Ultra-rapid, antagonist-precipitated opiate detoxification under general anaesthesia or sedation

Ultra-rapid opiate withdrawal precipitated by naloxone or naltrexone during general anaesthesia or varying degrees of sedation, usually with the addition of alpha-2 adrenergic agonists, is an increasingly popular technique. As with anaesthesia or effective analgesia for dentistry or obstetrics, it can be justified on general humane principles. It also simplifies and speeds the transition to treatment programmes involving naltrexone. This paper reviews its development and the current range of techniques, including the use of octreotide to prevent diarrhoea. The prospect of avoiding or shortening the worst discomforts of withdrawal may encourage more opiate addicts to attempt detoxification and opiate-free management, including patients who have been successfully rehabilitated on long-term methadone maintenance treatment (MMT). Despite good motivation and preparation, a significant minority of MMT patients consistently fail to complete conventional withdrawal programmes because of increasing physical discomfort. It is emphasized that there is usually more to the treatment of opiate dependence than withdrawal.