Introduction | Goals of Detoxification | Setting Choice | Clinical Characteristics of the Opioid (Mu Agonist) Withdrawal Syndrome | Opioid Agonist Substitution and Taper | Other Detoxification Agents and Methods | Rapid Antagonist Induction Under General Anesthesia | Special Problems | Conclusion | References
Opioid detoxification continues to be employed by the majority of heroin abusers as a pretreatment procedure prior to drug-free treatments, including opioid antagonist maintenance. Some individuals seek detoxification but do not seek long-term treatment, either because they expect to remain opioid-abstinent without additional help or because they do not seriously intend to remain abstinent. For those patients who do seek additional treatment, the prerequisite detoxification and withdrawal discomfort are often a barrier to entering and/or completing treatment. Thus, while detoxification is a necessary part of treatment for many patients, it has not achieved its full potential for the transition from opioid dependence to drug-free and/or antagonist maintenance treatments. The advent of buprenorphine for opioid detoxification may allow this transition to proceed safely, relatively quickly, and with a minimum of discomfort.