Opioid detoxification

 

Detoxification should be an available option for any user either in a community or residential setting. A community setting is preferred unless the patient has already suffered relapse, is detoxing from multiple drugs, they have social issues which limit their access to services or they require nursing care.

 

The patient should also be encouraged to participate in various psychosocial interventions throughout treatment and be informed about both the physical and psychological aspects of withdrawal and how this can be managed. They should also be warned about the risk of overdose with relapse and the support available to them.

 

To aid the withdrawal process, the patient should be encouraged to eat healthily, undertake regular exercise, get in to good sleeping habits and remain hydrated.

 

Rapid or ultra-rapid detoxification are controversial methods that shorten the duration of detoxification and withdrawal symptoms by starting withdrawal by the use of an opioid antagonist, such as naloxone or naltrexone.

 

Ultra- rapid detox is carried out over 24 hours via the use of general anaesthesia and heavy sedation to eliminate withdrawal symptoms, however, the patient cannot maintain the opening of their airways independently; therefore this option is not offered in the UK due to the risk of death.

 

Rapid detox is carried out over 1-5 days and also requires sedation, but only at moderate levels so that the patient can still maintain their airways and respond to verbal stimuli. This method is not routine and only used if the patient requests it and understands the risks.

 

Accelerated detox uses lower doses of an opioid antagonist, but is not routine due to the increased severity of withdrawal symptoms and the more frequent use of adjunctive medicines, which may cause interactions.