- Probably reduces craving even more than oral Naltrexone because there is no point in craving for what you can't have.
Disadvantages of Implants
- Involves (minor) surgery and a small scar with temporary tenderness and bruising
- Occasional local infection or inflammation of implant site, usually responding to antibiotics.
- Initially more expensive than oral Naltrexone.
The UROD and subsequent Implantation of the Naltrexone blockade together comprise the medical component of deaddiction. There is now a need for aftercare counselling to allow thorough social integration and psychotherapeutic techniques become much more effective when the preoccupation with the drug dies down. Aftercare counselling is essential to ensure that healthy and appropriate coping behaviours are learnt, rather than substituting other drugs for heroin and methadone.
(Dr. Sanjay Chugh is a Senior Neuro-Psychiatrist.)
Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.
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