Rapid opiate detoxification

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7109.682 (Published 13 September 1997) Cite this as: BMJ 1997;315:682

Assessment is needed to exclude certain patients before detoxification

  1. Daphne Rumball, Consultant psychiatrista,
  2. Justin Williams, Registrara
  1. a Norfolk Mental Health Care NHS Trust, Bure Centre, Norwich NR2 2PA
  2. Ealing Hospital NHS Trust, Southall, Middlesex UB1 3HW

    Editor—Susan Mayor's news item on rapid opiate detoxification brought confusion and unnecessary alarm to the subject by failing to distinguish clearly between the rapid detoxification method and the similar process delivered with anaesthesia.1 Rapid detoxification in which naltrexone is used to precipitate withdrawal and clonidine is used to modify symptoms of withdrawal was described in detail as long ago as 1986.2 3 Our service has had eight years' experience of detoxification based on these descriptions; in recent years clonidine has been replaced by lofexidine, with enhanced acceptability and a reduced side effects profile. It is the introduction of anaesthesia and polypharmacy to the process that has, we believe, quite unnecessarily introduced major hazards.

    Our experience has clarified the importance of proper assessment before detoxification. The …

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