Rapid opiate detoxification treatments

Abstract Recent endeavours to improve the efficiency of treatment of the opiate withdrawal syndrome have resulted in the development of a variety of rapid opiate detoxification schedules, some of which are now in regular clinical use. The neuropharamacological basis of rapid withdrawal techniques, the evolution of treatment schedules and issues relating to clinical efficacy and safety are reviewed. Early studies with naloxone provided the basis for later refinements using opiate antagonists in conjunction with clonidine, benzodiazepines sedation and full anaesthesia. These treatments may accelerate the resolution of the opiate withdrawal syndrome; however, controlled studies comparing them with conventional treatments are lacking. There is insufficient evidence available to carry out an informed risk/benefit analysis. Rapid opiate detoxification treatments have considerable potential for increasing the speed and reducing the discomfort of the opiate withdrawal syndrome, but there is an urgent need for controlled clinical trials and outcome studies to determine their longer‐term impact on opiate use.