Opiate detoxification protocols. A clinical manual

The purpose of any opiate detoxification protocol is to minimize or eliminate the signs and symptoms associated with opiate withdrawal, thereby decreasing the chances of relapse to opiate dependence. In the last few years, because of the development of new medications such as clonidine, for the treatment of opiate withdrawal, a number of new protocols have been developed. Four different types of protocols are reviewed and outlined: methadone substitution/detoxification, codeine or other opiate substitution/detoxification, opiate of choice detoxification, and buprenorphine substitution/detoxification. In addition, six protocols utilizing clonidine are presented, including a protocol utilizing opiate antagonist precipitated withdrawal. Finally, two protocols that utilize naltrexone are outlined, and adjunct medications potentially useful in opiate detoxification are reviewed. Some suggestions for the treatment of drug-seeking behavior during detoxification and the advantages and disadvantages of the various protocols are summarized.