The technique of domiciliary rapid opiate detoxification (ROD) developed in Asturias since 1994 enables patients dependent on heroin and/or methadone (or other opiates) to start antagonist maintenance with a full dose of naltrexone (50 mg) and largely recover from the acute opiate withdrawal syndrome in a few hours at home without direct medical or nursing involvement. Detailed information on 1368 procedures is presented but in Asturias, over 3000 procedures have been completed to date without any deaths or serious medical or psychiatric complications. We also describe some recent modifications to the procedure involving the use of octreotide as an antidiarrhoeal and the insertion of subcutaneous naltrexone implants to prevent early relapse. Rather than domiciliary ROD, we think the procedure is more usefully conceptualized as domiciliary rapid antagonist induction (RAI), because treatment with well-supervised naltrexone is known to be effective in reducing relapse rates. Now that controlled studies uniformly describe greatly increased rates of transfer to naltrexone maintenance treatment following RAI, compared with conventional slower withdrawal and naltrexone induction procedures, it is important that the safety, acceptability and simplicity of this 'Asturian' RAI/ROD technique become more widely known.
RESUMENSe presentan 156 tratamientos realizados en pacientes con dependencia de opiáceos (criterios CIE-10), con un programa de mantenimiento con antagonistas opiáceos depot (Naltrexona), iniciado tras una pauta de antagonización rápida ambulatoria. Se ha realizado un seguimiento de un año a los pacientes tras el alta. Se concluye, que el programa es seguro para los pacientes; tiene mejor índice de retención que los programas con antagonistas por vía oral, y al menos iguala la de los programas con agonistas, mejorando el cumplimiento (urinoanálisis negativos) de estos últimos.
ABSTRACT156 treatments are presented carried out in patient with dependence of opiate (CIE-10), with a maintenance program with antagonist opiate depot (Naltrexon), initiate after a rule of ambulatory quick antagoniza-
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