Which is NOT used in treatment of heroin dependence

SYMPTOMATIC DETOXIFICATION Patients withdrawal symptoms is treated with suppoive care Anti-spasmodic for abdominal cramps Anti-diarrheal for diarrheas Anti-emetics for vomiting Sedatives for reduction of anxiety Clonidine 0.1mg four times a day Antispasmodic Sedatives AGONIST ASSOSIATED DETOXIFICATION Methadone====== it's a long acting opioid thus it has less abuse potential, as it acts on the mu receptor and results in respiratory depression as it has risk of abuse and respiratory depression it is used only by the practioner who has a license to prescribe methadone Bupenorphine (suboxone) It has paial agonist in mu receptor; thus, it has high affinity, less efficacy, slow dissociation. Thus, they have ceiling effect and hence there is no risk of respiratory depression and less chance of abuse ANTAGONIST ASSOSIATED DETOXIFICATION If we use suppoive measures or agonist associated detoxification it results in 14 days and by the time to move from an opioid state to non-opioid state, during which the patient may lapse again. To overcome that there is a method rapid detoxification where the patient is given naltrexone to drive away the opioid and to make the patient unaware of the withdrawal symptoms the patient is placed under anesthesia. This method of naltrexone+ anesthesia used detoxification is called ultra-rapid detoxification Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.681