Objective: 1. To determine whether
naltrexone-accelerated detoxification with minimal sedation is an
acceptable and effective form of induction onto naltrexone. 2. To
monitor outcomes of detoxified patients.
Design: Observational study.
Setting: Medical ward of a general hospital (for
detoxification) and a community 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 flunitrazepam (2-3 mg), clonidine (150-750 µg)
and octreotide (300 µg) for symptomatic 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
three 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 opioid use.
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 (60%) reported that it was a
"quite" acceptable procedure, 18 (60%) required only one night's
hospitalisation, and 24 (80%) were successfully inducted onto
naltrexone (defined as taking naltrexone on Day 8). Three months
later, six (20%) were still taking naltrexone (with four of these
occasionally using heroin) and seven (23%) were abstinent from
opioids, including five not taking naltrexone. Eleven had gone onto
methadone maintenance, seven had relapsed 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
common.