Unexpected Delirium During Rapid Opioid Detoxification (ROD), Golden SA, Sakhrani DL. Journal of Addictive Diseases 2004 23;1:65-74
Dear Colleagues,
This is one of the very few descriptions of a series of rapid opioid detoxification (ROD) cases. Many such reports have been anecdotal, coronial or selected cases, and thus of limited scientific value. This Pittsburgh series is drawn from 20 consecutive patients ‘requesting’ rapid detoxification with an appraisal of their outcomes and complications. Some of these complications are very worrying, and they are not infrequent. Five patients (25%) developed delirium and had to have the procedure abandoned. One of the 5 patients who developed delirium had to be treated in intensive care for hypotension. Another had bradycardia, a problems also reported by the Spanish group with most experience in this area (Seaone et al.). One further patient of this twenty refused to take the naltrexone on day two. Thus an early relapse rate of 30% may be indicated. The average hospital stay was 6 days.
Even though the follow up is patchy (it only lasted for ‘the study period’, the length of which was not stated), at least 4 (20%) cases had to be readmitted for further detoxification (‘traditional’, not ‘ROD’) in the immediate post-treatment period at the same institution while others treated lived at some distance and could not be followed up at all.
These results are extremely poor compared with other reports, but they would appear to be influenced by very high rates of depression, anxiety and other co-morbid conditions, notably the use of benzodiazepines and other drugs in combination with opiates. Also, it is hardly surprising that the patients who were being forcibly reduced from methadone would not do well with an abstinence based treatment.
According to some experts, rapid opioid detoxification is most likely to prove appropriate for a group of addicts who (1) are pure opiate users, (2) do not suffer severe Axis II disorders, (3) who have had beneficial periods of abstinence in the past, (4) who suffer particularly severe EARLY withdrawal symptoms with traditional detoxification AND (5) who are competently assessed as being currently 'equipped' for abstinence. Importantly, this means that it is not a sufficient criterion for rapid detox to just ‘not want methadone’. Similarly, few diabetics would choose insulin treatment unless there were no simpler alternative.
comments by Andrew Byrne ..
Citation:
Golden SA, Sakhrani DL. Unexpected Delirium During Rapid Opioid Detoxification (ROD). Journal of Addictive Diseases 2004 23;1:65-74
