RAPID OPIATE DETOXIFICATION

We report on clinical and practical aspects of treatment of opiate add iction with a relatively new;approach, rapid opiate detoxification (RO D). The goal is to induce rapid narcotic withdrawal in a controlled en vironment using narcotic antagonists while suppressing withdrawal symp toms with sedative drugs, thus effecting a dramatic abbreviation of th e traditional withdrawal schedule. Twenty-five consecutive heroin-addi cted patients presenting for detoxification were treated at a universi ty hospital. There were 14 women and 11 men, with a mean age 32.6 year s (range, 24-48). They underwent 29 separate detoxifications over a 4- month period. All but 3 of the detoxifications were effected with ROD. Several different techniques were used over the 4-month period, rangi ng from intramuscular and oral sedation to intravenous sedation, paral ysis, and intubation. Efficacy of detoxification was demonstrated for all patients undergoing ROD; all were given 50 mg of naltrexone PO pri or to discharge, and none had withdrawal symptoms. (The three patients treated with abstinence were not so tested.) We derive three conclusi ons from this early clinical experience: First, ROD appears to be a va luable tool in the treatment of heroin addiction. ROD is an efficient, effective technique that can play an important role in an integrated rehabilitation program. Second, the optimal method of ROD is yet to be determined; a continuum of approaches is available. Third, ROD is pro bably most suited to designated outpatient centers.