RAPID AND ULTRARAPID OPIOID DETOXIFICATION TECHNIQUES

Objective.-To review the scientific literature on the effectiveness of rapid opioid detoxification (RD) (opioid withdrawal precipitated by n aloxone hydrochloride or naltrexone) and ultrarapid opioid detoxificat ion (URD) (opioid withdrawal precipitated by naloxone or naltrexone un der anesthesia or heavy sedation) techniques. Data Sources.-The MEDLIN E database was searched from 1966 through 1997 using the indexing term s naloxone, naltrexone, substance dependence, and substance withdrawal syndrome, Additional data sources included bibliographies of papers i dentified on MEDLINE and bibliographies in textbooks on substance abus e. Study Selection.-Inclusion criteria were studies of RD or URD, phar macologic protocols specified, and clinical outcomes specified and rep orted. Exclusion criteria were unpublished data, data not in peer-revi ewed journals, abstract-only publications, and review articles. Data E xtraction.-The methodologic characteristics of studies were extracted by the authors and summarized according to key components of research design concerning subject characteristics, therapy allocation, and out comes assessed. Data Synthesis.-A qualitative analysis was performed o n the 12 studies of RD and the 9 studies of URD identified in our sear ch, The RD studies enrolled 641 subjects (range for individual studies , 1-162): 7 were inpatient studies, and the protocols varied considera bly, as did the outcomes assessed. Three RD studies included a control group, 2 used a randomized design, and 3 reported outcomes beyond 12 days, The URD studies enrolled 424 subjects (range for individual stud ies, 6-300): all were inpatient studies, the detoxification and anesth esia protocols varied, 3 included a control group, 2 used a randomized design, and 2 reported outcomes for URD beyond 7 days. Conclusions.-T he existing literature on RD and URD is limited in terms of the number of subjects evaluated, the variation in protocols studied, lack of ra ndomized design and use of control groups, and the short-term nature o f the outcomes reported, Further research is needed using more rigorou s research methods, longer-term outcomes, and comparisons with other m ethods of treatment for opioid dependence.