Complications of Ultrarapid Opioid Detoxification with Subcutaneous Naltrexone Pellets

Rapid and ultrarapid opioid detoxifica- tion (ROD and UROD) centers promise quick, pain- less, same-day detoxification treatment for patients with opioid addiction. The goal of ROD and UROD is to provide a rapid transition from opioid dependency to oral naltrexone therapy. The patient is given gen- eral anesthesia and high-dose opioid antagonists. This induces a severe withdrawal but spares the pa- tient the experience. In theory, the process is com- plete within four to five hours. The patient awakens without opioid dependency and is started on oral nal- trexone. Any subsequent, persistent withdrawal symptoms are treated symptomatically. A novel, un- approved approach is to compound a pellet of nal- trexone and implant it in the subcutaneous tissue. In theory, this should result in continuous therapeutic levels for this drug, and avoid issues with noncom- pliance. Case series: This article reports six cases of complications from the same detoxification center that performed UROD with naltrexone pellet implan- tation, including pulmonary edema, prolonged with- drawal, drug toxicity, withdrawal from cross-addic- tion to alcohol and benzodiazepines, variceal rupture, aspiration pneumonia, and death. Conclusions: The risks of this procedure are great and further studies should assess its safety and the novel use of naltrex- one. Key words: opioids; heroin; addiction; detoxifi- cation; rapid detoxification; ultrarapid detoxification; naltrexone. ACADEMIC EMERGENCY MEDICINE 2002; 9:63-68