CLONIDINE IN OPIATE DETOXIFICATION

Indian J. Psychiat. (1982), 24(4), 387—388 CLONIDINE IN OPIATE DETOXIFICATION B.N. GANGADHAR1, M.D. B. SUBRAHMANYA*, M.B.B.S., D.P.M., H.S. VENKATESH', M.D., S.M. GHANNABASAVANNA', M.D.,

Detoxification, the initial step in the 6.3). The dosage was rapidly stepped up treatment of opiate dependence (Freedman, to the needs of a given patient (from three 1980) has been facing difficulties in our tablets per day to a maximum of nine country as the widely used drug methadone tablets per day, within two to three days). is not available. Earlier practices were Blood pressure was recorded at eight hourly either abrupt withdrawal or gradual taper- intervals in these patients. Glonidine was ing of the dose of the opiate to which the tapered off within two to three days after individual was dependent. Recently clo- the patients were symptom free for one nidine has been used with success for detoxi- week. The severity of withdrawal symptoms fication and treatment of opiate withdrawal at the time of admission was graded using symptoms (Gold et al., 1978; Washton and a rating scale (Blanchly, 1966). For a Resnick,. 1980; Channabasavanna and control group, case charts of nine patients Subramanya, 1981). Glonidine acts through who were detoxified either by abrupt withinhibiting the norepinephrinergic system drawal (n=4) or by gradual tapering of by a presynaptic feedback mechanism the opiate (n=5) were selected. The (Hamburg and Fallman, 1981). Studies information available in all these nine comparing the efficacy of clonidine with charts was complete. Based on the records other methods of opiate detoxification are the severity of the withdrawal symptoms rather few (Washton and Resnick, 1980). of these patients at the lime of admission The present study was conducted to com- was also graded similarly (Blanchly, 1966). pare the efficacy of a clonidine with the Patients received tranquillizers and other earlier methods of detoxification, namely symptomatic treatment as determined by abrupt withdrawal and gradual tapering. clinical State. The total amount of opiates they were receiving per day prior to admisMATERIAL AND METHODS sion was similar in both the clonidine and Patient sample comprised of nineteen control group. The severity of withdrawal male patients of age group 21-53 years, symptoms at the time of admission were who met the DSM III criteria (American comparable in the two groups. Within Psychiatric Association, 1980) for opiate the control group there were no statistically dependence. All the nineteen patients significant differences between the abrupt were dependent on parental opiates (mor- withdrawal group and the gradual taperingdose group with respect to the severity of phine or pethidine). Ten patients received withdrawal symptoms at admission, duraclonidine (100 mg) tablets from the day tion of hospital stay and the cost of drugs of admission. The mean interval between used per patient. All patients were disthe last dose of the opiate and the initiation charged drug free and symptomfree. The of clonidine treatment was 28 hours ( S D = 1. Lecturer in Psychiatry 2. Senior Residents 3. Professor of Psychiatry

NIMHANS, Bangalare-560029 INDIA

388

B.N- GANGADHAR *t at.

efficacy of clonidine was j u d g e d by comp a r i n g t h e n u m b e r of days of hospitalization required for detoxification a n d t h e cost of all drugs given to the p a t i e n t s during their hospital stay in the two groups. RESULTS Clonidine controlled the non-purposive w i t h d r a w a l symptoms within t w o or three days following a b r u p t opiate w i t h d r a w a l . However purposive w i t h d r a w a l symptoms persisted much longer, i.e., eight to ten days. None of t h e patients developed n e w w i t h d r a w a l symptoms after being started on clonidine. This indicates t h a t clonidine can also effectively prevent the further occurrance of w i t h d r a w a l symptoms in those w h o have a l r e a d y manifested. None of t h e patients while receiving clonidine developed either hypotension, sedation or dryness of mouth as a side effect. Even though on statistical tests t h e difference

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in t h e m e a n n u m b e r of days of hospitalization between t h e two groups d i d n o t reach statistical significance, it c a n b e seen from Fig. 1 t h a t patients treated with clonidine tended to get discharged early. T h e cost of providing t r e a t m e n t with clonidine when compared to t h e earlier methods was n o t significantly higher (Fig. 1). DISCUSSION Clonidine is a widely used a n t i h y p e r tensive d r u g with n o addictive potential (Lancet, 1980). T h e safety a n d efficacy of t h e d r u g facilitates detoxification of opiate addicts even a t peripheral hospitals without much additional cost a n d m a y in fact be done in a shorter period. T h e findings a r e of particular i m p o r t a n c e to t h e physicians from countries where m e t h a d o n e is not available. W e suggest t h a t even where the m e t h a d o n e is available it is worth c o m p a r i n g clonidine with t h e former drug with respect to its cost effectiveness. ACKNOWLEDGEMENT

11

1

B.

— Clonidine

E3 — Control

AMERICAN PSYCHIATRIC ASSOCIATION

(1980).

Diag-

nostic a n d Statistical Manual of Mental Disorders. Ed. 3, Washington, D . C BLANCHLY, P . H . (1966). Management of opiate abstinance syndrome. Amer. J . Psychiat., 122, 742. S.

M.

AND B.

SUBRAHMANYA

(1981). Clonidine for opiate withdrawal. Lancet ii, 313. FREEDMAN, A. M . (1980). Opiate Dependence, I N : Kaplan, I . H . , Freedman, A. M . a n d Sadock, B.J. (Eds.) Comprehensive Text Book of Psychiatry, Williams and Williams, 1519. G O L D , M . S., D . E. EDMOND, J R . , AND H . D . KLESER

(1978). Clonidine blocks acute opiate withdrawal symptoms. Lancet, ii, 599. HAMBURG, M . , AND J . F . FALLMAN (1981).

of days of

Mean ± SEM. Cost of all drugs used during hospitalization (in rupees) •

REFERENCES

CHANNABASAVANNA,

B

Figure 1 : A. Mean A ^ SEM number hospitalization.

Authors wish to t h a n k D r . M . S. K e s h a v a n , Lecturer in Psychiatry for h e l p ful discussions.

n=10 n=9

Chronic

morphine administration increases the apparent number of Alpha,-adrenergic receptors in r a t brain. Nature, 291, 493. LANCET (1980). Treatment of opiate withdrawal symptoms. Editorial, ii, 349. WASHTON, A. M . AND R . B. RESNICK (1980).

Cloni-

dine for opiate detoxification : Outpatient clinical Trials. Amer. J . Psychiat., 137, 112.1.