[Ultra-rapid detoxification of opiate dependent patients: review of the literature, critiques and proposition for an experimental protocol].
Ultra-rapid opioid detoxification (UROD) is an increasingly popular technique for detoxifying patients addicted to opiates. This technique aims at reducing not only the duration but also the intensity of withdrawal by using general anesthesia coupled with a naloxone or naltrexone medication. In this paper the authors attempt to review the history of UROD and the logic of its procedure and results whilst also demonstrating its advantages and limits.


METHODS
The MEDLINE database was searched from 1966 to 2000 using the terms "ultra-rapid opioid detoxification, rapid opioid detoxification under anesthesia, naloxone, naltrexone, opioid-related disorders". Additional data sources included bibliographies in textbooks on substance abuse.


RESULTS
Nine studies identified in our search were analysed. The technique is based on a three-phases procedure. It consists of a medical and psychiatric selection of patients addicted to opiates, followed by the detoxification itself and finally a medical and psychosocial follow-up. A brief presentation is made of the theoretical aspects based on the use of a specific opioid receptor antagonist (naloxone and naltrexone). Only inpatients were included in the studies. The detoxification and anesthesia protocols varied. In every study all the subjects were completely detoxified. Only three studies included a control group and two used a randomized design. Three studies reported a follow-up beyond 30 days.


CONCLUSIONS
Although this technique constitutes a safe and effective solution for opiate addicted patients, there are criticisms to be made. The absence of an animal model prior to the study of a human model, the lack of comparison with other procedures, the limitation of available literature, the cost and the risks of this technique and the lack of long-term treatment outcomes obtained from rigorous clinical trials, all call for further assessments. A more rigorous protocol based on the main areas of criticism is proposed (presentation of the inclusion and exclusion criterias, description of the three preliminary interviews, presentation of the UROD technique itself and finally a detailled nine month follow-up).


CONCLUSIONS
Ultra-rapid opiate detoxification represents a potentially safe and effective treatment for opiate addicted patients but more rigorous research methods are needed to render this procedure entirely valid.
Fontaine
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Hôpital Vincent Van Gogh, CHU de Charleroi, Service de Psychiatrie, 55, rue de l'Hôpital, B-6030 Marchienne-au-Pont, Belgique. eric.fontaine@CHU-charleroi.be
Godfroid
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Guillaume
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D000768:Anesthesia, General; D002986:Clinical Trials as Topic; D006801:Humans; D009270:Naloxone / Q000009:adverse effects / Q000627:therapeutic use*; D009271:Naltrexone / Q000009:adverse effects / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control; D013997:Time Factors
D009270:Naloxone; D009271:Naltrexone