Is ultra-rapid opioid detoxification a viable option in the treatment of opioid dependence?

Ultra-rapid opioid detoxification (UROD) involves the acceleration of opioi d withdrawal hv administering thp opioid receptor antagonist naltrexone und er general anaesthesia. There is evidence from uncontrolled and a few contr olled studies that UROD accelerates opioid withdrawal and that it achieves high rates of completion of acute opioid withdrawal. However, there is clear evidence that the use of a general anaesthetic is n ot required to accelerate withdrawal or to achieve high rates of completion of acute opioid withdrawal. These goals can be achieved by using naltrexon e or naloxone to accelerate withdrawal under light sedation, a procedure kn own as rapid opioid detoxification under sedation (ROD). There is also evid ence that use of an opioid antagonist is not required to achieve a high rat e of completion of acute opioid withdrawal. The mixed agonist-antagonist bu prenorphine has achieved comparable rates of completion in similarly select ed patients with fewer withdrawal symptoms. There is no evidence from contr olled trials that either UROD or ROD increases the rate of abstinence from opioids 6 or 12 months after withdrawal. UROD and ROD may increase the numb er of patients who are inducted onto naltrexone maintenance (NM) therapy bu t extensive experience with NM therapy suggests that it only has a limited role in selected patients. Given the lack of evidence of substantially incr eased rates of abstinence, and the need for anaesthetists and high dependen cy beds, UROD has at best a very minor role in the treatment of a handful o f opioid dependent patients who are unable to complete withdraw in any othe r way. ROD may have more of a role as one option for opioid withdrawal in w ell motivated patients who want to be rapidly inducted onto NM therapy or w ho want to enter other types of abstinence-oriented treatment.