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Addiction Treatment
& Psychology Services

Opiate Detoxification (OD) is the use of naltrexone under controlled conditions to allow rapid, safe and highly effective detoxification from opiates, including methadone.

Naltrexone is chemically similar to opiates and attaches to opiate receptors in the body. However, it has the opposite effect as it does not stimulate the various opiate receptors, but blocks the effect of opiates. When used as a maintenance medication it prevents use of opiates as it blocks their effect and also dramatically reduces craving for the drug. On the other hand, it allows the body's own natural opiates, called endorphins to attach to the receptors and to stimulate these sites to enhance the person's sense of well being. When using external opiates the body shuts down endorphin production and it takes a few days for this production to resume. During this time the dependent person feels very fatigued with insomnia and lack of appetite.

Normally withdrawal from heroin would take place over 4 to 6 days with a range of symptoms, including vomiting, diarrhea, back pain, leg cramps, stomach cramps, hot and cold sweats, runny eyes and nose, sneezing and yawning, high levels of anxiety and craving for the drug. Also the person experiences severe fatigue, but cannot sleep. Withdrawal from methadone is generally more severe and can continue for 10 days or more, sometimes people reporting little sleep for weeks. Because of the pain and discomfort and the mental craving most people do not complete detoxification so that they can enter the recovery phase. Recently released figures show that only 3% of addicts complete home detoxification or ‘cold turkey' detoxification .

If naltrexone is taken while a person is still addicted to opiates it causes an immediate and very acute withdrawal and if there is no medical supervision it has the potential to cause serious health problems including pulmonary oedema and dehydration because of the fluid loss from the vomiting and diarrhea. However, when administered under the care of a doctor in a high dependency unit, risks are dramatically reduced as medication can be given to counter act any withdrawal symptoms. For example, in most cases, despite the acute withdrawal there is little if any diarrhea or vomiting. Additionally the patient is given some light sedation. This is designed to reduce any trauma associated with the acute withdrawal, as many patients have no memory of the procedure. However, it does not have the risks associated with General Anaesthetic as it allows the person to swallow, breath without assistance and to respond to instructions from medical staff. General Anaesthetic is not required as it makes the procedure no more effective, it is much more costly and increases the risks.

The advantage of ROD is that it ensures successful completion of detoxification. We have close to 100% completion. It also means the patient's discomfort is minimised. Moreover, because of the amount of naltrexone used during the procedure, not only does this ensure displacement of the opiate, especially methadone, it also means that if the person were to use opiates over the next few days, especially in an effort to overcome fatigue and improve sleep, then the naltrexone would completely block the effect of the opiate. If a person has a naltrexone implant following the procedure, then they are completely protected from re-addiction or overdose for some months after detoxification.

The important point to be made is that ROD is just a form of detoxification, albeit more effective with much higher completion rates than traditional methods. The Government funds numerous detoxification facilities and the costs are excessive because of the very low completion rates and re-admissions for detoxification. The recently completed Government funded NEPOD study found that ROD using sedation was not only the most effective form of detoxification, but also the most cost effective treatment. What happens following detoxification is independent of the form of detoxification. In other words, on-going outcomes are dependent on other factors, such as use of naltrexone to prevent relapse, social support and follow up counseling and after-care and most importantly the motivation and capacity of the individual to make changes in their lives. Moreover, ROD or the use of naltrexone does not increase risks of overdose or death. Anyone who detoxifies from opiates and whose tolerance has been reduced, experiences an increase in risk, more so on return to their environment after a period of time in prison or in a rehabilitation program.

Our method is a relatively safe, effective and holistic approach for individuals addicted to heroin, morphine, opium and methadone. Based on rigorous data collection, research and a commitment to excellence, our three-stage program is another treatment régime against addiction. ATPS provides a safe and effective detoxification in combination with intensive psychosocial services.

Research indicates that approximately 80% of patients remain opiate-free after 6 months after ROD and having had a 3 month naltrexone implant.

While this treatment is still considered experimental by some groups, it has been used successfully overseas for many years, as well as in Australia . Recently the NSW Government has approved the use of Naltrexone to facilitate detoxification from opiates. As with any medical procedure there are some risks and these risks will be fully explained before any treatment takes place.

The ATPS program is based on a multi-disciplinary and research based approach to overcoming opiate dependency. It is dedicated to finding and implementing compassionate and effective solutions for our clients with addiction and psychological problems.

THE ADDICTION TREATMENT AND PSYCHOLOGY SERVICES PROGRAM

• Assessment, Selection and Preparation
Before the person makes any commitment to the program, either financially or in any other way the program is explained in detail with the patient and their support people and there is no obligation to go ahead if they are not fully satisfied that they want the treatment and that they believe it will benefit them. There is no charge for this introduction to the program if they decide not to proceed. We also make it clear that the person has to fulfill our requirements and that if we judge that they may be unsuitable for the program they will not be accepted. At the time of the initial assessment patients are given written information on the program and on naltrexone implants and are given a copy of the Treatment Agreement and Informed Consent for them to read and discuss with their support person before they are accepted into the program.

Selection criteria ensure patient's motivation and a solid support structure. A psychosocial assessment and a thorough medical assessment determine suitability. At least two sessions of pre-detoxification counselling are undertaken. A Psychologist appointment with client and support person will complete preparation.

• Opiate Detoxification (OD)
A short, safe and effective medical detoxification procedure administered in an accredited high dependency detoxification unit. The procedure takes place under medical and nursing supervision, using naltrexone and a number of medications to counter the withdrawal effects and for sedation.

• Aftercare
A comprehensive aftercare program that includes support during the immediate post detoxification period, 6-12 months Naltrexone maintenance, individual and family counselling and employment/education assistance.

Research indicates that approximately 80% of patients remain opiate-free after 6 months after ROD and having had a 3 month naltrexone implant.