A compressed opiate detoxification regime with naltrexone maintenance: patient tolerance, risk assessment and abstinence rates

Opiate detoxification using methadone programmes are inefficient and expens ive. Rapid and ultra-rapid detoxification using precipitated withdrawal und er heavy sedation or anaesthesia provide increased efficiency and speed, bu t are limited by the requirement for high-dependency facilities and are per ceived as high-risk procedures. Procedures using precipitated withdrawal ov er longer periods with lower sedation are safer, but 20% of patients fail t o tolerate these. Here we evaluate a naltrexone compressed opiate detoxific ation (NCOD) protocol. We investigated patient acceptance, organ function a nd abstinence rates on 504 consecutive patients undergoing treatment at the Harrogate Detox5 centre between February 1996 and January 1999. Ninety-eig ht per cent of patients completed the procedure; 81% of patients reported w ithdrawal was "better than expected". Only 3% of patients reported any pain . Laboratory investigations demonstrated no organ dysfunction. Abstinence r ates post-detox were high with 71%, 61% and 51% of patients free of opiates 3, 6 and 12 months post-detox, respectively. Compliance with the naltrexon e maintenance in abstinent patients was 66%, 68% and 30% at these time poin ts. This NCOD protocol provides an efficient method of detoxifying opiate a busers with little patient discomfort or risk to health. Abstinence rates a re better than those in comparable studies using other programmes.