Ultrarapid opioid detoxification: effects on cardiopulmonary physiology, stress hormones and clinical outcomes

This study explored the acute and long-term consequences of ultrarapid opio id detoxification (URD) in individuals with opioid dependence. In an open c ase series, seven patients underwent URD and subsequent treatment with dail y naltrexone. Structured interviews, integrated rehabilitation and hair sam pling were employed in the 12-week course of longitudinal follow-up. Cardia c and pulmonary physiology did not change significantly during the anesthes ia phase of URD, but plasma ACTH and cortisol levels increased 15- and 13-f old, respectively. Marked withdrawal and tachypnea in all patients and resp iratory distress in one patient occurred during the acute post-anesthesia p hase. Withdrawal scores were significantly elevated for 3 weeks compared wi th baseline in the face of minimal self-reported craving for opioids. Anxie ty, depression and vegetative symptoms improved gradually. Four patients re mained abstinent of opioid use, two reported a brief period of opioid intak e and one relapsed into daily opioid consumption. Given its effect on breat hing and stress hormones, this procedure should be conducted by experienced anesthesiologists. The fact that URD and subsequent naltrexone treatment a ppears to cause a dissociation effect in the usual relationship between wit hdrawal and craving has implications for behavioral pharmacology. Further r esearch is needed on the efficacy, safety, mechanisms and neurobiological s equelae of the procedure. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.