title: Opioid detoxification and naltrexone induction strategies: recommendations for clinical practice.
abstract: BACKGROUND
  Opioid dependence is a significant public health problem associated with high risk for relapse if treatment is not ongoing. While maintenance on opioid agonists (i.e., methadone, buprenorphine) often produces favorable outcomes, detoxification followed by treatment with the μ-opioid receptor antagonist naltrexone may offer a potentially useful alternative to agonist maintenance for some patients.
  
  
  METHODS
  Treatment approaches for making this transition are described here based on a literature review and solicitation of opinions from several expert clinicians and scientists regarding patient selection, level of care, and detoxification strategies.
  
  
  CONCLUSIONS
  Among the current detoxification regimens, the available clinical and scientific data suggest that the best approach may be using an initial 2-4 mg dose of buprenorphine combined with clonidine, other ancillary medications, and progressively increasing doses of oral naltrexone over 3-5 days up to the target dose of naltrexone. However, more research is needed to empirically validate the best approach for making this transition.
authors.affiliation: Department of Psychiatry, University of Vermont College of Medicine, Burlington, 05401, USA. stacey.sigmon@uvm.edu
authors.forename: Stacey C
authors.initials: SC
authors.lastname: Sigmon
authors.forename: Adam
authors.initials: A
authors.lastname: Bisaga
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
authors.forename: Patrick G
authors.initials: PG
authors.lastname: O'Connor
authors.forename: Thomas
authors.initials: T
authors.lastname: Kosten
authors.forename: George
authors.initials: G
authors.lastname: Woody
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use; D002985:Clinical Protocols; D003000:Clonidine / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009271:Naltrexone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D009292:Narcotic Antagonists; D009294:Narcotics; D002047:Buprenorphine; D009271:Naltrexone; D003000:Clonidine; D008691:Methadone