This study was done in order to examine the hypothesis that so-called ultra-rapid
opiate detoxification provides a mild, short, and safe withdrawal. A total of 22 patients
who were addicted to opiates exclusively underwent ultra-rapid detoxification. Each
patient was pretreated with methadone. During general anesthesia lasting about six
hours with methohexital or propofol, naloxone was administered with doubling of the
dose every 15 minutes with a starting bolus dose of 0.4 mg. The total bolus dose of
12.4 mg, delivered within 60 minutes, was followed by a naloxone infusion of 0.8 mg/h
until the next morning. On the day of anesthesia naltrexone (50 mg/d) treatment was
initiated. When withdrawal symptoms occurred, specific medications, e.g., clonidine,
were added. After determining baseline values, withdrawal symptoms were investigated
during a further four weeks by means of established clinical scales. The results document
marked withdrawal symptoms for at least one week after detoxification. The intensity
of withdrawal symptoms during the first seven days of treatment was significantly
(p < 0.05) more marked than during baseline. None of the patients underwent a life-threatening
complication and only one patient failed to complete the detoxification procedure.
Finally, about 75 % of the patients could be referred for further treatment. In this
study ultra-rapid detoxification provided a safe withdrawal procedure with high rates
of completed withdrawals and referrals for further treatment, respectively. However,
in contrast to previous reports, many patients suffered from middle-grade withdrawal
symptoms over several days. Due to the risks of general anesthesia and the expense
associated with this treatment, only patients addicted to opiates alone and for whom
other detoxification strategies are unsuitable should undergo a ultra-rapid detoxification
procedure.
