INTRODUCTION

For the last few decades, most countries in the world have been in the grip of the epidemic of Addiction. It is widely believed that trade in illicit drugs is the largest business in the world and so, the supply of drugs is not going to dry up for the epidemic to get over. What is required is for the demand to be reduced or for the addict to become and stay deaddicted. Unfortunately, very few know and understand the meaning and implications of addiction and so it remains one of the most poorly treated diseases in the world.
THE PROBLEM

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!!

THE SOLUTION

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.

ULTRA RAPID OPIATE DETOXIFICATION WITHOUT ANAESTHESIA

The patient’s fear of withdrawal perpetuates dependency or makes it more permanent. For the late stage opiate addicted individual, fear of the pain from withdrawal can be THE single factor that continues their dependency. They are so overwhelmingly frightened of the pain of Detox that they would much rather continue taking the drug than face the withdrawal. Ultra-rapid Detoxification is a painless way of withdrawal for Opiate addicts.
An intriguing feature of this new procedure is that the withdrawal is maximally hastened while the addict is under the effect of LIGHT SEDATION. Therefore, the individual does not consciously experience any significant symptoms of opiate withdrawal. The prospects of not having to experience any withdrawal symptoms make this procedure non-threatening to addicts and therefore very successful.
Rapid opioid detoxification under LIGHT SEDATION can be safely performed by adhering to current medical standards. The efficacy of this rapid opioid detoxification followed by Naltrexone maintenance and psychotherapy has the potential to be an extremely efficacious treatment for opioid addiction. The detoxification process is 100% effective in that every one who undergoes this procedure becomes detoxified, which is not the case with conventional, long drawn Detox where patients very often drop out of treatment.

Naltrexone implants appear to give effective blood levels for TWELVE 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 CONCLUSION

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.
In Asia, the combination of UROD (without Anesthesia) along with Naltrexone implants is available only at the Institute of Deaddiction Research And Therapy (IIDRT), New Delhi, India. Also available are long stay facilities, rehabilitation facilities and strategies for management of all kinds of severe and chronic psychiatric disorders. Dr. Sanjay Chugh promises, “We would look at collaborative ventures with a private hospital or Deaddiction facility based in Nepal to make these facilities available here, thus making them much more easily accessible to people in this country.”
About the Author
Dr. Sharad M Tamrakar
MBBS, MD (Psychiatry)
Norvic Escorts Int’l Hospital
Tel: 4258554, Mob: 9851007474
Email: dr_rod2004@yahoo.com