Ultra-rapid opioid detoxification: current status and controversies

Opioid dependence is a major health problem and a cause of increasing concern to physicians and other health professionals worldwide. A crucial first step in intervention is detoxification. Recent trends in medical practice have seen the emergence of newer techniques that claim to accelerate the detoxification procedure and ensure prevention of relapse by rapid induction onto maintenance treatment with opioid antagonists such as naltrexone. This review delves into the theoretical and methodological aspects related to ultra-rapid opioid detoxification (opioid detoxification procedure using opioid antagonists, performed under general anaesthesia or heavy sedation) and discusses the status of the same in light of the available evidence regarding its applicability, safety and effectiveness. Although useful in some respects (especially in completion rates for detoxification and subsequent induction onto naltrexone maintenance), the justification of this procedure lies in (a) the resolution of the ethical conflicts surrounding the procedure and (b) conduction of methodologically sound long-term studies to demonstrate greater efficacy over routine/standard detoxification procedures beyond the short-term detoxification period.