Unexpected delirium during Rapid Opioid Detoxification (ROD)

Rapid Opioid Detoxification (ROD), using a combination of the long acting opioid antagonist, Naltrexone and the alpha 2 agonist Clonidine, is a method to detoxify patients who are opioid dependent. The daily administration of Naltrexone in increasing dosages decreases the duration of the withdrawal syndrome associated with opioids, especially longer acting drugs such as Methadone. This study is intended to report the frequency of delirium, as defined in DSM IV, during the ROD of Methadone maintained patients. A chart review was conducted of twenty consecutive patients who received in-patient ROD from Methadone maintenance from January 1999 to December 1999. Methadone was tapered and discontinued prior to ROD and Naltrexone was administered in increasing daily doses. Five individuals developed delirium and discontinued the procedure on the first day, fourteen patients completed the protocol, and one dropped out prior to completion. A significant incidence of delirium resulted from the ROD procedure.