Therapeutic apheresis in addiction

I.P.Pavlov first St. Petersburg State Medical University, Saint-Petersburg, Russia

Voinov V.A.
Summary
Various forms of drug addiction and alcoholism are becoming more common, while
there are virtually no reliable methods for their treatment. Elimination from the body
accumulated toxic metabolites using methods of therapeutic apheresis is able to
facilitate the subsequent recovery of such patients.
Key words: drug addiction, alcoholism, therapeutic apheresis, plasmapheresis.

Underlying diseases of this profile is a psychological dependence addiction to

alcohol, drugs or certain pharmacological or toxic substances (substance abuse).
However, in the body thus arises also some kind of metabolic processes violation, the
normal flow which is impossible without the inclusion of the substances or their
derivatives. Depriving them induced severe withdrawal syndromes, often with fatal
outcome. In all cases there is a severe mental disorders hallucinations, delusions,
phobic state, often pushing these persons to the crime.
Alcoholism (alcohol disease) is the most common type of addiction. According to
various statistical studies of them suffer from 4 to 45% of the population. It is believed
that dose daily use of alcohol (in terms of absolute alcohol) 20-60 grams for men and
10-40 grams for women are relatively safe, but the real need of the organism in alcohol
does not exceed 10 grams per day, and it is entirely covered at the expense of
endogenously produced alcohols, like most of our smaller brothers animals, which
none, even the most careful owner, does not consider it necessary to add to their daily
diet of any alcohol additives.
However, exceeding even this moderate level increases the risk of toxic lesions,
especially at the level of individual failure ferment of alcohol dehydrogenase that breaks
down alcohol. With an excess of alcohol included catalase and monooxygenase
oxidation with activation of peroxides, oxidation of lipids and the overproduction of
acetaldehyde, and if there is a non-wealth also acetal dehydrogenase (ferment that
destroys the last one), there is the onset of acute or chronic alcohol intoxication.
Particularly dangerous cheap liquors alcohols from non-food materials (hydrolysis or

petroleum distillates) which contain toxic impurities aldehydes, ketones, ethers,

methanol, propanol, acids, etc. [Moiseyev VS, cucumbers, PP, 1997].
And yet, despite the danger of a direct toxic damage of the body with occasional
admission of high doses of alcohol, deceit disease is getting used to it, that prolongs
this toxemia and causes even more severe health problems to the development of fatty
and protein liver disease with the outcome of cirrhosis, damage to other organs.
At the moment there is a tendency to weighting of alcohol abstinence syndrome. At
the same time appointed of drugs often lead to various side effects and aggravate the
condition of patients. There for It this warranted inclusion in the protocol binding
membrane plasmapheresis procedures at admission of patients in a state of alcohol
chronic intoxication and at the peak of acute withdrawal disorder (second or third day,
and on the 10th day of his treatment).
In addition, chronic alcohol intoxication there is accompanied by immunosuppression. At the same time, even ordinary respiratory infections are more malignant,
more difficult runs also peritonitis, which requires emergency detoxification using
plasmapheresis [Loktin EM et al., 2010].
Drugs and other toxicants are even more foreign to the body, and also contribute
to the development of severe chronic endotoxemia. In the pathogenesis of diseases of
the central nervous system under the influence of the drug plays an important role
activation and destruction of catecholamine release norepinephrine and dopamine in
the presynaptic level structures. In this case, length-tional drug use leads to a deficiency
of these catecholamines. However with abrupt cessation of drug reception level of
decay comes to normal, but their synthesis is still accelerated, leading to a significant
increase in the level of dopamine in the brain. Excess dopamine associated with
neuropeptides, becoming more toxic properties [Morozov G.V. et al. 1981]. In opium
addiction violated also lipid peroxidation with the inhibition of antioxidant defense
system [Chirco V.V. et al., 1994].
Recent years have been characterized by steady growth in the number of patients
suffering from alcoholism and drug addiction with all the ensuing heavy social and
demographic consequences. But the tragedy of the situation is not so much in a
constant increase in the number of persons involved in these addictions, as the inability
to achieve a stable recovery. It is promoted not only limited possibilities of drug therapy
and various psychotherapeutic effects, but significant metabolic disorder causing the
accumulation in the body not only exogenous toxicants, but also secondary and no less

toxic pathological metabolites that support a persistent desire even in remission. Here
are also the violation of neurotransmitter exchange with shifts levels of endorphins and
other neuropeptides, catecholamines and serotonin.
Violations of the cortical activity as well as the adrenal medulla lead to disorders of
protein, mineral and carbohydrate metabolism. Prolonged exposure to exogenous and
endogenous toxicants keeps in constant tension enzyme system in the liver, lipid
peroxidation and proteolysis, immune defense mechanisms. Chronic endotoxemia
leads to exhaustion, and then suppress detoxification systems with the emergence of a
number of vicious circles to break out of which the body is no longer able. The situation
is exacerbated as viral hepatitis, carried forward by many drug addicts, or chronic
hepatitis during long-term alcohol dependence.
An important role in the formation of dependence to drugs plays also
immunological disorders. Thus, in patients with opium addiction discovered suppression
of T-cell immunity and increase the functional activity of B-lymphocytes, which are
producers of antibody. Appear IgM-antibodies to morphine with boosting of circulated
immune complexes which may have a damaging effect not only on the structure of the
central nervous system, but also to other organs. It is believed that the formation of
antibodies occurs in the presence of even small amounts of antigen, but growing up
constantly. In addiction such as morphine acts antigen associated with plasma proteins
[Malin D.I., 1997].
Therefore, up to the beginning of treatment, many patients there are able to not
only severe exogenous, but also endogenous toxicity and immunosuppression. Even in
cases of effective psychotherapeutics impact with the elimination of pathological drive
health status of such a person remains extremely upset. In addition, without removing
the physical addiction all impact on the psyche of the patient do not provide a lasting
effect.
Treatment of these diseases is extremely complex problem, since in the usual
therapeutic measures, "coding", "stitch" and other methods there are practically
ineffective. Since the body being wound metabolism disorder, remains an irresistible
attraction to drugs and removing psychological dependence does not exempt from the
physical. Elimination of physical dependence, in turn, also not release from mental.
Memories of the resulting "high" irresistibly pushes, even against the will, to relapse.
Under these conditions, only the consistent application of efferent therapy and
psychotherapy can contribute to the success [Chirco V.V. et al., 1994; Shpilenya L.S. et
al., 1995]. Plasmapheresis, as at the height of withdrawal symptoms (2-3 day after the

drugs cancellation) and in the final stages (5-6 days), contributes to a more rapid
reduction algic, somatic vegetative and psychopathological symptoms of withdrawal
syndrome [Malin D.I., Kostitsin N.V., 1998]. Wherein there is used also hemosorption
(hemocarboperfusion) [Kirkovski VV et al. 1997].
Most effective and safest method proved continuous membrane plasmapheresis in
the treatment of acute psychotic states and abstinence, especially in severe
concomitant disorders of the cardiovascular system, lung disease, liver and kidney
pathology [Strelets N.V. et al., 1999]. Plasmapheresis particularly indicated for patients
with opioid addiction in cases of increasing levels of IgM-antibodies and the CIC of 2 or
more times [Gamaleja NB. et al., 1995]. Therapeutic apheresis is indicated also for
the relief of reactions while taking naltrexone in patients abusing fentanyl derivatives
("methadone") oppression consciousness, bradipnoe, bradycardia, and hypotension.
The greatest effect at the same time provided hemosorption.
Given the possibility of performing of plasmapheresis sessions in a day, it is
advisable to supplement this by introducing an additional therapy of hemosorption
session on the second day of treatment (between the first and second sessions of
plasmapheresis). Then, at the crucial first period of treatment the patient will be practical
continuously perform cleansing the body of pathological metabolites, and subsequently
breaks one day will have it easier to endure [Voinov V.A., 1999]. Additionally, there are
uses various mechanisms of action of these methods. In particular hemosorption there
is more effective in the activation of the sympathetic division, and plasmapheresis
parasympathetic part of vegetative nervous system. Infusion of ozonated solutions of
sodium chloride enhances the detoxifying effect of therapeutic apheresis in these
patients.
In addition to removing themselves narcotic drugs and their derivatives,
therapeutic apheresis helps to normalize also other metabolic disorders and
endogenous toxemia, which are constant companions of these states. There are arrive
disorders of dopamine regulation. For example, blood levels of dopamine over 180%
there are correspond to the hard abstinence, and at 250-300% may develop delirious
state. Often, these are patients have also the accompanying severe organ failure - the
liver, kidneys, myocardium, central and peripheral nervous system, secondary toxic
immunosuppression. Therefore, in complex of therapeutic apheresis methods it is
necessary to include quantum immune correction and indirect electrochemical oxidation
of the blood. Only then it come the more qualitative rehabilitation of patients, restoring
their health and performance.

Most often in patients with drug occurs infection with hepatitis B, C, and even HIV
[Walsh N., Maher L., 2013; Bonar E.E. et al., 2014; Wiessing L. et al., 2014], which is in
itself an indication for plasmapheresis to prevent the development of chronic hepatitis.
In the case of the upcoming surgery in patients with heroin addicts also suitable active
detoxification [Sivolap Y.P., et al., 1995].
Our experience in treating patients with substance and alcohol abuse shows a
relatively high efficiency of the complex course of the therapeutic apheresis and
immune correction. In all cases, up to the end of the course there was the gradual
elimination of symptoms of withdrawal syndrome and occurred normalization and
somatic-vegetative disorders the restoration of normal sleep, appetite, psychoemotional status. Most of the patients at the end of the course passed to specialists for
subsequent psychotherapy.
The appearance in recent years of sufficiently effective Russian plasmafilters,
simplicity and safety methods of membrane plasmapheresis and even hemosorption on
a portable device Hemofenix [Voinov V.A., 2010], given the possibility of therapeutic
apheresis in the broadest network of medical institutions, up to the municipal level. In
addition, such procedures can be successfully carried out even on an outpatient basis
(within a day hospital). This opens up the possibility of a wider use of therapeutic
apheresis in Addiction.

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