{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:28:36Z","timestamp":1777858116797,"version":"3.51.4"},"reference-count":80,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2013,9,16]],"date-time":"2013-09-16T00:00:00Z","timestamp":1379289600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Psychopharmacol"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:p>When abstinence is an appropriate goal, controlled studies and systematic reviews confirm that rapid, antagonist-precipitated opiate withdrawal procedures are the most effective and cost effective methods of initiating abstinence, and naltrexone (NTX) maintenance. While \u2018rapid\u2019 withdrawal, better conceptualised as Rapid Antagonist Induction (RAI), can often be humanely achieved with modest sedation levels, we present three case histories to support our argument that for some patients, general anaesthesia (GA), or techniques of intravenous sedation (IVS) that approach GA, are essential for safety and success. This includes patients with intercurrent disease (e.g. epilepsy or insulin-dependent diabetes) but also those with severe withdrawal phobia after previous distressing experiences. We discuss the history of the procedure. The dangers of RAI under GA or IVS in experienced hands have been exaggerated and the appropriate expertise should be more easily available. Patients and clinicians readily accept risks of major surgery for the excessive intake of food that causes most obesity. Similar risk-acceptance exists in cosmetic surgery and obstetrics. The increasing use and effectiveness of long-acting implants or depot-injections of NTX for relapse-prevention have largely solved compliance problems that undermined the potential of oral NTX. Their ability to prevent opiate overdose in abstinent, non-tolerant patients also strengthens arguments both for offering RAI as a therapeutic option and for reducing psychological, professional and practical barriers to using it.<\/jats:p>","DOI":"10.1177\/0269881113504835","type":"journal-article","created":{"date-parts":[[2013,9,16]],"date-time":"2013-09-16T21:28:30Z","timestamp":1379366910000},"page":"67-75","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Rapid opiate detoxification and antagonist induction under general anaesthesia or intravenous sedation is humane, sometimes essential and should always be an option. Three illustrative case reports involving diabetes and epilepsy and a review of the literature"],"prefix":"10.1177","volume":"28","author":[{"given":"Colin","family":"Brewer","sequence":"first","affiliation":[{"name":"The Stapleford Centre, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"de Jong","sequence":"additional","affiliation":[{"name":"Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Williams","sequence":"additional","affiliation":[{"name":"Brighton and Sussex University Hospitals, Brighton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2013,9,16]]},"reference":[{"key":"bibr1-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1080\/09595230310001613949"},{"key":"bibr2-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200502000-00005"},{"key":"bibr3-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2003.tb00629.x"},{"key":"bibr4-0269881113504835","doi-asserted-by":"publisher","DOI":"10.5055\/jom.2005.0007"},{"key":"bibr5-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60990-8"},{"key":"bibr6-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-007-9357-y"},{"key":"bibr7-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1111\/j.1369-1600.2000.tb00215.x"},{"key":"bibr8-0269881113504835","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1999.tb123493.x"},{"key":"bibr9-0269881113504835","first-page":"327","volume-title":"Development in the Field of Drug Abuse","author":"Blachly P","year":"1975"},{"key":"bibr10-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.153.3.340"},{"key":"bibr11-0269881113504835","first-page":"4","author":"Brewer C","year":"1989","journal-title":"Wellington Hospital News"},{"key":"bibr12-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1080\/13556219772589"},{"key":"bibr13-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)78171-X"},{"key":"bibr14-0269881113504835","first-page":"426","volume":"24","author":"Brewer C","year":"1999","journal-title":"Rev Espan Drogodepend"},{"key":"bibr15-0269881113504835","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200014050-00001"},{"key":"bibr16-0269881113504835","doi-asserted-by":"publisher","DOI":"10.20882\/adicciones.420"},{"key":"bibr17-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-59745-197-0_26"},{"key":"bibr18-0269881113504835","first-page":"607","author":"Carre\u00f1o JE","year":"1997","journal-title":"Libro de Actas XXIV Jornadas Nacionales Socidrogalcohol"},{"key":"bibr19-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1080\/135562102200120479"},{"key":"bibr20-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1080\/13556210310001646402"},{"key":"bibr21-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/S1353-1131(96)90012-7"},{"key":"bibr22-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1982.04290110077013"},{"key":"bibr23-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.8.903"},{"key":"bibr24-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/S0740-5472(97)00020-2"},{"key":"bibr25-0269881113504835","unstructured":"Currie J, Collins L, Mudaliar Y, (2000) Rapid induction onto naltrexone: A randomized clinical trial of anesthesia-assisted versus sedation-assisted techniques, and a comparison with conventional detoxification. Western Sydney Area Health Service Drug and Alcohol Service \u2013 Report to Government of New South Wales. Summary available at http:\/\/findings.org.uk\/count\/downloads\/download.php?file=nug_7_1_back.pdf (accessed 5 November 2012)."},{"key":"bibr26-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2010.08.007"},{"key":"bibr27-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2004.00959.x"},{"key":"bibr28-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1080\/10550490601184472"},{"key":"bibr29-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2004.00959.x"},{"key":"bibr30-0269881113504835","first-page":"887","volume":"295","author":"De Jong CJ","year":"2006","journal-title":"JAMA"},{"key":"bibr31-0269881113504835","first-page":"450","volume":"99","author":"Digiusto E","year":"2004","journal-title":"Serious adverse events in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) Addiction"},{"key":"bibr32-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2007.12.015"},{"key":"bibr33-0269881113504835","unstructured":"Eklund C (1996) Withdrawal from Methadone Maintenance Treatment in Sweden. Uppsala: University Press, pp.9\u201310."},{"key":"bibr34-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-198812000-00018"},{"key":"bibr35-0269881113504835","first-page":"B30","volume":"151","author":"Floch-Tudal C","year":"2000","journal-title":"Ann Med Interne (Paris)"},{"key":"bibr36-0269881113504835","first-page":"232","volume":"4","author":"Foster J","year":"1999","journal-title":"Addiction Biol"},{"key":"bibr37-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1080\/1355621031000117446"},{"key":"bibr38-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/0740-5472(94)00077-8"},{"key":"bibr39-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1055\/s-2000-10423"},{"key":"bibr40-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.158.5.697"},{"key":"bibr41-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.177.3.262"},{"key":"bibr42-0269881113504835","author":"Gowing L","year":"2010","journal-title":"Cochrane"},{"key":"bibr43-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1300\/J069v19n04_05"},{"key":"bibr44-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2002.tb01169.x"},{"key":"bibr45-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2006.07.009"},{"key":"bibr46-0269881113504835","unstructured":"Home Office Drug Strategy (2010) Reducing demand, restricting supply, building recovery: supporting people to live a drug-free life. http:\/\/www.homeoffice.gov.uk\/publications\/alcohol-drugs\/drugs\/drug-strategy\/drug-strategy-2010?view=Binary (accessed 3 November 2012)."},{"key":"bibr47-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1159\/000141641"},{"key":"bibr48-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1080\/13556210310001602257"},{"key":"bibr49-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1080\/13556210410001674103"},{"key":"bibr50-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2005.02.009"},{"key":"bibr51-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2009.130"},{"key":"bibr52-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.2011.01523.x"},{"key":"bibr53-0269881113504835","doi-asserted-by":"publisher","DOI":"10.3109\/00952998908993405"},{"key":"bibr54-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1080\/13556210310001602275"},{"key":"bibr55-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2004.02.002"},{"key":"bibr56-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2012.1a"},{"key":"bibr57-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.108.055319"},{"key":"bibr58-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.9.1143"},{"key":"bibr59-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/0376-8716(94)90115-5"},{"key":"bibr60-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31819b5bdc"},{"key":"bibr61-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3956(89)90020-4"},{"key":"bibr62-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2009.02653.x"},{"key":"bibr63-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/S0376-8716(02)00077-7"},{"key":"bibr64-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1080\/09687630410001723229"},{"key":"bibr65-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.143.6.739"},{"key":"bibr66-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198882010-00021"},{"key":"bibr67-0269881113504835","unstructured":"National Institute for Clinical Excellence. (NICE) (2008) Drug misuse. Opioid detoxification. The NICE guideline. 2008. 122-44. http:\/\/www.nice.org.uk\/nicemedia\/live\/11813\/35999\/35999.pdf (accessed 3 November 2012)."},{"key":"bibr68-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2005.01020.x"},{"key":"bibr69-0269881113504835","first-page":"43","volume":"37","author":"Pfab R","year":"1999","journal-title":"Clin Toxicol"},{"key":"bibr70-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1002\/cpt1977214409"},{"key":"bibr71-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/0740-5472(91)90048-F"},{"key":"bibr72-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.171.4.340"},{"key":"bibr73-0269881113504835","first-page":"20","author":"Shanahan MD","year":"2005","journal-title":"Addict Behav"},{"key":"bibr74-0269881113504835","doi-asserted-by":"publisher","DOI":"10.3109\/00952990.2011.653426"},{"key":"bibr75-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2005.05.036"},{"key":"bibr76-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7396.959"},{"key":"bibr77-0269881113504835","first-page":"444","volume":"55","author":"Strang J","year":"2005","journal-title":"Br J Gen Pract"},{"key":"bibr78-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2007.08.014"},{"key":"bibr79-0269881113504835","first-page":"1660","volume":"123","author":"Waal H","year":"2003","journal-title":"Tidsskr Nor Laegeforen"},{"key":"bibr80-0269881113504835","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.121"}],"container-title":["Journal of Psychopharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0269881113504835","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0269881113504835","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0269881113504835","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:07:51Z","timestamp":1777507671000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0269881113504835"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,9,16]]},"references-count":80,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2014,1]]}},"alternative-id":["10.1177\/0269881113504835"],"URL":"https:\/\/doi.org\/10.1177\/0269881113504835","relation":{},"ISSN":["0269-8811","1461-7285"],"issn-type":[{"value":"0269-8811","type":"print"},{"value":"1461-7285","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,9,16]]}}}