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Review
. 2012 May;38(3):187-99.
doi: 10.3109/00952990.2011.653426. Epub 2012 Mar 12.

Opioid detoxification and naltrexone induction strategies: recommendations for clinical practice

Stacey C Sigmon  1 , Adam Bisaga, Edward V Nunes, Patrick G O'Connor, Thomas Kosten, George Woody
Affiliations
Review

Opioid detoxification and naltrexone induction strategies: recommendations for clinical practice

Stacey C Sigmon et al. Am J Drug Alcohol Abuse. 2012 May.

Abstract

Background: Opioid dependence is a significant public health problem associated with high risk for relapse if treatment is not ongoing. While maintenance on opioid agonists (i.e., methadone, buprenorphine) often produces favorable outcomes, detoxification followed by treatment with the μ-opioid receptor antagonist naltrexone may offer a potentially useful alternative to agonist maintenance for some patients.

Method: Treatment approaches for making this transition are described here based on a literature review and solicitation of opinions from several expert clinicians and scientists regarding patient selection, level of care, and detoxification strategies.

Conclusion: Among the current detoxification regimens, the available clinical and scientific data suggest that the best approach may be using an initial 2-4 mg dose of buprenorphine combined with clonidine, other ancillary medications, and progressively increasing doses of oral naltrexone over 3-5 days up to the target dose of naltrexone. However, more research is needed to empirically validate the best approach for making this transition.

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Conflict of interest statement

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

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