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Unexpected delirium during Rapid Opioid Detoxification (ROD)
Scott A Golden1, Duru L Sakhrani
1Center for Treatment of Addictive Disorders, VA Medical Center, 116A-H, 7180 Highland Drive, Pittsburgh, PA 15206, USA. goldensa@msx.upmc.edu
Journal of Addictive Diseases
|April 14, 2004
Summary
Rapid Opioid Detoxification (ROD) using Naltrexone and Clonidine can lead to delirium in patients undergoing Methadone maintenance. This study found a significant incidence of delirium during the ROD procedure, impacting treatment completion.
Area of Science:
- Addiction Medicine
- Pharmacology
- Psychiatry
Background:
- Opioid dependence is a significant public health issue.
- Rapid Opioid Detoxification (ROD) aims to manage withdrawal symptoms effectively.
- Naltrexone and Clonidine are key pharmacological agents in ROD.
Purpose of the Study:
- To determine the frequency of delirium during ROD for Methadone-maintained patients.
- To assess the impact of ROD on patients with long-acting opioid dependence.
Main Methods:
- Chart review of twenty consecutive in-patient ROD cases.
- Patients received escalating doses of Naltrexone after Methadone tapering.
- Delirium diagnosis based on DSM IV criteria.
Main Results:
- Five of twenty patients developed delirium on day one and discontinued treatment.
- Fourteen patients successfully completed the ROD protocol.
- One patient withdrew prior to protocol completion.
Conclusions:
- Rapid Opioid Detoxification (ROD) in Methadone-maintained patients is associated with a significant risk of delirium.
- The incidence of delirium may necessitate modifications to the ROD protocol for this patient population.