Accelerated withdrawal from methadone maintenance therapy using naltrexone and minimal sedation: a case series analysis: A case-series analysis

The aim of this study was to measure the acceptability to stable methadone maintenance clients seeking termination of methadone treatment of accelerated withdrawal using a standardized protocol of naltrexone and minimal sedation; and to provide a first assessment of the probable demand for such treatment, characterize the withdrawal experience, and describe the outcomes for the clients using naltrexone for maintenance therapy for 3 months following withdrawal. We used an open label observational study of 14 stable, methadone maintenance programme clients within the Australian Capital Territory. We found a high degree of acceptability of the withdrawal approach to clients and staff. Three phases of withdrawal identified over a 3-week period. There was rapid attrition from naltrexone maintenance over 3 months of follow-up and a return to dependent opiate use in four clients. The protocol is a humane, effective approach to accelerated withdrawal from methadone maintenance. It is a useful modification to ultra-rapid and other rapid withdrawal techniques. Naltrexone maintenance has a limited potential role in this group of subjects. This role also needs further clarification through well-designed randomized clinical trials.