Complications of ultrarapid opioid detoxification with subcutaneous naltrexone pellets.
Rapid and ultrarapid opioid detoxification (ROD and UROD) centers promise quick, painless, same-day detoxification treatment for patients with opioid addiction. The goal of ROD and UROD is to provide a rapid transition from opioid dependency to oral naltrexone therapy. The patient is given general anesthesia and high-dose opioid antagonists. This induces a severe withdrawal but spares the patient the experience. In theory, the process is complete within four to five hours. The patient awakens without opioid dependency and is started on oral naltrexone. Any subsequent, persistent withdrawal symptoms are treated symptomatically. A novel, unapproved approach is to compound a pellet of naltrexone and implant it in the subcutaneous tissue. In theory, this should result in continuous therapeutic levels for this drug, and avoid issues with noncompliance.


METHODS
This article reports six cases of complications from the same detoxification center that performed UROD with naltrexone pellet implantation, including pulmonary edema, prolonged withdrawal, drug toxicity, withdrawal from cross-addiction to alcohol and benzodiazepines, variceal rupture, aspiration pneumonia, and death.


CONCLUSIONS
The risks of this procedure are great and further studies should assess its safety and the novel use of naltrexone.
Hamilton
Richard J
RJ
MCP Hahnemann University, Philadelphia, PA 19129, USA. richard.hamilton@drexel.edu
Olmedo
Ruben E
RE
Shah
Sachin
S
Hung
Oliver L
OL
Howland
Mary Ann
MA
Perrone
Jeanmarie
J
Nelson
Lewis S
LS
Lewin
Neal L
NL
Hoffman
Robert S
RS
D000279:Administration, Cutaneous; D000328:Adult; D003692:Delayed-Action Preparations / Q000009:adverse effects; D004343:Drug Implants / Q000009:adverse effects*; D004638:Emergency Treatment / Q000009:adverse effects / Q000379:methods; D004830:Epilepsy, Tonic-Clonic / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation*; D011654:Pulmonary Edema / Q000209:etiology; D018570:Risk Assessment; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*; D013997:Time Factors; D014474:Unconsciousness / Q000209:etiology; D014839:Vomiting / Q000209:etiology
D003692:Delayed-Action Preparations; D004343:Drug Implants; D009292:Narcotic Antagonists; D009271:Naltrexone