Objective: 1. To determine whether naltrexone-accelerated detoxification wi
th minimal sedation is an acceptable and effective form of induction onto n
altrexone. 2. To monitor outcomes of detoxified patients.
Design: Observational study.
Setting: Medical ward of a general hospital (for detoxification) and a comm
unity clinic (for follow-up) in Sydney, NSW, 1998.
Patients: 15 heroin users and 15 people seeking withdrawal from methadone.
Intervention: Detoxification used naltrexone (12.5 or 50 mg), with flunitra
zepam (2-3 mg), clonidine (150-750 mu g) and octreotide (300 mu g) for symp
tomatic support. Patients remained awake and were discharged when they felt
well enough. Follow-up was daily for four days and then weekly for up to t
hree months for supportive care.
Main outcome measures: Acute side effects; patient ratings of severity and
acceptability of withdrawal; nights of hospitalisation; rates of induction
onto naltrexone; retention in treatment over three months; and relapse to o
Results: Acute withdrawal with delirium lasted about four hours. Octreotide
was crucial for controlling vomiting; with octreotide no patient required
intravenous fluids. There were no major complications. Eighteen patients (6
0%) reported that it was a "quite" acceptable procedure, 18 (60%) required
only one night's hospitalisation, and 24 (80%) were successfully inducted o
nto naltrexone (defined as taking naltrexone on Day 8). Three months later,
six (20%) were still taking naltrexone (with four of these occasionally us
ing heroin) and seven (23%) were abstinent from opioids, including five not
taking naltrexone. Eleven had gone onto methadone maintenance, seven had r
elapsed to heroin use, and one had died of a heroin overdose.
Conclusions: Rates of induction onto naltrexone were comparable with those
reported for accelerated detoxification under sedation, suggesting that it
can be performed successfully with minimal sedation. As in other studies of
naltrexone maintenance, retention was low, and relapse to heroin use was c