Rapid opioid detoxification using opioid antagonists: history, theory and the state of the art

Rapid opioid detoxification is a technique for detoxifying patients addicted to narcotics which is increasing in popularity. This technique is potentially useful in getting some patients through the withdrawal phase of substance abuse therapy so that they may engage in further treatment earlier in the course of their disease. However, this procedure, which can and should be done safely, has in the past been pushed to limits which approach boundaries outside of the provider's area of expertise. This paper attempts to present a critical review of previous publications relating to rapid opioid detoxification to address these and other issues. There appears to be a pharmacologic basis for the efficacy of this treatment on a longer-term basis which centers around upregulation of opioid receptors induced by opioid antagonists. This paper also attempts to offer evidence in support of this theory.